Investigating the relationship between neighbourhood social cohesion, economic deprivation and residents' health

Attributes of places may influence health over and above effects of individual risk factors. This thesis describes investigation of the role of social cohesion and its joint effect with economic deprivation in explaining health inequalities between neighbourhoods. Social cohesion was measured in over 250 neighbourhoods in England and Scotland by postal survey. Aggregated responses and economic deprivation data from the census data were linked to existing health databases from the Health Survey for England, the Scottish Health Survey and the Whitehall II study. One set of respondents reported on their perception of social cohesion in their neighbourhood and a different set of respondents (living in the same neighbourhoods) reported on their health, thus avoiding affect bias. The prevalence of poor self-rated health was higher in neighbourhoods with more family ties, lower participation rates, less integration into wider society and lower levels of trust, attachment and tolerance, after accounting for participant's age, sex and socioeconomic position. Effect sizes were comparable with a 15 year increase in age. Greater contact with local family and lower integration were associated with increased smoking providing some evidence that local norms influence smoking behaviour. Residents in neighbourhoods with higher levels of trust and attachment had somewhat better social support and were less vigilant for threat, indicating two possible pathways linking the neighbourhood environment to individual health. Neighbourhood social cohesion was highly correlated with economic deprivation. All associations between social cohesion and health listed above were attenuated after adjustment for economic deprivation. Whilst significant associations between social cohesion and several health indicators and plausible pathways linking these have been demonstrated, it appears that social cohesion and economic deprivation are closely coupled and independent effects of social cohesion could not be identified. A major conclusion of this study is that initiatives which seek to increase social cohesion while ignoring the structural factors that perpetuate economic deprivation are unlikely to have major impacts on health