Citation

Stafford M, Martikainen P, Lahelma E, Marmot M. J. Epidemiol. Community Health 2004; 58(9): 772-778.

Affiliation

International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1-19 Torrington Place, London WC1E 6BT, UK. m.stafford@public-health.ucl.ac.uk

Copyright

(Copyright © 2004, BMJ Publishing Group)

DOI

10.1136/jech.2003.015941

PMID

15310804

PMCID

PMC1732870

Abstract

STUDY OBJECTIVE: Mortality and morbidity vary across neighbourhoods and larger residential areas. Effects of area deprivation on health may vary across countries, because of greater spatial separation of people occupying high and low socioeconomic positions and differences in the provision of local services and facilities. Neighbourhood variations in health and the contribution of residents' characteristics and neighbourhood indicators were compared in London and Helsinki, two settings where inequality and welfare policies differ. DESIGN: Data from two cohorts were used to investigate associations between self rated health and neighbourhood indicators using a multilevel approach. SETTING: London and Helsinki. PARTICIPANTS: From the Whitehall II study (London, aged 39-63) and the Helsinki health study (aged 40-60). MAIN RESULTS: Socioeconomic segregation was higher in London than in Helsinki. Age and sex adjusted differences in self rated health between neighbourhoods were also greater in London. Independent of individual socioeconomic position, neighbourhood unemployment, proportion of residents in manual occupations, and proportion of single households were associated with health. In pooled data, residence in a neighbourhood with highest unemployment was associated with an odds ratio of less than good self rated health of 1.51 (95% CI 1.30 to 1.75). High rates of single parenthood were associated with health in London but not in Helsinki. CONCLUSIONS: Neighbourhood socioeconomic context was associated with health in both countries, with some evidence of greater neighbourhood effects in London. Greater socioeconomic segregation in London may have emergent effects at the neighbourhood level. Local and national social policies may reduce, or restrict, inequality and segregation between areas.

Language: en