Health & Place

Published by Elsevier
Print ISSN: 1353-8292
Publications
This study examined how low neighbourhood human capital (measured by percentage of residents with no qualifications) may be related to trajectories of children׳s emotional and behavioural problems from early-to-middle childhood. It also assessed whether effects of neighbourhood human capital or its pathways were moderated by child nonverbal cognitive ability. Using data on 9850 children in England participating in the Millennium Cohort Study, we found that, after adjusting for key child and family background characteristics, the adverse effects of low neighbourhood human capital on hyperactivity and peer problems remained, and were fully attenuated by the achievement level of children׳s schools. The effect of low neighbourhood human capital on the change in conduct problems over time was robust. Moreover, higher nonverbal ability did not dampen the adverse impact of low neighbourhood human capital on the trajectory of conduct problems or that of low performing schools on hyperactivity and peer problems.
 
Two studies were conducted to examine the interactions between gender, play area, motor skills and free play activity in 8-11 year old school children. In both studies, boys were more active than girls. In boys, but not in girls, energy expenditure was greater for high-skill than for low-skill children (p = 0.0002), and increased as play area increased (p = 0.01). These results suggest that motor skills and play space are important variables in determining the free play activity of boys, but not of girls. This may be related to widely different play styles among boys and girls.
 
This multilevel study included 11,175 participants interviewed 2000-2002 in Sweden. The association between neighbourhood linking social capital (voting in national elections) and self-rated health was analysed. Individuals living in neighbourhoods with the lowest levels of linking social capital exhibited a significantly higher risk of poor health than individuals living in neighbourhoods with the highest levels of linking social capital, after adjustment for individual characteristics, including individual voting. The neighbourhood variance indicated significant differences in self-rated health between neighbourhoods. Both individuals and neighbourhoods need to be targeted in order to enhance people's health in neighbourhoods with low linking social capital.
 
Geographic Information Systems (GIS) can be used to objectively measure features of the built environment that may influence adults' physical activity, which is an important determinant of chronic disease. We describe how a previously developed index of walkability was operationalised in an Australian context, using available spatial data. The index was used to generate a stratified sampling frame for the selection of households from 32 communities for the PLACE (Physical Activity in Localities and Community Environments) study. GIS data have the potential to be used to construct measures of environmental attributes and to develop indices of walkability for cities, regions or local communities.
 
Sir Frederic Truby King's work at Seacliff Asylum in New Zealand, between 1889 and 1922, illustrates a prominent role of agriculture in relationship to human health and the environment. King utilized farming practices, a rural setting, occupational therapy, dietary changes and moves towards self-sufficiency as examples of asylum management practices, but these also ensured patient health and well-being. In this article, we analyze King's practices at Seacliff as a genealogical precursor to today's green care and care farming movements.
 
Mean values of local government district (LGD) characteristics for England, Scotland, and Wales: included a versus excluded.
Flow of cohort member's addresses included in the analyses, by study year.
Selected area and individual characteristics of cohort members who were included and excluded in 1950 (aged 4 years) and 1972 (aged 26 years).
those cohort members residing in local government districts in the highest and lowest quartiles of area socioeconomic measures a in 1950, their subsequent distribution (%) of quartile ranking in 1972 and 1999.
A major limitation of past work linking area socioeconomic conditions to health in mid-life has been the reliance on single point in time measurement of area. Using the MRC National Survey of Health and Development, this study for the first time linked place of residence at three major life periods of childhood (1950), young adulthood (1972), and mid-life (1999) to area-socioeconomic data from the nearest census years. Using objective measures of physical capability as the outcome, the purpose of this study was to highlight four methodological challenges of attrition bias, secular changes in socio-economic measures, historical data availability, and changing reporting units over time. In general, standing balance and chair rise time showed clear cross-sectional associations with residing in areas with high deprivation. However, it was the process of overcoming the methodological challenges, which led to the conclusion that in this example percent low social class occupations was the most appropriate measure to use when extending cross-sectional analysis of standing balance and chair rise to life course investigation.
 
