Inequalities in health and wellbeing in later life: does neighbourhood matter?

Abstract: An ‘area health effect’ refers to the notion that health outcomes are influenced not only by an individual’s circumstances and choices but also by a wide range of neighbourhood characteristics. These characteristics are varied and include the quality of the built environment, the local distribution and level of income, walkability, crime (or the perception of), strength and quality of local social networks and the nature and quality of food on sale from outlets. All these aspects of neighbourhood are proposed as routes through which area health effects might operate. Such ideas are long-standing and have proved seductive to policy makers concerned with tackling health (and other) inequalities with a raft of government policies implicitly drawing on the area health effects literature in their attempts to reduce health inequality. At the same time strong criticisms of quantitative studies of area health effects, both theoretical and methodological, have emerged in the literature that remain unresolved and that have led to an observation that the field of research stands at an important crossroads. This paper attempts to engage with these criticisms through a longitudinal analysis of a rich data source on the health and circumstances of older people, the English Longitudinal Study of Ageing (ELSA). A special version of ELSA with fine geographical detail is linked to data on neighbourhoods and broader measures of area disadvantage including both objective and subjective indicators in order to examine potential pathways through which area health effects might operate. The key aim of the presentation will be to consider the extent to which local neighbourhood conditions influence health (and health-related) outcomes in later life and the extent to which longitudinal data provide more convincing evidence for area health effects.

Biographical statement: Alan joined Edinburgh in 2017 as Senior Lecturer in Quantitative Methods and director of the Q-Step Centre. He has previously held lecturing positions in Social Statistics at the University of Manchester (where he retains on honorary research position) and the University of St Andrews. Alan is a Social Statistician by training with both substantive and methodological research interests. His substantive research uses longitudinal data from social surveys in the UK and overseas to better understand the social and biological determinants of inequalities observed in health and wellbeing in later life. Alan has made methodological research contributions around the development of local estimates and projections of populations and of populations in poor health in collaboration with the UK's National statistical agencies and local authorities.