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

健康状况有社会梯度：收入低或受教育程度低的人健康状况较差，死亡率高于较富裕的人。但是健康不仅仅是由个人因素决定的。在以前的工作中，我们表明在小区域层面（例如在城市社区）运作的因素起着独立的作用。虽然在小地区一级，邻里异质性和保健不平等之间的联系现在已广为人知，但在个人一级，作为这种联系基础的社会机制尚未得到充分了解。此外，环境暴露也影响健康，并可能与社会机制相互作用。在这里，我们提出一种跨学科的方法（流行病学-社会学）来首先建立对这个问题的联合理论认识。然后，我们将采用创新的方法（地理空间统计，它添加了分层模型中缺失的空间维度）来定义以自我为中心的社区。这样，一个社区与健康有关的规模可因社会机制和/或所涉环境而异，而不取决于任意的行政边界。我们将使用这种方法来分析现有的纵向数据集，以创建关于暴露和社会机制及其相互作用的新经验证据，这些暴露和社会机制及其相互作用导致了从邻里异质性到健康不平等。因此，我们进一步告知理论基础，并提供新的方法/工具，以(a)在可能的第二个项目阶段收集新的，针对问题的经验数据，(b)开发基于证据的干预措施来支持弱势地区。鉴于人们在经济上或种族上对社区的强烈选择可能对其健康有害，这一问题与政治和公共卫生高度相关。

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.