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

人们生活的自然和社会环境或“背景”影响着他们的健康。由于有利和不利的环境因素分配不均，它们可能造成卫生不平等。正如我们在以前的研究中所显示的那样，将边缘化或弱势群体安置在更贫困的地区可能会增加他们的健康风险和医疗保健需求。这一论点也适用于德国的难民。他们不仅更有可能被安置在贫困地区/城市；此外，住房本身可能具有不利于健康的物理和社会属性。因此，收容难民的方式（以及基本的政策决定）可以被解释为一种“他者”的形式。在所有相关的空间层面确定和实施环境因素是制定补救干预措施的先决条件。到目前为止，环境对健康的影响主要是在相对较大的行政层面进行的研究。在子项目“剥夺”中，我们将开发创新的概念和统计手段，将微观层面（如难民住宿和相应的空间/行政尺度）纳入多重剥夺指数（imd），如Maier等人开发的“德国多重剥夺指数”。为此，我们将(i)开发一种难民住宿类型；以及（ii）统计方法，以包括反映物质或象征性“其他”进入imd的后果的住宿的微观层面。新的难民住宿类型将以系统审查和现实主义审查所提供的统计聚类分析为基础。实证工作将以一个分析框架为指导，将难民住宿视为一种异托邦（遵循福柯）。我们将得到其他子项目的支持。类型学将住房的物理和社会方面与潜在的地方、州或国家政策结合起来。次级项目NEXUS和LARGE将使用类型学的第一个版本，在多层次模型中实证研究难民住宿对健康的影响，以确定哪些住宿相关特征与不利的健康结果有关。这两个次级项目的经验调查结果将反馈给难民方案，以便修订和改进难民住房的分析框架和类型学；以及（ii）支持我们发展包含多个政治/空间/制度尺度的高分辨率imd。作为另一项创新，在研究环境卫生影响及其在产生卫生不平等方面的作用时，这种疾病综合发展指数允许将较小的空间层面（例如住宿）包括在内。

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.