Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities
Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities
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DOI：
10.1016/j.socscimed.2016.01.026
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发表时间：
2016-03-01
影响因子：
5.4
通讯作者：
Tannahill, Carol
中科院分区：
文献类型：
--
作者：
Egan, Matt;Kearns, Ade;Tannahill, Carol
减少健康不平等的建议往往强调改善健康的社会环境决定因素。“比例普适主义”的支持者认为，这种改善应该按人口需求按比例分配。我们测试了全市对格拉斯哥(英国)城市更新的投资是否分配给了“需要”，以及这是否减少了健康不平等。我们通过2006年和2011年在14个不同贫困社区进行的调查的数据联系，确定了纵向队列(n=1006)。在此期间，每个社区都获得了重建投资，根据住房需求进行分配。我们将社区分为“高”、“中”或“低”三种投资水平。我们使用SF12版本2工具比较了这三组居民在一段时间内自我报告的身心健康状况。根据基线性别、年龄、教育程度、家庭结构、住房保有期、建筑类型、出生国和集群进行了调整的多元线性回归。在基线健康、收入剥夺和社会劣势标志方面，获得较高投资的地区往往处于最不利的地位。五年后，“高投资”地区的平均心理健康得分比“低投资”地区有所改善(b=4.26；95%CI=0.29，8.22；P=0.036)。同样，与低投资地区相比，高投资地区的平均身体健康得分下降得更少(b=3.8695%CI=1.965.76；P<；0.001)。中等投资(与较低投资相比)领域的相对改善在统计上并不显著。调查结果表明，住房投资带动的更新是根据人口需求分配的，这导致五年后以地区为基础的卫生不平等现象略有减少。研究的局限性包括选择偏差的风险。这项研究展示了如何而且我们认为应该对非健康干预措施进行评估，以更好地了解是否以及如何通过根据需要分配对健康的社会决定因素的投资来减少健康不平等。(C)2016年提交人。爱思唯尔有限公司出版。
Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF 12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need. (C) 2016 The Authors. Published by Elsevier Ltd.