Can we develop a ‘life course’ of place to understand spatial inequalities in health?

There has been a great deal of recent interest amongst social scientists and public health researchers on the multitude of social, economic and cultural factors that operate across the life course to affect our health.  Life course perspectives have helped us to appreciate that socioeconomic status and health in older age are not independent of social and economic inequalities earlier in life.  Two related pathways are possible. First, social and economic factors accumulate over our lives and this accrual is associated with health later in life. Second, negative socioeconomic exposures early in life influence our social trajectory, in turn affecting health; in other words the playing field in early life is uneven and this helps to establish subsequent health inequalities.

Given that life course perspectives have been so useful it is perhaps surprising that those of us with interests in ‘place’ or the ‘environment’ and health have rarely taken a life course perspective. Place-based factors early in life as well as cumulative exposure to the environment over the life course may well be important for subsequent health. Yet this assertion has rarely been tested despite the possibilities that these approaches offer for enhancing our understanding of health-environment relations. Longitudinal studies of health and the environment have almost exclusively focused on area-level social disadvantage (e.g. using historical census data) and the cumulative effects on health of living in a low income area.

Of course many aspects of the environment have been implicated in explaining health outcomes so why is it that there have been so few studies examining the health implications of a broad set of environmental characteristics over the life course? The likely answer to this question is that we have been put off by the difficultly of the task!  It is rare that neighbourhood-level historical information for multiple points in time (e.g. green spaces, local infrastructure, housing quality etc.) is readily available. Even when geographical information is obtainable it is often in an inconvenient form (e.g. a paper map or buried in an archive) or incompatible with social and health information on individuals over the life courses.

Current work at CRESH is exploring the feasibility of developing a ‘life course of places’. We are examining whether we can develop a heuristic for measuring a range of ‘health-related’ neighbourhood measures across the Lothian region of Scotland at various time points over the past 80 years.  We are considering the suitability of a range of available data sources including past censuses, historical maps, aerial photography and historical land use information. Of course the environmental characteristics will have a plausible link to health and may include local green space, population and housing density, street connectivity, local destinations, air pollution, availability of services, public space and transport links.  We are developing the measures with a view to combining the data with cohort information relating to individuals born in the Lothian region.

If we are successful in our work, then this study promises to provide some new perspectives on understanding the role of place in explaining health outcomes in later life. Watch this space to follow our progress….

 Jamie Pearce, February 2013

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