Why place matters: insights into associations between

neighbourhoods and health

Deborah Warr*, Margaret Kelaher#, Theonie Tacticos# and Peter Feldman#

*McCaughey Centre#Centre for Health Policy, Programs and Economics

University of Melbourne

Presentation for ‘People, Places, Processes’ forumVicHealth

14th April 2008

Why place matters -

The heightening significance of place

Mechanisms generating area-effects on health Physical disorders Social incivilities Neighbourhood stigma

Snapshots of selected findings

Summary of key issues

• Evidence that Australian suburbs are a mosaic reflecting diverse, complex and characteristic physical and social landscapes

• Identify 7 types of localities (Baum, O’Connor & Stimson 2005)

– 3 types of advantaged localities• ‘new economy extremely advantaged localities’ • ‘gentrifying’/population change advantaged localities’• ‘middle-class advantaged suburban localities’

– 4 types of disadvantaged localities• ‘working-class-battler disadvantaged localities’• ‘battling family/mortgage stress disadvantaged localities’• ‘old-economy extremely disadvantaged localities’• ‘peri-urban disadvantaged localities’

• Labels fuse spatial, economic and social properties of places

‘Working-class-battler disadvantaged localities’

• Traditional working class localities • Incomes below the average, lower

educational levels• Ratio of high-income to low-income

households below the average• Tend to have low levels of

unemployment and above average labour force participation rates, lower educational levels

• Tend to have low proportions of newly arrived migrants

‘Peri-urban disadvantaged localities’

• More people employed in agriculture• Above average proportions of people

employed in ‘vulnerable occupations’• Population growing through internal

(rather then external) migration• Low education levels, lower labour-

force participation• Home ownership above average, higher

levels of mortgage stress• Above average levels of people

receiving an aged pension

‘Battling family/mortgage stress disadvantaged localities’

• Living in mortgage belts in middle and outer suburbs

• Families attracted to these areas because of housing affordability

• Above average levels of disadvantaged household circumstances (ie. Sole parent families, non-earner families)

• High levels of mortgage stress• Incomes below average, lower

educational levels• Ratio of high-income to low-income

households below the average

‘Old-economy extremely disadvantaged localities’

• High levels of people working in vulnerable occupations and ‘old-economy’ industries

• Low levels of people working in ‘new-economy work and educated professionals

• High levels of unemployment• High rates of single parent families and

families with no employed parent• High proportion of households living in

public housing• Households paying off housing loan more

likely to be suffering mortgage stress

Mechanisms generating area-effects on health :

• Neighbourhood resources, infrastructure and facilities

• Local social relations and networks

• Aspects of physical and social environments

– Physical disorders (derelict buildings; neglected properties; vandalism; rubbish; graffiti)

– Social environments/incivilities (local social networks; neighbourhood stigma/disrespect; sense of social cohesion, social capital, associational activity public drinking or drug use, conflict, evident criminality)

Effects:• ‘weathering’ effects of cumulative, interlaced factors• Impairs sense of well-being/ sense of safety and security• Provokes feelings of worry, stress and anxiety• triggers harmful physiological responses

Physical environments (disorders):

• The way the people treat the place- dirty, rubbish lying around everywhere. They have no respect. 2. Noisy traffic. Noisy people- loud music, parties anytime night or day’ (R)

• “MY HOUSE IS SHIT, NOTHING GETS FIXED 2. “General untidiness - dirty streets. Lack of pride in suburb” (M)

• “young drunk teenagers with no respect. Vandalism, loud mouths” (R)

• ‘General appearance of the neighbourhood. The aggressive behaviour of fellow community members’ (R)

• 'Services being taken away - shops. Shop roller doors unattractive” (R)

• ‘Neighbours. Derelict buildings’ (R)

Social environment (incivilities):

• “Not feeling safe in my court” (R)• “Burn outs from cars” (R)• “Kids stone the house and have stolen grandson’s bike.

