Neighbourhood demolition, relocation and health. A qualitative longitudinal study of housing-led urban regeneration in Glasgow, UK

Long-term effects of urban renewal on health and health inequalities: the Neighbourhoods Law in Barcelona, Spain

INTRODUCTION

Few studies exist examining the long-term effects of urban renewal programmes on health. The purpose of this study is to examine the long-term effects of an urban renewal programme on the health and health inequality outcomes of residents living in the neighbourhoods intervened in Barcelona city by the Neighbourhoods Law (NL), while comparing them to a comparison group of non-intervention neighbourhoods with similar socioeconomic status.

METHODS

The Barcelona Health Survey was used for studying changes in self-rated health, mental health, hypertension and meeting walking requirements set by the WHO in pre (2006) and post (2016) years of neighbourhoods intervened by the NL and a group of comparison neighbourhoods with similar socioeconomic characteristics. We used logistic regression models to examine pre-post differences in health outcomes within intervention or comparison neighbourhoods. A difference-in-difference regression was used to assess the overtime impact of the NL intervention on the health outcomes compared with the comparison groups. All models were adjusted by the highest education level attained and age.

RESULTS

In the intervention neighbourhoods, self-rated health improved for manual workers, hypertension dropped in men and more women met the walking requirements compared with similar groups in the comparison neighbourhoods. Across all groups, mental health worsened.

CONCLUSIONS

Our study is among the first to examine the long-term effects of urban renewal programmes. Although there exist complexities in studying these long-term effects, they are critical to ensure urban renewal programmes continue to improve health and reduce inequality among residents.

Structural changes in a Danish social housing area: The impact of forced permanent rehousing on contact frequency with general practitioner and use of antidepressants

There is a lack of knowledge about the health consequences of politically initiated forced permanent rehousing (FPR) of residents in social housing areas. This study investigates if FPR is associated with the contact frequency with general practitioner (GP) and the proportion of residents who use antidepressants. The study included 432 rehoused residents matched 1:2 with remaining residents and residents from a comparable neighbouring area without exposure to rehousing. For GP contact frequency, we conducted a difference-in-difference analysis while the proportion of residents who used antidepressants was investigated through descriptive statistics. We found high GP contact frequency in the three groups, but no significant differences. Further, we found a low proportion of residents who used antidepressants in all groups, but a small increase from baseline to follow-up. Our results thus suggest that FPR neither affected the rehoused residents' GP contact frequency nor the proportion who used antidepressants.

Understanding the mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods: A realist review

Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). This realist review aimed at understanding underlying mechanisms linking holistic housing renovations to health and well-being of adults in disadvantaged neighbourhoods. Following systematic and iterative searching, and relevance and quality appraisals, 18 scientific articles and reports were analysed. We identified three pathways via which physical housing improvements affect health, four pathways via which social and socioeconomic interventions affect health, and two pathways via which both reinforce each other in their health effects. Our findings are theoretically novel, relevant for those conducting holistic housing renovations, and point towards gaps in the literature.

'They are breaking us into pieces': A longitudinal multi-method study on urban regeneration and place-based social relations among social housing residents in Denmark

Urban regeneration often intends to improve the physical, economic, and social environment of disadvantaged neighborhoods. However, evidence on the consequences of such interventions on place-based social relations is limited in Scandinavia. This study investigates the relationship between urban regeneration and diverse forms of place-based social relations among middle-aged and older social housing residents in Denmark. A longitudinal multi-method design was applied using data from administrative registers and semi-structured individual interviews. The quantitative results showed small changes in household-restricted place-based social relations, whereas participants in the qualitative sample described the disruption of place-based social relations to negatively affect their well-being.

Assessing the impact of selective licencing schemes for private rental housing on mental health and well-being: protocol for a mixed-method natural experiment study in Greater London, UK

INTRODUCTION

The UK private rental housing market has poorer quality housing compared with other sectors and is subjected to calls for better regulation. Poor quality housing poses risks to mental and physical health, and housing improvement can potentially benefit health and well-being. Local authorities have powers to implement selective licencing (SL) schemes in specific localities. Such schemes involve landlord registration, payment of licence fees, local authority inspection and requirements that landlords conduct any necessary renovation works to ensure housing standards are met. We aim to evaluate SL in Greater London and to test the feasibility of a national evaluation.

METHODS AND ANALYSIS

We will measure individual-level and area-level impacts of SL in Greater London between 2011 and 2019. A difference-in-differences approach with propensity score-matched controls will be used. We propose to exploit data from the Annual Population Survey (APS) and health and social benefit registers to measure mental health and well-being at individual (self-reported anxiety) and area (Small Area Mental Health Index) level. We estimate 633 APS participants in our intervention groups compared with 1899 participants in control areas (1:3 ratio of intervention to control). Secondary outcomes will be self-reported well-being and residential stability at the individual level and incidence of police-recorded antisocial behaviour calls and population turnover at the area level. The study size of the area-level analyses will be 3684 lower layer super output areas (including controls). Qualitative semistructured interviews with lead implementers in several London boroughs will produce insights into variations and commonalities between schemes.