This paper discusses a cross-national comparative study, which compares the implementation and geographical outcomes of mental health reforms in Britain and Italy since 1950. Working within a cross-national framework, the research adopts a sensitivity to the role of place by exploring the social and spatial restructuring of mental health care service provision in two localities - Sheffield and Verona. By focusing upon the local experiences of mental health care reform, the research strives to gain a clearer understanding of why local geographies of mental health care provision appear to vary across space, both within national boundaries and across them.
 
Age, sex and cause-specific death rates for the elderly population of 16 western European countries are examined for 1960, 1970, 1980 and 1990. Over the 30 years, the all-cause rates have fallen by around 23-41% depending on age and sex. Mortality from stroke has declined substantially and from cardiovascular disorders has recently fallen, but cancer health rates have increased among men. A comparison of the UK death rates with the west European and Swiss rates finds relative improvement in the UK for male mortality, but that female mortality at the younger ages has worsened sharply. Cardiovascular and stroke mortality is now exceptionally high in the UK among females aged 60-64 years and the 1980s trends for the 60-64 and 70-74 years age groups were unfavourable for several other causes of death.
 
The aim of the present work was to explore small-area differences in mortality from all causes among males and females within the city of Oulu during the period 1978--1995 and to identify areas where mortality has been persistently high or low. Analyses carried out using Geographical Information System techniques with geo-referenced mortality data produced at a resolution of 1 x 1 km showed significant regional variations in mortality within the city. The differences were wide enough to suggest variations of several years in longevity, and were probably indicative of marked variations in the incidences of diseases. Observed mortality differences may reflect the influence of the rapidly changing urban structure and consequent health effects based on selection, lifestyles, work exposures and deprivation.
 
Globalisation is mediated through a variety of flows including persons, information and ideas, capital, and goods. The process is increasingly recognised as a potential mediator of changes in attitudes and habits around the globe. This research investigated the relationship between globalisation and suicide rates in 35 countries over the period 1980-2006. The association between a globalisation "index" and suicide rates was tested using a fixed-effects regression model. The model also tested the influence of eleven other socio-economic variables on male and female suicide rates. Overall, high levels of the globalisation index were associated with higher male and female suicide rates; however, the significance of this association dropped when assessed alongside other social and economic variables. While the nature of these findings should be regarded as exploratory, this paper highlights the need for researchers to consider the influence of world-changing phenomena like globalisation on suicide, which might deeply upset the traditional structure of societies with mixed types of impact.
 
This study analyses demographic and spatial factors that underlie the rise in murder rates seen in Britain between 1981 and 2000 and considers the possible contribution of a public health approach to the understanding of murder. Comparison of murder rates by age group and sex finds that increases occurred only among males aged 5-59 years, and were greatest among males aged 20-24 years. Analysis of the relationship with poverty at the area level, using the Breadline Britain index and deciles based on wards, demonstrates that increases in murder rates were concentrated in the poorest areas. Rates of murder have risen in the same population groups and areas that have experienced increases in suicide and may be associated with worsening social and spatial inequality.
 
The aim of this paper is to pilot a method for geo-demographic classification for mortality patterns in Britain. Age and sex directly standardised mortality ratios (DSMRs) for 100 grouped International Classification of Disease series 9 causes of death (ICD-9) were calculated. The 84 European Parliamentary (EP) constituencies as defined in 1999 were used as the spatial basis of this study to allow regional comparisons to be made while comparing units of similar population sizes. Scotland was excluded from the final analysis, leaving 76 regions. This paper is a preliminary investigation of the patterns of the causes of death over time and space in England and Wales using cluster analysis to summarise some of the structure in the data. Seven major and three minor cluster profiles were developed.
 
Map of Manchester showing district health authority boundaries, main psychiatric hospitals and location of North Manchester community mental health facilities.
This paper explores the circumstances around the setting up of the Harpurhey Resettlement Team, an innovative project which, in the late 1980s, resettled around 20 long-stay patients from Springfield Hospital in North Manchester into ordinary tenancies within the same neighbourhood. It argues that Springfield's position as a marginalised and neglected institution produced the conditions for such innovation; while the particular and unexpected convergence of national policies, local structures and institutional politics created space for a process of change which, in both form and outcome, could not have occurred in the more regulated psychiatric environments elsewhere in Manchester.
 
