Identifying, conceptualising, and modelling micro-area factors with effects on the health of vulnerable populations (DEPRIV)

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The physical and social environment or “context” in which people live affects their health. As favourable and less favourable contextual factors are not equally distributed they may contribute to producing health inequities. Settling marginalized or vulnerable groups in more deprived areas may increase their health risks and health care needs, as we have shown in previous studies. This argument can be extended to refugees in Germany. Not only are they more likely to be accommodated in deprived districts/cities; also, the housing itself may have physical and social attributes not conducive to health. The way refugees are accommodated (and the underlying policy decisions) can thus be interpreted as a form of ‘othering’.Identifying and operationalizing contextual factors at all relevant spatial levels is a prerequisite for developing remedial interventions. So far, contextual effects on health have mainly been studied at relatively large administrative levels. In the sub-project DEPRIV we will develop innovative conceptual and statistical means to include micro-level dimensions like refugee accommodation and the corresponding spatial/administrative scales into Indexes of Multiple Deprivation (IMDs) such as the “German Index of Multiple Deprivation” developed by Maier et al. For this purpose, we will (i) develop a typology of refugee accommodation; and (ii) the statistical methodology to include micro-level dimensions of accommodation reflecting the consequences of material or symbolic ‘othering’ into IMDs.The new typology of refugee accommodation will be based on a statistical cluster analysis informed by a systematic review and a realist review. The empirical work will be guided by an analytical framework conceiving refugee accommodation as a heterotopia (following Foucault). We will be supported by sub-project OTHER. The typology will combine physical and social aspects of housing with underlying local, state, or national policies. Sub-projects NEXUS and LARGE will use a first version of the typology to empirically study health effects of refugee accommodation in multi-level modelling to establish which accommodation-related characteristics are associated with unfavourable health outcomes. Empirical findings of these two sub-projects will be fed back to DEPRIV to (i) revise and improve the analytical framework and the typology of refugee accommodation; and (ii) support our development of higher-resolution IMDs comprising multiple political/spatial/institutional scales. Such IMDs allow, as yet another innovation, to include smaller spatial levels, e.g. accommodation, when studying contextual health effects and their role in producing health inequities.