health and wellbeing
Improved or changed housing and neighbourhood conditions may impact upon general health and the incidence of illnesses (short and medium term).
The way in which these changes are delivered, and the residential and social conditions in which people live, may also affect how people feel and behave. Given that local environments both reflect and influence lifestyles, we are also interested in mental health and wellbeing and in health behaviours – most notably walking, smoking and alcohol consumption.
All these health impacts may also be reflected in levels of use of health services. The distribution of impacts within and across communities may contribute positively, or negatively, to the scale of health inequalities.
Key findings to date relating to this outcome are summarised below.
Migration and health
A review of the evidence around migration and health, found that although there is evidence that migrants from different cultures can exert a positive influence on health-related behaviours in their new resident communities, there is also evidence that subsequent integration of migrants into mainstream society and culture can have negative impacts on migrants own health.
In addition, while some studies have shown that selective migration can influence area based health measures and inequalities, an analysis of widening health inequalities in Glasgow between 1991 and 2011 suggests that factors other than migration are the cause of the increasing health gap. So although the impact of migration on health and inequalities remains debatable, it should be considered alongside regeneration investment, in explaining any changes in health outcomes, behaviours or inequalities.
Housing, neighbourhood and health
Exploration of resident’s beliefs around the impact that their home and neighbourhood can have on their health found that many of the factors considered to have important health consequences were not directly linked to the physical condition of their homes – although homes considered too small, damp and costly to heat were perceived to have adverse health consequences in terms of mental wellbeing, childhood asthma and related illnesses. Rather social relationships and support structures within and beyond the local neighbourhood including participation within the community; individual or community support from community organisations and professional services (e.g. health, police, housing, etc); and relocation as part of the clearance and new build programme were considered important for a range of health and wellbeing issues.
Perceived relative position and mental wellbeing
An examination of perceived relative position and mental wellbeing showed that rating your home as being of relatively good quality compared to others in your locality, and feeling that your neighbourhood contained at least some people on higher incomes than others, were positively associated with mental wellbeing.
Source: 'The psychosocial pathway to mental wellbeing at the local level' - Kearns et al. (2013) (external link)
Regeneration and mental wellbeing
Using the WEMWBS scale, we examined influences upon positive mental wellbeing in our Wave 2 data. We found that the appearance of the home as well as the aesthetic quality of the local neighbourhood environment were positively associated with mental wellbeing. But so too were other less tangible residential factors such as being very satisfied with the services of one's landlord, and perceiving that one's neighbours spoke well of the area (i.e. it had a good internal reputation).
Source: Briefing Paper 12
Mental health of residents
Between 2006 and 2008, there was a reported increase in the number of respondents who said they had visited their doctor in the past year for a mental health reason. In the Wider Surrounding Areas and in the Local Regeneration Areas, this increase was large (over 10%) and statistically significant. In all types of study area, there was also an increase in the number of people who said they had a long-term psychological or emotional problem (lasting a year at least).
Source: Progress for People and Places, Chapter 9
An unexpectedly high proportion of our respondents at Wave 2 reported eating five portions of fruit and vegetables in the past 24 hours. The GoWell rate of five a day, at 55%, is more than twice the equivalent Scottish Health Survey figure, and higher than the rate reported for Greater Glasgow in an NHS survey (38%). The number of people who ate their main meal from a fast-food outlet at least once in the past week fell between Wave 1 and Wave 2, from 47% to 43%. Our review of the wider evidence suggests that these patterns of diet are unlikely to be explained by the local food retail environment in our study areas, though we will need to examine influences upon eating habits in more depth within the study.
The prevalence of smoking among our study populations dropped slightly over the period 2006-2008, but at 40% is still much higher than the national rate of a quarter of adults. Two in five (44%) of the smokers in our study said they would never quit smoking. Smoking is a significant health issue in our study areas, as the lung cancer mortality rate for GoWell areas (at 127 per 100,000) is twice the national rate and a third higher than the rate for Glasgow as a whole. In one of our study areas, Drumchapel, the lung cancer mortality rate is extremely high - 190 per 100,000.
Source: Progress for People and Places, page 142; Health and Wellbeing in Glasgow and the GoWell Areas, Chapter 5
At our baseline in 2006, 29% of respondents said that they walked around their neighbourhood most (five or more) days of the week. We examined what factors influenced regular local walking, and found that the following things had a positive effect:
- Being a user of amenities such as parks and play areas, general shops and fast-food outlets.
- Living in an area with fewer multi-storey flats.
- Having a strong sense of community in terms of safety, belonging, social harmony and expected informal social control.
- Perceiving that one's neighbourhood has a good external reputation.
These findings indicate that both physical and social regeneration are required in order to boost moderate physical activity through walking.
Source: Briefing Paper 14
Rates of physical inactivity were found to be very high at Wave 2, in 2008. Two-thirds of our respondents had not done any moderate or vigorous physical activity (for more than ten minutes) in the past week. National rates of physical inactivity (over a four week period) were approximately half this level. Those more likely to report physical inactivity included:
- Those born in the UK.
- Adults aged over 40.
- Adults living alone, and under retirement age.
- Those who were unemployed, long-term sick or retired.
Source: Progress for People and Places, page 140
Prevalence of long-term health conditions
Between 2006 and 2008, we found that the number of respondents reporting long-term health conditions fell by approximately 7%. However, the mean number of conditions reported by those who experience long-term health problems increased; thus, co-morbidity was on the rise among our study populations. Over the same period, two long-term health conditions related to mental health increased significantly in prevalence among our respondents who remained living in the regeneration areas - stress, anxiety and depression increased by 10%; migraines or frequent headaches increase by 3%.
Child and maternal health
Child and maternal health varied across our study area types. For example:
- A quarter of pregnant women in Transformational Regeneration Areas smoke during pregnancy, and almost half do so in Peripheral Estates.
- Around 60% of babies are breastfed in the Transformational Regeneration Areas, compared with only 10% in the Peripheral Estates.
Source: Briefing Paper 1
Life expectancy in the GoWell study areas
Using mortality data from GRO (Scotland) and CHI population data, we estimated that, for the pre-study period of 2001-5, life expectancy for 15 year old boys in all our study area types was well below the Scottish average. While 79% of 15 year old boys in Scotland could expect to live to age 65, the survival rate in our study areas was much lower: 58% in Transformational Regeneration Areas; 55% in Peripheral Estates; and 43% in Local Regeneration Areas.
Deprivation and health
We profiled our study areas in terms of deprivation and health to establish a baseline position for the study. Using data from the Department of Work and Pensions, we calculated that the proportion of our study populations who lived in households that were 'income deprived' ranged from 25% to 54% in 2006. The equivalent figures for Glasgow and Scotland at the time were 25% and 14% respectively. Thus, all our study areas are very deprived in relative terms.