Social gifting and islands: a study of remoteness and wellbeing in Scotland

Existing research shows that physical and social environments are important for human wellbeing. In Western nations, living in more geographically remote locations appears to benefit aspects of mental and physical health and has been linked to elevated levels of social capital. This thesis attempts to strengthen understanding in the field by exploring the geographical distribution of wellbeing in Scotland’s adult population, and the role of the social character of neighbourhoods in mediating that relationship. It addresses shortcomings of the existing research, making theoretical and practical contributions to knowledge by extending understanding of sociospatial theory of health and applying its empirical findings through recommendations for research and policymaking aimed at reducing health inequality. The first of these shortcomings regards lack of synthesis surrounding how health outcomes are both the manifestation of places’ social character and a product of geographical location due to the role of physical space in shaping social processes. To examine the link between place, social capital, and health, data on health variables known to be influenced by social capital were selected as the outcome measures. For mental health, these factors were self-reported mental wellbeing recorded in the census, and clinically identified cases of anxiety and depression according to prescribed medications. For physical health, the focus was on administrative health records on birthweights as a manifestation of maternal exposures and an especially important physical health outcome given its potential for intergenerational and life-course consequences. These wellbeing outcomes were compared across levels of geographical remoteness and adjusted for indicators that included proxy measures of social capital. The second limitation of existing studies concerns methods of defining remoteness, which have focused on rurality without distinction between island and mainland areas. The thesis argues that the experience of living on islands is different due to their unique physical isolation. Thus, it measures health outcomes and effects of social factors along an enriched scale of remoteness, adapting the Scottish Government’s official Urban Rural scales to incorporate additional Island Mainland levels. A third limitation is that methods have tended to rely upon small-scale cross-sectional studies, creating a gap for more representative large-scale and longitudinal analysis. In response, this thesis applied multilevel modelling to data on Scotland’s adult population using large nationally representative linked administrative datasets (range N=114428-359169) spanning multiple years (1981-2017). The exact time periods and variables used for each of the empirical chapters varied according to the different aims of the study and availability of data, but the enriched versions of the Scottish Government’s classification of geographical remoteness were used throughout. Fourthly, although social capital is recognised as an instrumental collective-level resource in the context of wellbeing, there are very few practical tools by which it can be measured at neighbourhood level, rendering it difficult to control for in data analysis. Therefore, alongside examination of health and existing social capital proxies (e.g. crime, Social Fragmentation Index), the thesis develops a novel research indicator – the Social Gifting Index - designed to improve small-area level estimation of people’s willingness to donate time to others as a proxy for social capital. Overall, the thesis’ empirical findings show that, for the mental and physical health markers measured: (i) there is a positive correlation with rurality; (ii) island residence confers an additional beneficial effect; (iii) social aspects are important mediators of this process; and (iv) the new Social Gifting Index is an improved tool for capturing small-area level effects of social capital. These main findings are synthesised with evidence and existing theory under a health geography of remoteness, to suggest that remoteness of residential location plays a part in production of socially cohesive neighbourhoods that are likely to benefit residents’ mental and physical wellbeing. The likely (but not here empirically tested) underlying mechanism is attributed to biopsychosocial impacts of situated embodied relational processes, including social participation as a function of placemaking with impacts to health from physiological stress responses. Crucially, the social link between place and health is modifiable and hence promising for its potential contribution to combatting non-communicable disease. Acknowledging this, a final contribution of the thesis was to develop its theoretical and practical findings into suggestions for future policy and research. Exclusive use of Scottish data means that the research and its outputs (including the recommendations) are most applicable to Scotland and its current Mental Health Strategy and Sustainable Development Goals. Notwithstanding, the intersection of place, health, and social mechanisms is of international concern, making the findings more widely relevant in assisting with goals of the World Health Organisation and United Nations for healthy, resilient, inclusive, and sustainable communities.