Introducing flood control to an area of endemic waterborne diseases could have significant impacts on spatio-temporal occurrence of cholera. Using 21-year data from Bangladesh, we conducted cluster analysis to explore changes in spatial and temporal distribution of cholera incidence since the construction of flood control structures. Striking changes in temporal cluster patterns emerged, including a shift from dry-season to rainy-season clusters following flood protection and delayed clustering inside the protected areas. Spatial differences in pre-flood protection and post-protection cholera clusters are weaker. Changes in spatio-temporal cholera clustering, associated with implementation of flood protection strategies, could affect local cholera prevention efforts.
 
This paper examines changing patterns in the utilisation and geographic access to health services in Great Britain using National Travel Survey data (1985-2006). The utilisation rate was derived using the proportion of journeys made to access health services. Geographic access was analysed by separating the concept into its accessibility and mobility dimensions. Regression analyses were conducted to investigate the differences between different socio-spatial groups in these indicators over the period 1985-2006. This study found that journey distances to health facilities were significantly shorter and also gradually reduced over the period in question for Londoners, females, those without a car or on low incomes, and older people. However, most of their rates of utilisation of health services were found to be significantly lower because their journey times were significantly longer and also gradually increased over the periods. These findings indicate that the rate of utilisation of health services largely depends on mobility level although previous research studies have traditionally overlooked the mobility dimension.
 
Our objective was to investigate regional health differences among Finnish children using a population-based longitudinal register data. All live births born in 1987 were included in the study (N=59,546) and followed-up until the age of seven years. Statistically significant regional variation was found for all health indicators but diabetes. Background variables, such as maternal age and social class, explained only the difference in mortality. Various indicators gave different geographical patterns. Regional equity in childhood health has not been achieved in Finland. Existing health registers were feasible in studying regional variation in health, but a set of comprehensive morbidity indicators - preferably derived from different data sources - should be developed to monitor equity in health.
 
The incidence of suicide exhibits marked geographic variability; however, documentation of features in its spatial distribution, or the magnitude of differences, is limited. Standardised mortality ratios, commonly presented in maps, are calculated in each area independently and incorporate no information about heterogeneity or clustering. Bayesian hierarchical models with random effects for between-area and local variability in neighbouring areas were used to map age- and sex-specific estimates of rate ratios of suicide across wards in England and Wales. Differences were greater than expected due to random variation alone. Although the geography of suicide differed across age/sex groups, some common patterns emerged e.g. high rates in (a) central parts of cities and (b) remote and coastal areas. Some features were common to all, while others appeared male specific or specific to the younger age group. Suicide prevention strategies can be informed by an understanding and addressing the geography of suicide.
 
This paper offers an investigation of the spatial consequences of changes in the structural organization of residential care in England between 1988 and 1993. Data from various government publications were analysed using descriptive and spatial statistical methods. While the study period witnessed an overall levelling of residential care growth, the independent (i.e. private and voluntary) sector's share of all elderly residents in England increased from 56% to 73%. At both national and intra-regional scales, the structural changes resulted in an increasing geographical concentration of public sector residents and a moderate trend towards a more uniform spatial distribution of private residents.
 
The Czech Republic, together with Slovakia and Poland, forms a region within Central-Eastern Europe in which the values of life expectancy at birth have been increasing during the period of transformation. However, the tempo of mortality reduction has differed spatially within the territory of the Czech Republic, as have other outcomes of the transformation process. This paper discussed possible socio-economic explanations of regional differences in the tempos of mortality change between 1990/91 and 1995/96. Standardized mortality rates for males aged 0-64 years specified for the three most frequent causes of death were examined by means of the regression and correlation analysis.
 
This study identified the sociodemographic and geographic patterns of using firearms to commit suicide in the United States. Data from the Mortality Detail Files (1989-1993) were analyzed using logistic regression. The adjusted odds of using firearms increased with age among men and decreased among women. Widowed men and married women had the highest odds of using firearms. The odds were highest among those without college education, in nonmetropolitan areas and in the East South Central and West South Central geographic divisions. The likelihood of using firearms to commit suicide varies significantly across sociodemographic and geographic subgroups of the US population and parallels patterns of gun ownership. The results of this study suggest that regional cultural factors play an important role in accounting for the differential rates in suicidal behavior involving firearms.
 
