From urban neighbourhood heterogeneities to health inequalities: social mechanisms, environmental exposures and their interaction

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Health follows a social gradient: persons with low income or low education levels have worse health and a higher mortality than those who are better off. But health is not determined only by individual-level factors. In previous work we showed that factors operating at the small-area level (e.g. in urban neighbourhoods) play an independent role. Although the association at the small-area level between neighbourhood heterogeneities and health inequalities is by now well known, the social mechanisms at the level of the individual, which underlie this association, are not yet fully understood. Moreover, environmental exposures also affect health and may interact with the social mechanisms.Here we propose an interdisciplinary approach (epidemiology-sociology) to first establish a joint theoretical understanding of the problem. We will then employ innovative methods (geo-spatial statistics, which add the spatial dimension missed in hierarchical models) to define ego-centred neighbourhoods. In this way the health-relevant size of a neighbourhood can vary with the social mechanism and/or the environmental exposure in question and is not dependent on arbitrary administrative borders. We will use this approach to analyse existing longitudinal data sets to create new empirical evidence regarding exposures and social mechanisms and their interaction, which lead from neighbourhood heterogeneities to health inequalities. We thus further inform the theoretical foundation and offer new methods/tools for (a) collecting new, problem-specific empirical data in a possible second project phase and (b) developing evidence-based interventions to support disadvantaged areas. Given the strong economic or ethnic selection of people into neighbourhoods that may be harmful to their health, this issue is highly relevant to politics and public health.