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

人们生活的物质和社会环境或"背景"影响他们的健康。由于有利和不利的环境因素分布不均，它们可能会造成卫生不公平。正如我们在以前的研究中所表明的那样，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。这一论点可以延伸到德国的难民身上。他们不仅更有可能被安置在贫困地区/城市，而且住房本身可能具有不利于健康的物质和社会属性。因此，安置难民的方式（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上查明和落实背景因素是制定补救措施的先决条件。到目前为止，对健康的环境影响主要是在相对较大的行政级别上进行研究的。在DEPRIV分项目中，我们将开发创新的概念和统计手段，将难民收容等微观层面和相应的空间/行政尺度纳入多重收容指数，如Maier等人开发的"德国多重收容指数"。以及（ii）统计方法，包括反映物质或象征性的"他者"进入IMD的后果的微观层面的住宿。难民住宿的新类型将基于系统审查和现实主义审查的统计聚类分析。实证工作将遵循一个分析框架，将难民收容视为一种异托邦（追随福柯）。我们将得到其他子项目的支持。这种类型学将联合收割机住房的物理和社会方面与当地、州或国家的基本政策结合起来。分项目NEXUS和LARGE将使用第一版的类型学，以多层次模式对难民住宿的健康影响进行实证研究，以确定哪些与住宿有关的特征与不利的健康结果有关。这两个分项目的实证结果将反馈给DEPRIV，以（i）修订和改进难民收容的分析框架和类型学;（ii）支持我们开发包含多个政治/空间/机构尺度的更高分辨率的IMD。作为另一项创新，这种IMD允许在研究环境健康影响及其在产生健康不平等方面的作用时包括较小的空间水平，例如住宿。

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.