Teenagers sit & smoke & drink on lawn and my wife & I get scared and intimidated” (R)

• “Some of the idiots around here-with their foul mouths, hotted up cars, and fighting in the street at night, can’t even walk to visit neighbours because dogs attack you. If you ring up no one cares” (R)

• “Conflict between races” (M)• “Speeding through the area is dangerous for the

children” (M)• “Mainly the people (some) because I put a scarf on some

people go past me in the neighbourhood and start abusing me” (M)

• “Don't feel safe myself in house” (M)• “With people pee and throw up within building e.g. in

stairway and in the park” (HR)

• “Very poor area, not very good environment; people do not care for each other” (M)

• “Rough people that live in the area” (M)• “Stigma of ‘Birdsville’” (M)• “Bad neighbours always scream and yell and fight. Every

one can hear and it’s scary” (HR)• “I don't like the way people knock the area” (R)• “Young people not respecting others properties” (R)• “Community is too complex, the residents all have

different backgrounds” (HR)• “Living lonely with illness- no body know if I'm suddenly

broken down” (HR)• “Problems with neighbours who have mental health

problems”• “the rest of the neighbours, too many dogs wandering

around, too many people causing too many problems”• “Everyone being labelled the same” (R)

Neighbourhood conditions Area (% reporting poor or unsafe conditions)

NR LGA ALL

n % yes

n % yes n % yes

Poor neighbourhood conditions in general3990 14.2 1850 3.3 5840 10.8

Poor local crime & safety ingeneral

3931 41.7 1797 14.4 5728 33.2

Unsafe to walk alone at night3868 59.3 1785 33.2 5653 51.1

Poor local police service3734 47.2 1647 17.1 5381 38.0

Unsafe for children to play outside3793 55.6 1736 24.5 5529 45.8

Poor level of trust in other residents3817 38.4 1778 13.7 5595 30.5

Residents do not look out for each other

3786 28.0 1775 12.7 5561 23.1

Poor health and neighbourhood safety, whole of sample

Poor or Unsafe Neighbourhood conditions

No Yes

% fair/poor health

Poor neighbourhood conditions in general

29.9 47.4

Poor local crime & safety ingeneral

27.0 41.6

Unsafe to walk alone at night 25.2 37.8

Poor local police service 27.2 39.1

Unsafe for children to play outside 25.2 38.4

Poor level of trust in other residents 28.5 39.8

Residents do not look out for each other

30.0 37.4

Relationship between social incivilities and being in fair/poor health

% fair or poor healthAOR fair/poor health

Minor no problem

Big problem AOR* p

Dangerous driving33.7 39.9

1.15 (0.96-1.37) 0.121

Young people in groups34.3 42.4

1.47 (1.23-1.75) 0.000

Alcohol or drug use34.3 40.1

1.30 (1.07-1.59) 0.007

Domestic violence36.8 40.7

1.20 (0.99-1.44) 0.055

Poor street lighting37.3 38.7

1.10 (0.93-1.31) 0.248

Aggressive behaviour34.8 42.6

1.41 (1.18-1.69) 0.000

House robberies or theft34.7 42.6

1.48 (1.24-1.77) 0.000

Car theft or joyriding34.6 41.9

1.38 (1.15-1.66) 0.000

Neighbourhood stigma:

• Almost half of NR residents compared to 9.4% of LGA residents felt that their neighbourhood did not have a good reputation in the surrounding area

• More commonly reported by young people in both NR and LGA samples

• People educated above year 10 in NR sites more likely than people educated below year 10 to report perceptions of area-based stigma

• Perceptions of area-based stigma was associated with lower odds of being in excellent/very good/good health

Place-based approaches:• Channels resources to particular populations and

address aspects of particular places

• Embeds initiatives in everyday and local settings, and promotes the co-ordination of responses

• Effective for improving physical and social environments of neighbourhoods - this appears to be important in making a difference to people’s lives (and health) Promotes social goods such as a sense of safety and security Promotes access to facilities (for learning, leisure, sociability

etc.) Influence how residents feel about themselves What is signalled to people living in other neighbourhoods Promotes capacities to build critical linking networks

• ‘Grounded’ processes most effective for working with communities – this is very important!

Summary of key issues:

• Place is important because it is a local context for everyday life

• Frames the opportunities and constraints of individuals• The combination of household and concentrated poverty

creates additional hardships for people • Poor neighbourhoods tend to comprise a diversity of

households (socio-economic, tenure, ethnicity, family-structure)

• This diversity is a source of strength and creativity as much as ‘indicators of disadvantage’

• The affluent have increasing capacities to ‘spatially sort themselves’ away from those who are poor

• Issues manifesting within neighbourhoods also stem from outside settings (global, national, other neighbourhoods) - limited capacity to be addressed only at the local level