Neighbourhood inequality, neighbourhood affluence and population health☆
Introduction
Our aim in this paper is to untangle a series of related issues concerning the effects of neighbourhood socio-economic characteristics on individual health. While there is now a considerable evidence that the neighbourhood income (poverty/affluence) exerts an independent effect on health net of individual-level socio-economic resources, there is little evidence for the claim that neighbourhood inequality is consequential (for reviews see Brooks–Gunn, Duncan, & Aber, 1997; Deaton, 2003; Wagstaff & van Doorslaer, 2000; Wen, Browning, & Cagney, 2003). Our goal is to show why this is so.
The usual explanation for the absence of an inequality effect on health at the neighbourhood level is economic homogeneity (Wilkinson, 1997). Most neighbourhoods, it is claimed, are highly segregated by income so that the salient economic heterogeneity is missing at the neighbourhood level. High levels of economic segregation in large urban areas mean that average neighbourhood living standards matter but the neighbourhood distribution of income is less salient. While there are any number of good reasons to expect that the effects of inequality on health are less likely to appear at the neighbourhood level, we show that the assumption of neighbourhood homogeneity is not one of them and some other mechanism must be at work.
Section snippets
Neighbourhood inequality and health: two causal pathways
Recent attention to the relationship between health and geographic income inequality is due in no small measure to the provocative thesis advanced by Wilkinson (1992), Wilkinson (1996) and others (e.g. Daniels, Kennedy, & Kawachi, 1999), namely that the causal mechanisms linking inequality to health in affluent nations are psycho-social not just material in nature. As Wagstaff and van Doorslaer (2000) highlight, however, the several variants of the more general thesis (Kawachi & Kennedy, 1999)
Data
Our analysis is based on cross-sectional household data from Statistics Canada's 1996/97 National Population Health Survey (NPHS) and neighbourhood characteristics estimated from the 1996 Census 20% sample micro-data. The study is based on 34,613 NPHS respondents aged 12 or older who were residing in one of Canada's 25 Census Metropolitan Areas (CMAs), urban areas with a population of at least 100,000. Thus, the results of this study should not be generalized to small town and rural residents.
The ecological effect of neighbourhood income inequality
As shown in Table 2, we find that, on average, individuals in low inequality neighbourhoods report better health than those living in higher inequality neighbourhoods. Results for the five income inequality measures are similar in that they are all significantly associated with individual health in the same direction but differ with respect to where the differences are located and the strength of the association. Furthermore, the relationship is non-linear. The coefficients show a shallow
Discussion
We have attempted to untangle a series of related issues concerning the “effects” of neighbourhood socio-economic characteristics on individual health. We begin our discussion with the relative income hypothesis (RIH) since the cumulative evidence is reasonably straightforward and consistent across studies.
Do the less affluent benefit as a result of sharing neighbourhoods with more affluent individuals as Wilson (1987) argues? Or, following Wilkinson (1998) and related arguments (Jencks &
Acknowledgements
We would like to thank James Dunn, Nancy Ross, Blair Wheaton, Russell Wilkins, and Michael Wolfson for their helpful comments and suggestions. This paper represents the views of the authors and does not necessarily reflect the opinions of the institutes where the authors work.
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