Elsevier

Social Science & Medicine

Volume 60, Issue 7, April 2005, Pages 1557-1569
Social Science & Medicine

Neighbourhood inequality, neighbourhood affluence and population health

https://doi.org/10.1016/j.socscimed.2004.08.033Get rights and content

Abstract

While there is now considerable evidence that the neighbourhood income levels (poverty/affluence) exert an independent effect on health, there is little evidence that neighbourhood income inequality is consequential, net of individual-level socio-economic resources. We show that the usual explanation for the absence of an independent effect of neighbourhood inequality—the assumption of economic homogeneity at the neighbourhood level—cannot account for this result. The authors use hierarchical models that combine individual micro-data from Statistics Canada's 1996/97 National Population Health Survey (NPHS) with neighbourhood and city-level socio-economic characteristics from the 1996 Census of Canada to estimate the effects of neighbourhood affluence and income inequality on self-reported health status. The findings indicate that the negative “ecological” correlation between average neighbourhood health and neighbourhood income inequality is the result not only of compositional differences among individuals but also of contextual neighbourhood effects associated with low and high inequality neighbourhoods.

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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