Through exploring the geographically differentiated effects of restructuring on the work of home care practitioners, labor process change is found to be spatially specific. It is through examining the spatiallity of labor process change that the differential impacts of health care restructuring on human health care resources can be determined. This has implications for human health care resource availability and service provision, which is particularly an issue for medically under-serviced regions. The restructuring approach, together with regulation theory, is used in this paper as tools for exploring the effects of health care reform on the local labor process. Both quantitative and qualitative data collected from home care practitioners in Ontario (Canada) show that the general trends in labor process change (work transfer down the home care hierarchy, increased time constraints, and enhanced job stress) are being similarly experienced, while shedding light on specific local differences. Findings show two working life factors to be differently experienced across the size of the place in which practitioners live and work. Two representative localities provide a closer examination of local differences in labor process change via the examination of local service cultures, local institutional practices, and local practitioner advocacy. The two sites are Sault Ste. Marie, located in northern Ontario's medically under-serviced northern health region, and Guelph, found in the province's well-serviced southern region.
 
This paper aims to estimate the pattern of physician visits and hospitalisation by socioeconomic position in Great Britain and Spain before and after important changes in their health systems during the 1990s. These changes have been accompanied by a trend toward pro-rich inequality in physician use, especially in outpatient consultation in Great Britain, whereas the pro-poor inequality in GP consultation and the pro-rich inequality in specialist consultation in Spain before the changes have been maintained. Although the pro-rich inequality in hospitalisation observed in both countries before their health system changes continues to be seen, the differences have been reduced, suggesting a trend toward socioeconomic equality in hospitalisation. In any case, with the exception of visits to GP in Spain, in both countries greater use of health services by professionals and managers is observed than for the rest of the population.
 
Examination of the extent to which time and place affect people's health has been constrained by the resources available to answer this question. A British longitudinal, nationally representative survey of 8301 adults aged 16 years and older living in private households was used to consider the influence of household membership, area of residence and time using multilevel logistic regression. Self-rated health was assessed by general health and limiting illness during periods characterized by economic decline (1992), economic improvement (1996) and prosperity (2000). There was modest evidence of clustering of poor general health within areas and stronger support for within household similarities in general health which increased over time. Individual, household and area level deprivation accounted for almost all the area-level variability but had little effect on household variance. There was greater evidence of clustering of limiting illness within areas: deprivation did not account for this to any great extent. Area differences in general health reduced as the economy improved but time trends in differences in limiting illness lagged behind the timing of economic recovery. Both time and place are shown to affect self-rated health although the processes may differ depending on the health outcome.
 
This paper aims to describe the principal causes of violent deaths among young people in the city of São Paulo, Brazil. Data from routine mortality statistics were used in the analysis. Young males were found to have a dramatically increased risk of death from violent causes especially those resident in lower income areas of the city. Possible explanations for these findings include economic instability generating social and cultural inequalities.
 
This paper considers recent health care reform in New Zealand in the context of the continuing evolution of the 'neoliberal project'. It advocates the adoption of a Foucauldian governmentality approach to analysis as a productive way to extricate the changing understandings of space within evolving New Zealand health discourses. We analyse two policy documents released 9 years apart which, when examined together, encapsulate the changing discourses of the health care system in the 1990s. We note that through the 1990s the central governing rationality has shifted from competition towards cooperation in health care delivery. While place was held to be subservient to the market at the beginning of the decade, health care has been increasingly re-territorialised through 'community' and its associated constructions.
 
This study examines trends and differences in premarital sex prevalence from 1993 to 2003 among young women aged 15-24 in Kenya and the Philippines in relation to household and community membership. Using population-based Demographic and Health Surveys from these two countries, multilevel logistic models were used to estimate the relationships between premarital sex, community-level factors, and individual/household backgrounds. The results show a significant decline in premarital sex prevalence in Kenya but a significant increase in this in the Philippines, although, overall, premarital sex is more prevalent in Kenya than in the Philippines. Multilevel analyses further found dramatic differences in premarital sex risks across household and community membership and countries. The large difference in premarital sex risks across these countries suggests that policies aimed at promoting reproductive and sexual health among young women should be context specific.
 
