Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities

Abstract

Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.

“There goes the fear”: feelings of safety at home and in the neighborhood: The role of personal, social, and service factors

“…On the other hand, the longitudinal sample (although over 1,000 cases) is a little small for the number of variables included in the analysis, and hence some variables had similar effects in the two samples but were not statistically significant in the Markov models. Previous sensitivity analyses have also confirmed that the longitudinal sample and the repeat cross‐sectional samples in our study yield similar findings with regard to health outcomes (Egan et al., ).…”

Life in company dormitories and a career change are associated with anxiety over lack of privacy among radiation decontamination workers in Fukushima Prefecture, Japan

“…However, the association between anxiety over lack of privacy and the specific type of worker housing, such as company dormitories, has yet to be clarified. Company dormitories have never been studied as a factor related to health, although past studies examining the relationship between housing type and mental health have investigated the ownership status of the house ( tenure housing or not) [12][13][14] , the building type (high-rise or low-rise accommodations) 15,16) , the form of housing (detached house or apartment) 17,18) , the size of the residence (small, medium, or large) 19) , or property ownership (public housing or private housing) 20) as factors affecting mental health. Therefore, it is essential to add new information regarding the association between different housing types, such as company dormitories, and anxiety over lack of privacy.…”

Evaluation of the health impact of an urban regeneration policy: Neighbourhood Renewal in Northern Ireland

“…The concept of dose is further complicated where an intervention acts at different socioecological levels that have multiple different mechanisms of action 33 34. The evaluation of GoWell housing regeneration in Glasgow found that reductions in health inequalities were confined to ‘higher investment areas’ 35. Mental health improvements achieved through the Dutch District Approach were limited to districts that implemented more intensive programmes 29.…”