and child development - Promise, Pitfalls & Prospects by mmcsx


									  ‘Neighborhood effects’ on health
       and child development:
    Promise, Pitfalls & Prospects

                James R. Dunn, Ph.D.
  Centre for Research on Inner-City Health, St. Michael’s Hospital
Depts of Geography & Public Health Sciences , University of Toronto
 Neighbourhood Effects & Health
• resurgence of interest in how places shapes
  health since early 1990s
• main question: over and above individuals
  characteristics, does place matter to health?
• debate over ‘contextual’ vs. ‘compositional’ effects
      • can these be separated? can compositional features be
        emergent as contextual effects?
• now appears that there is no single ‘universal’
  effect of area on health
      • i.e., ‘do n’hoods affect health?’ is unanswerable
      • there are some area effects on some population groups in
        some places – a complex picture
• all agree that better theory is needed - complexity
N Engl J Med, 345(2): 99-106, July 12, 2001
     Do Neighbourhoods Matter?
• human life is intrinsically territorial
• neighbourhoods initially envisioned as re-creating
  the dynamics of small-town life
• despite romanticism, many people also like the
  anonymity of big city life
• Wellman and Leighton (1979) argued the
  territorial basis of community life had been
  overtaken by networked social relations
• but neighbourhoods appear to have had a re-
  birth – why do they matter?

Wellman, B. and Leighton, B. 1979. Networks, neighborhoods, and communities: Approaches to the
study of the community question. Urban Affairs Quarterly, 14(3): 363-390.
 The Importance of Residential
• centre of the residential neighbourhood is
  someone’s home. The home is a site for:
  – wealth storage / accumulation
  – ‘social reproduction’
  – the investment of meaning
  – the exercise of control
  – the centre point of purposeful activities
    outside the home – work, recreation, service
    need, etc.
            => its relative location matters
   In what ways are place and
   n’hood effects unimportant?
• examples of questions to pose:
• health behaviours – is residential proximity to fast
  food, for instance, important?
• does the importance of n’hood for shaping life
  chances differ from place to place?
      • depending on residential differentiation patterns, geography of
        the labour market, public transit, the public school system, the
        structure of local government, etc.?
• will n’hoods matter to some people more than
      • e.g., seniors, young children, youth, low SES, etc.
Neighbourhoods, Health and
   Human Development:
Neighbourhood Effects Theories
• miasma
• competition theory          •   crime & delinquency
• neighbourhood deprivation   •   child & youth
• neighbourhood affluence     •   early child dev’t
• social capital
• collective efficacy
                              •   mental health
• social disorganization      •   health behaviours
• ‘broken windows’            •   coronary heart disease
• community assets
                              •   neural tube defects
• public services
• reputation of               •   low birth weight
• opportunity structures
  Neighbourhoods & Complexity
• neighbourhoods are complex, “multi-
  attribute” phenomena
• existing research => neighbourhood may
  be a good site for intervention, but…
    • mainly just observational studies available
    • need more intervention studies => Q’s re: method
• realist evaluation:
  mechanism + context = outcome
• need theoretical research and diverse
  research strategy on interventions
Methods for Investigating
 Neighbourhood Effects
   Two Methodological Worlds
• Extensive research approaches
  – the view from 30,000 feet
     • multi-level models of n’hood effects
     • ecological studies of neighbourhood differences
     • visualization of the spatial pattern of such differences
• Intensive research approaches
  – spatially static (temporally too)
     • case studies & neighbourhood surveys
     • observer-based standardized checklists
     • studies of residential proximity to ‘goods’ and ‘bads’
       Extensive Approaches:
     Strengths and Weaknesses
• multi-level models of n’hood effects
      • analytically powerful, aided by MLM software, spatial databases
      • BUT small R2, cross-sectional, poor measures of n’hood context,
        non-independence of observations, non-random assignment
• ecological studies of n’hood differences
      • a good antidote to ‘atomistic fallacy’
      • BUT still vulnerable to problems of inference and the overall
        value of information provided
• visualization of spatial patterns
      • good tool for hypothesis generation and knowledge transfer
      • BUT, can falsely imply importance of proximity, is spatially and
        temporally static
  Language and Cognitive Development:
Percentage of students in the Bottom 10%
       Intensive Approaches:
     Strengths and Weaknesses
• case studies & neighbourhood surveys
      • helpful to identify possible ‘health opportunity structures’ &
      • BUT subject to self-report biases, difficult to know ‘generality’ of
• observer-based standardized checklists
      • can be used to test a hypothesis of the pathway between
        n’hood attributes and health
      • BUT, big inferential leap from visual appearance of n’hood to
        pathway, possible re-stigmatization, focus on extremes,
        relevance to other contexts?
• residential proximity to ‘goods’ and ‘bads’
      • may be effective way to study health effects of activities with
        known spatial externality fields
      • BUT is this fetishizing residential location?, how to account for
        contradictory effects?, not sensitive to time-space dynamics
Improving our Understanding
 of Neighbourhood Effects:
        Scaling Rose
    Scaling Rose: Implications
• need to identify ‘neighbourhood social facts’
  – attributes of n’hoods that differ systematically…AND…
  – have a plausible connection to a defined outcome for
    1+ sub-groups…AND…
  – be articulated through a thickly described, identifiable
    mechanisms with description of contextual mediation
• implication for policy: optimal mix and type of
  individual and context-level intervention?
• but how can these attributes and mechanisms be
Visualizing and Understanding
    Nested Geographies of
         Everyday Life
Towards a Space-Time Dynamic
Study of Neighbourhood Effects
• draw from principles of Hagerstrand’s time-
• use of GPS and mapping space-time patterns of
  daily activity
• marriage of time-use and transportation studies:
  space-time use studies
• overcomes over-emphasis on residential
  proximity, recall bias, gives richer self-report data
  and policy planning info
• may capture ‘shared pathways’ – some n’hood
  attributes may affect multiple outcomes
Hagerstrand Time-Geography
   Diagram: An Example
• great potential for neighbourhood effects research
     • a tool for overcoming the atomistic fallacy and the limits of
       policy based on individual behaviour change
• need to get beyond:
     • concerns about low R2 and non-random assignment
     • use of secondary data & weak conjectures from same
     • mechanism + context = outcome – need more work that
       investigates interventions in this manner
• time-space dynamic methods that are sub-group,
  outcome, and pathway specific & explicit
• ‘re-place’ the importance of the neighbourhood for
  health in daily time-space dynamics

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