This article identifies significant high-risk clusters of autism based on residence at birth in California for children born from 1993 to 2001. These clusters are geographically stable. Children born in a primary cluster are at four times greater risk for autism than children living in other parts of the state. This is comparable to the difference between males and females and twice the risk estimated for maternal age over 40. In every year roughly 3% of the new caseload of autism in California arises from the primary cluster we identify-a small zone 20 km by 50 km. We identify a set of secondary clusters that support the existence of the primary clusters. The identification of robust spatial clusters indicates that autism does not arise from a global treatment and indicates that important drivers of increased autism prevalence are located at the local level.
 
Numerous studies have noted a strong social gradient in many types of ill health. In particular, people in more deprived areas tend to be less healthy than those in more affluent communities, even once the demographic and socio-economic differences of the people in those areas have been taken into account. The social gradient is evident for many types of health outcomes, including diseases such as cancer. However, this positive relationship is not evident for rates of melanoma incidence and mortality, with rates of the disease tending to decrease with measures of disadvantage. In this study, we assess the relationship between the incidence of melanoma and deprivation in New Zealand, a country with particularly high rates of the disease. In the light of greater public awareness of the risk factors associated with melanoma, through public awareness campaigns such as 'Slip! Slap! Slop' and 'No Suntan is Safe', we analyse small-area data on standardised rates of melanoma for the period 1995-2000. We found that melanoma rates increase with social status, even once other confounding factors are controlled for, but that the relationship is very small. Furthermore, the relationship between melanoma incidence and deprivation is context-dependent. Possible explanations for the relationship between melanoma and deprivation are discussed, including more frequent exposure to intermittent sunshine among less disadvantaged groups and the underreporting of melanoma incidence in the New Zealand cancer registry among individuals in lower social groups.
 
Age-standardised mortality rates per 100 000 person years given by direct method according to sex, city and period.
Adjusted relative risks of death for socioeconomic status, period and age group, according to cities for men.
This study describes the inequalities in preventable avoidable mortality in relation to socioeconomic levels and analyses their evolution during the period 1996-2003 in the cities of Alicante, Castellon and Valencia. Four causes of preventable avoidable mortality were analysed according to sex: malignant tumour of the trachea, bronchus and lung, cirrhosis and other chronic diseases of the liver, motor vehicle accidents and AIDS, which had caused the death of non-institutionalised residents in the three cities during the period 1996-2003. The different census tracts were grouped into three socioeconomic levels. In general, socioeconomic inequalities in preventable avoidable mortality remain constant in time, except the ones caused by AIDS in Valencia, where they increase for men. Some census tracts in the three cities where the study was carried out were found to have significantly higher preventable mortality rates, and therefore require intervention.
 
Physical distance affects hospital use. In a densely populated city in China, we examined if child public hospital use was associated with individual-level proximity, and any differences by admission type or geo-spatially. We used negative binomial regression in a large, population-representative birth cohort to examine the adjusted associations of proximity to emergency facilities (A&E) with hospital admissions, bed-days and length of stay from 8 days to 8 years of age. We used geographically weighted regression to assess geo-spatial variation. Proximity was positively associated with emergency admissions (incidence rate ratio (IRR) 1.21, 95% confidence interval (CI) 1.10 to 1.34 for <1km compared to ≥2km) and bed-days but not with length of stay, adjusted for parental education and mother's birthplace. There was no such association for other admissions (IRR 1.03, 95% CI 0.84 to 1.26). There was little geo-spatial variation. Proximity was associated with emergency admissions. Given the societal costs of such use and the risks of iatrogenesis, attention should focus on achieving a more effective use of scarce resources.
 
Neural tube birth defects (NTDs) affect more than 4000 pregnancies in the US annually. The etiology of NTDs is believed to be multifactorial, but much remains unknown. We examined the pattern and magnitude of urban-rural variation in anencephaly, spina bifida without anencephaly, and encephalocele in Texas in relation with urban-rural residence for the period 1999-2003. There was no evidence that urban-rural residence was associated with changes in the rate of anencephaly or spina bifida without anencephaly in unadjusted or adjusted analyses. In contrast, rates of encephalocele were statistically significantly higher in areas classified as suburban or more rural compared to urban areas using four different urban-rural residence indicators.
 
