Beyond boundaries: Geographical aspects of urban health

In this thesis we look at urban health from a geographical perspective. It focuses specifically on environmental influences on health in Amsterdam. Spatial variations in health exist at multiple geographical scales. Differences in health between locations can be the result of individual characteristics of people, such as age, sex or educational level. However, in many cases differences can only be partly explained by individual characteristics of people. Characteristics of the environment may play a role as well. With the help of geographic information technology and micro-scale data we try to reveal ‘(un) healthy’ areas (hotspots) and environmental aspects influencing urban health. Characteristic of the studies in this thesis is that the environment or residential neighbourhood is not defined using the fixed boundaries of administrative areas. In this way we try to avoid scale and boundary effects associated with the use of such administratively defined areas in many previous studies. We employ two spatial approaches in order to define more relevant neighbourhoods., i.e. the hotspot and the bespoke environment approach. The studies show that environment has an impact on health. The associations we found are not strong although in some cases significant. The strongest effects were found at very local scales. Our findings suggest that policy intended to improve urban health should think and act locally instead of city-wide. In fact, not entire neighbourhoods but ‘local pockets’ should be the focus of attention and intervention. This requires problem identification and monitoring at very local scales. The thesis shows that, by generating accurate geographical information, micro-scale data and spatial analysis tools can support the formulation of integrated policies to improve the health and well-being of residents most in need