Context

In recent literature,  health outcomes have been found to be related with place components [1-3], such as social population profile and deprivation level [4], quality of the built environment [5], social cohesion [6] and presence of (or proximity to) health-related resources [7-9]. In such studies, various types of resources have been considered: health services, commercial resources, recreational and cultural resources and public transportation networks. Until now, accessibility to these resources has very often been evaluated in the neighbourhood of residence, an essential anchor space in personal daily organization. However, this traditional approach of place effects has two major limitations:

First, few public health studies have considered the variability of how people experience their neighbourhood when estimating neighbourhood resource accessibility. Actually, it is very common to define neighbourhoods such as spatial units of similar size (e.g. circular buffers of constant radius) or of roughly similar population size (e.g. census tracts). Yet, there may be important spatial discrepancies between such an uniform neighbourhood definition and the unique way people experience and perceive their neighbourhood of residence. The question of neighbourhood definition based on people’s place experiences has a rich history in neighbourhood and community studies, especially in the U.S. literature. Several studies have shown that people have unique neighbourhood experiences and locate their residential neighbourhood boundaries differently, even when living in close proximity [10-12]. Neglecting variability in people’s neighbourhood experiences may lead to underreport inequalities in access to neighbourhood resources – a problem recently defined as the ‘constant size neighbourhood trap [13].

The second limitation is related to the importance of accounting for people’s daily mobility and their activity space. It would be incorrect to treat people as if they were static and tied to their sole neighbourhood of residence when estimating number of urban resources to which people may have access [14-20]. The focus on the sole residential neighbourhood conceived as a local home-based continuous space has been questioned and calls have been made to overcome what has been referred to as the “residential” or “local” trap [21, 22].

It could then be relevant to adopt a more relational approach to place effects on health [23] accounting for people’ place experiences in their neighbourhood scale and in the whole metropolitan area. In this research field, some innovations have come from time-geography, where individual potential path areas have been developed to stress the fact that potential accessibility to resources should reflect individual space and time constraints. In this way, some authors strongly recommend the use of “people-based accessibility measures” rather than “place-based accessibility measures” alone [24, 25], because accessibility to resources is at least as much about people as it is about places [26, 27].

 

 

Références:

  1. Diez-Roux A. 2001. Investigating neighborhood and area effects on health. American Journal of Public Health 91(11):1783-1789
  2. Kawachi I, Berkman LF. 2003. Neighborhoods and Health. New-York: Oxford University Press
  3. Ellaway A, Macintyre S. 1996. Does where you live predict health related behaviours? A case study in Glasgow. Health Bulletin 54:443-6
  4. Ross CE. 2000. Neighborhood Disadvantage and Adult Depression. Journal of Health and Social Behavior 41:177-87
  5. Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. 2005. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health 59:822–7
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  20. Shareck M, Frohlich K. 2013. Rethinking Exposure in Area Studies on Social Inequities in Smoking in Youth and Young Adults. In Neighbourhood Structure and Health Promotion, ed. C Stock, A Ellaway, pp. 267-86
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