This paper asks how health and nature are represented in the Australian women's press during the late nineteenth century. A time of significant social change during which women, and sympathetic male colleagues, challenged traditional roles as pathological creatures of the domestic sphere, this period is explored through the writing of women working for popular magazines. As women captured, transformed and redeployed stereotypical views of them as essentially and naturally ill, they consolidated their push into the public realm, while also convincing themselves and others of their vital place in the private sphere, but as capable, well and fit creators of people and of a nation.
 
This study examines the relative effects of population density and area-level SES on all-cause mortality in Denmark. A shared frailty model was fitted with 2.7 million persons aged 30-81 years in 2,121 parishes. Residence in areas with high population density increased all-cause mortality for all age groups. For older age groups, residence in areas with higher proportions of unemployed persons had an additional effect. Area-level factors explained considerably more variation in mortality among the elderly than among younger generations. Overall this study suggests that structural prevention efforts in neighborhoods could help reduce mortality when mediating processes between area-level socioeconomic status, population density and mortality are found.
 
Neighbourhoods may influence the health of individual residents in different ways: via the social and physical environment, as well as through facilities and services. Not all factors may be equally important for all population subgroups. A cross-sectional analysis of the Scottish Household Survey 2001 examined a range of neighbourhood factors for links with three health outcomes and two health-related behaviours. The results support the hypothesis that the neighbourhood has a multi-dimensional impact on health. There was also some evidence that the relationship between neighbourhood factors and health varied according to the population subgroup, although not in a consistent manner.
 
Recently, there have been calls for health geographers to add critical and theoretical debate to 'post-medical' geographies, whilst at the same time informing 'new' public health strategies (Soc. Sci. Med. 50(9)1273; Area 33(4) (2002) 361). In this paper we reflect on how, alongside 'professional epidemiologies', 'citizen epidemiologies' can have credibility in informing public health policy and practice. We do this by drawing on mixed method and participatory research that used a citizens' panel to articulate the health and social outcomes of the 2001 foot and mouth disease disaster. We consider the difficulties of creating dialogue between on the one hand, time-limited, discrete, theoretical, visible and by implication legitimate, 'professional' knowledge and on the other, ongoing, holistic, experiential and often hidden 'citizen' knowledge of the foot and mouth disease epidemic. Despite significant evidence that in disaster and crisis situations, people need to be actively involved in key 'recovery' decisions (see for example At Risk Natural Hazards, People's Vulnerability, and Disasters, Routledge, London; A New Species of Trouble, Norton, New York), lay accounts, which may in themselves provide valuable evidence about the impact of the disaster, are often ignored. If health geographers are to critically inform 'new' public health policy then we need to consider research approaches that give voice to citizens' understanding of health outcomes as well as those of professionals. If 'new' public health is concerned with the material character of health inequalities, with fostering 'healthy' living and working environments, the promotion of community participation and individual empowerment (Area 33(4) (2002) 361), then we argue that situated, negotiated, everyday geographies of lay epidemiologies can and should inform public health policy.
 
There has been much focus on separating contextual and compositional influences on social inequalities in health. However, there has been less focus on the important role of place in shaping the distribution of risk factors. Spatial variations in worklessness are one such factor. In this paper, then we examine the extent to which between and within regional differences in the social gradient in self-rated general health are associated with differences in rates of worklessness. Data were obtained for men and women of working age (25-59) who had ever worked from the Sample of Anonymised Records (Individual SAR)-a 3% representative sample of the 2001 English Census (349,699 women and 349,181 men). Generalised linear models were used to calculate region and age adjusted prevalence difference for not good health by education (as an indicator of socio-economic status) and employment status. The slope index of an inequality was also calculated for each region. For both men and women, educational inequalities in worklessness and not good health are largest in those regions with the highest overall levels of worklessness. Adjusting for worklessness considerably attenuated the educational health gradient within all English regions (by over 60%) and virtually eliminated between region differences. Macroeconomic policies, which influence the demand for labour, may have an important role in creating inequalities in general health of the working age population both within and between regions. Employment policy may therefore be one important approach to tackling spatial and socio-economic health inequalities.
 
