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Physical built environments and health inequalities

Final Report Summary - PHYBEHI (Physical built environments and health inequalities)

Throughout the world health inequalities remain a significant challenge for academics and policy makers. International evidence from the EU and elsewhere demonstrates strong and rising geographical inequalities in health at a range of spatial scales, from between countries to across neighbourhoods in the same city. Health inequalities remain a fundamental concern of our time; reductions in health inequalities is a policy priority across many nation states as well as for the European Commission. However, the mechanisms underpinning rising health inequalities are poorly understood which leaves an urgent need to develop evidence as to ‘what works’ in reducing them. The aim of our ERC-funded study has been to investigate the role of the environment – or ‘place’ – at various spatial scales in affecting the changing spatial inequalities in. We were particularly concerned with identifying the characteristics of places that might promote resilience and disrupt the usual conversion of socioeconomic disadvantage into poor health. Where possible we used longitudinal data to investigate how geographical inequalities have changed over time, the likely multiscalar drivers of these trends, and developed new methodological approaches for examining the influence of the environment over the life course.

Over the past five years, over 30 publications ( books, journal papers and chapters) have emerged from the ERC-funded PhyBEHI project, with numerous other papers under review or currently being finalised for publication. The research findings can be grouped into five themes:
1. At the macro-level we have identified that over the past 25 years, health inequalities across regions of the EU have remained stable despite the concerted policy efforts of Member States. We have identified a number of geographical mechanisms that are likely to partially explain this EU-wide phenomenon including: country rather than city-level processes; the uneven distribution of physical environmental features such as air pollution; selective migration and mobility patters between regions of the EU; different levels of social investment between Member States; regional differences in socio-economic circumstances including those relating to the labour market; and different degrees of social participation between countries.
2. We have undertaken longitudinal analyses to reveal how selective migration and mobility patterns influence geographical inequalities in health through the ‘sorting’ of populations into different physical and social environments. We have shown how the migration process can contribute to the combined accumulation of poor mental health and greater social disadvantage, and the role of ‘difficult life events’ in prompting moves to more disadvantageous environments.
3. We have completed a programme of novel and policy relevant research to examine two key public health priorities in Europe – tobacco and alcohol - and considered how local contextual factors affect related behaviours and health outcomes. In particular we have shown how the local provision of tobacco and alcohol products influence behavioural priorities amongst young people and adults. We argue that the ‘next generation’ of public health priorities must address the over provision of these harmful products in our local communities.
4. We have provided important insights into the connections between green space, health and wellbeing. Longitudinal work at the national-level has shown how green space provision is important for child wellbeing and developmental trajectories. At the European-level our findings reveal how socioeconomic inequalities in mental health are narrower for those with good access to green space.
5. A key methodological and substantive contribution has been our efforts in developing a new agenda for examining how environmental factors accumulate over the life course to influence health outcomes later in life. We have established new methods for developing life time measures of environmental exposure, and integrated these with birth cohort data to show how environmental exposure in early life matter for health outcomes such as cognitive ageing towards the end of life.

In summary, the findings from the PhyBEHI the research have provided important new knowledge about the intersection of physical, social and economic environments and their influence on health experiences, behaviours and outcomes. Beyond the empirical aspects of the research, we have established the ‘Centre for Research on Environment, Society and Health’ (CRESH) which is a centre of research excellence that is developing a strong and sustainable international profile in the area of environment and health research.