Multilevel regressions on body mass index, 2001 and 2005. 
(a) Clusters with highest risk of elevated BMI in 2001 (in dark area), (b) clusters with highest risk of elevated BMI in 2005 (in dark area), (c) clusters with high risk of elevated BMI in 2005 (in dark area).  
Spatial lag regression model on body mass index, 2001 and 2005. 
Expected spatial spillover effect, 2001 and 2005.  
a displays the significant spatial clustering of neighborhoods (townships) by per capita income from 2001 to 2005. LISA reveals that in 2001, neighborhoods with significantly higher than average per capita income clustered in the northern, middle, and southern urban areas of Taiwan (dark areas in a). A close examination of the government data reveals that these areas were  
Obesity poses a significant health threat in industrialized countries, with its incidence increasing steadily in Taiwan. This study addresses how neighborhood contexts influence individuals, using a multilevel spatial analysis of obesity risk from 2001 to 2005. A priority concern was whether contextual influences on health are limited to the immediate neighborhood or extend to a wider geographical area. The results led to the following conclusions. First, neighborhood factors related to obesity risk are likely to operate over a broad geographical area and are not limited to the focal neighborhood of residence. Second, a geographically based epidemiological change in the likelihood of obesity risk was observed from 2001 to 2005 in Taiwan. Third, the spatial lag model revealed significant spatial spillover of obesity risk in the study area in 2005. Policy interventions are recommended for the neighborhoods associated with the strong spillover effect. The results demonstrate that, in addition to enhancing the accuracy of prediction regarding the effects of neighborhood factors on obesity, incorporating spatial dynamics at the neighborhood level can encourage the development of contextually sensitive policy interventions.
 
We investigate links between increasing longevity and health status in Thailand. Using data from 2002 and 2007 national surveys of the elderly, healthy life expectancies at older ages were estimated. Change depended on health indicator, gender and age. Self-reported health and self-care disability showed expansion of morbidity. Mobility disability change indicated compression but a wording change means this may be an artefact. We compare these findings with the 1990 and 2010 results of the Global Burden of Disease study. Using HLE based on disease prevalence, the GBD found that Thailand experienced small longevity gains and morbidity compression. Our findings suggest these results should be treated with caution, as, since 2000, Thailand has introduced universal health care.
 
Although small area effects on health-related quality of life (HRQoL) have been extensively studied, less is known at the regional level, particularly in France where no multilevel evidence is available. Using data from a large representative cross-sectional survey conducted in 2003 (N=16 732), this study explores individual and regional determinants of the SF-36 Physical Functioning and Mental Health subscales. We considered a causal pathway leading from deindustrialization to HRQoL and assessed the roles of net migratory flows, deprivation, and the social and physical environments. Worse HRQoL results were found in regions most affected by deindustrialization, with evidence for mediating effects of migration, voter abstention rate and individual health-related behaviors. Cross-level interactions and intraregional heterogeneity were also found, confirming the complexity of individual-area relationships and the need for carefully conceptualized multilevel analyses to guide health policies effectively.
 
This paper examines newspaper coverage of the impact on NHS Scotland of recent Central and Eastern European immigration. It follows rising public interest in the impacts of 'record' and 'unexpected' levels of migration after the 2004 and 2007 European Union (EU) enlargements. We reviewed reporting in six Scottish newspapers during 2004-2008 to track underlying themes within their coverage of EU migration. The framework of Social Representations Theory (SRT) was used to analyse how migration's impact was conceptualised and explained. This research shows that portrayal of migrants posing a threat to the NHS (e.g. European staff with inadequate qualifications), has increased in frequency but changed in nature over the past 4 years. Meanwhile, reports have also portrayed themes of reassurance (e.g. NHS management control) to allay societies' fears. The overall pattern is of representations of threat in the Scottish press being closely followed by those of reassurances. The most important reassurances relate to Scottish socioeconomic conditions, which raises questions might be seen in other UK newspapers as well as what will happen in Scotland if A8 migration decreases.
 
To determine the role of alcohol-related knowledge, behaviours and attitudes in regional inequalities of binge drinking in England. Adults in all regions except West Midlands and men in the East of England had significantly higher odds of binge drinking than in London. Odds of binge drinking were significantly higher among adults who had had an alcoholic drink in the last 7 days in the North East, Yorkshire and the Humber, and women in the South West. Alcohol-related risk factors for binge drinking were heaviest drinking day being a Friday for men, or Saturday; on heaviest drinking day drinking 2+ drink types, or strong beer only for men, alcopops only for women; drinking more on heaviest drinking day; wanting to drink less alcohol; and thinking it acceptable to get drunk. Protective factors were drinking spirits only on the heaviest day; drinking the same on more than one day compared with drinking on one day only for women; disagreeing it was easier to enjoy a social event if had a drink; supporting alcohol taxation; and not having heard of alcohol units for men. Alcohol-related attitudinal and behavioural factors were associated with regional variations in binge drinking.
 
To measure, describe and analyse regional differences in health-related quality of life measured by EQ-5D in China. Data were obtained via face-to-face interviews on a national representative sample (n=120,703, 15-103 years). The EQ-5D instrument was used to measure health status. Rural areas had worse health status than urban areas. Health status was worst in western areas and best in eastern areas, and such disparities were profounder in rural areas. In urban areas, health status was best in middle-sized cities. In rural areas, health status increased with the economic development level of a county. Our study enhances understanding of the urban-rural differences and east-middle-west differences in health and sheds light on inequalities in health status between different city categories in the urban areas and county categories in the rural areas.
 
The first cases of swine flu in the UK were detected on 27th April 2009. Two weeks later Birmingham became a "hotspot" for the HIN1 pandemic in England. This paper describes the experiences of local public health agencies during the pandemic and the problems encountered when trying to work within a hierarchical and hermetic system of national policy making. We argue that over reliance on the speculative logic of modellers, together with a failure to adapt swiftly the nation's preparedness plans and public health apparatus created in readiness for a serious and fatal disease, led to an institutional void of policy making during the pandemic, where new rules and concepts emerged about what constituted scientifically acceptable and politically legitimate interventions. The imposition of a single national approach to managing the pandemic and a disregard for the role of local authorities seriously impaired the ability of local agencies to respond in a flexible, timely and pragmatic way to the rapidly emerging situation. Future planning for pandemics must recognise that global epidemics are curbed at the local level, and ensure that any response is proportionate, flexible and effective.
 
We sought to evaluate the effect of geographical location of residence on disease burden in Canadian First Nations (FN) populations during the 2009 pandemic influenza A(H1N1). Descriptive statistics and regression analysis of data for cases of pandemic A(H1N1) infection and hospitalization in the province of Manitoba, Canada, were conducted to estimate the odds of hospitalization and delay in time-to-hospitalization for on-reserve and off-reserve FN populations, while considering their geographical proximity to urban centers. We found that on-reserve FN individuals experienced a longer delay between infection and hospitalization compared to off-reserve FN individuals (p<0.001). The average fraction of FN cases that experienced a delay longer than 4 days for hospitalization was 20% higher for on-reserve compared to off-reserve residence. The odds of hospitalization were twice as high for FN people living on-reserve as compared to off-reserve (odds ratio=2.34; 95% CI: 1.16-4.73). Given the independent effect of on-reserve residency, higher disease burden among FN people cannot be attributed entirely to limited healthcare access due to remoteness from urban centers.
 
This article explores how the 2009 pandemic of swine flu (H1N1) intersected with issues of biosecurity in the context of an increasing entanglement between the spread of disease and the spread of information. Drawing on research into metacommunication, the article studies the rise of communication about ways in which swine flu was communicated, both globally and locally, during the pandemic. It examines and compares two corpora of texts, namely UK newspaper articles and blogs, written between 28 March and 11 June 2009, that is, the period from the start of the outbreak till the WHO announcement of the pandemic. Findings show that the interaction between traditional and digital media as well as the interaction between warnings about swine flu and previous warnings about other epidemics contributed to a heightened discourse of blame and counter-blame but also, more surprisingly, self-blame and reflections about the role the media in pandemic communication. The consequences of this increase in metacommunication for research into crisis communication are explored.
 
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Neville Owen
  • Baker Heart and Diabetes Institute
Lawrence D Frank
  • University of British Columbia - Vancouver
Wei Luo
  • Northern Illinois University
Billie Giles-Corti
  • University of Melbourne
Eva Leslie
  • Flinders University