ETHICS AND DISSEMINATION

Ethical approval was obtained from London School of Hygiene and Tropical Medicine's Ethics Committee (reference number 26481) and London Borough of Hackney. All interviewees will be asked for informed written consent. Study findings will be published in a peer-reviewed journal.

The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing

BACKGROUND

The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The "Regeneración Urbana, Calidad de Vida y Salud" (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile.

METHODS

RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population.

DISCUSSION

RUCAS' design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors -including COVID-19 pandemic and associated lockdowns- and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS' outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.

Built Environment and Self-Rated Health: Comparing Young, Middle-Aged, and Older People in Chengdu, China

OBJECTIVES

This article explores how the building-scale built environment is associated with self-rated health, examining differences in this association among younger, middle-aged, and older age groups. Features examined included building type, building condition, and sidewalk presence in front of dwellings.

BACKGROUND

Understanding how the relationships between built environments and health vary across age groups helps to build a healthy environment for all. However, most studies have concentrated on the neighborhood or indoor environment, rather than whole buildings, and few have compared age groups.

METHODS

This study analyzed survey data from 1,019 adults living in 40 neighborhoods in Chengdu, China, recruited through a clustered random sampling approach. It used a Bayesian logistic mixed-effects model with interaction terms between age-group indicators and other variables.

RESULTS

Significant differences exist in the relationships of self-rated health with some environmental and other indicators among age groups. For older people, living in multi-floor buildings, having a household smoker, and undertaking fewer hours of weekly exercise were associated with lower odds of reporting good, very good, or excellent health. These relationships were not identified among middle-aged and younger people. More education was associated with higher odds of reporting better health among older and middle-aged groups.

CONCLUSIONS

Older people experience more health-related challenges compared to middle-aged and younger people. However, among the examined built environment factors, building type was the only significant factor related to self-rated health among older people. To promote health among older people, this study recommends adding elevators in the multi-floor buildings.

Evaluating the effect of change in the built environment on mental health and subjective well-being: a natural experiment

BACKGROUND

Neighbourhood characteristics may affect mental health and well-being, but longitudinal evidence is limited. We examined the effect of relocating to East Village (the former London 2012 Olympic Athletes' Village), repurposed to encourage healthy active living, on mental health and well-being.

METHODS

1278 adults seeking different housing tenures in East village were recruited and examined during 2013-2015. 877 (69%) were followed-up after 2  years; 50% had moved to East Village. Analysis examined change in objective measures of the built environment, neighbourhood perceptions (scored from low to high; quality -12 to 12, safety -10 to 10 units), self-reported mental health (depression and anxiety) and well-being (life satisfaction, life being worthwhile and happiness) among East Village participants compared with controls who did not move to East Village. Follow-up measures were regressed on baseline for each outcome with group status as a binary variable, adjusted for age, sex, ethnicity, housing tenure and household clustering (random effect).

RESULTS

Participants who moved to East Village lived closer to their nearest park (528 m, 95% CI 482 to 575 m), in more walkable areas, and had better access to public transport, compared with controls. Living in East Village was associated with marked improvements in neighbourhood perceptions (quality 5.0, 95% CI 4.5 to 5.4 units; safety 3.4, 95% CI 2.9 to 3.9 units), but there was no overall effect on mental health and well-being outcomes.

CONCLUSION

Despite large improvements in the built environment, there was no evidence that moving to East Village improved mental health and well-being. Changes in the built environment alone are insufficient to improve mental health and well-being.

Investigate the Conduction Path of Stakeholder Conflict of Urban Regeneration Sustainability in China: the Application of Social-Based Solutions

Urban regeneration, as an important way to enhance urban sustainable development capacity, is advancing at a high speed in China. However, urban regeneration involves various stakeholders, and there are frequent conflicts between these stakeholders due to the vast differences in their interests. When conflicts among stakeholders are not effectively controlled, they can have serious negative social and economic impacts, such as increased pressure on the government to maintain stability, increased costs to developers and reduced willingness of property owners to participate. These are all critical factor affecting the sustainability of urban regeneration. Therefore, this paper explored the mechanism underlying stakeholder conflict conduction in urban regeneration. Next, a literature review and case study were conducted to identify key conflict factors. Then, the factors of stakeholder conflict were assessed using questionnaire survey. Finally, the structural equation model (SEM) was used to analyze the pathways of stakeholder conflict conduction in urban regeneration; and 35 conflict conduction paths were found. Based on Pareto’s Law, 7 of the 35 stakeholder conflict paths were identified as critical paths with coefficients between 0.245–0.364. Empirical results revealed that different types of conflict factors have different impacts on stakeholder conflict conduction, among which interest distribution and stakeholder coordination were the critical factors to be considered. The findings provide alternatives Social-Based Solutions (SBS) for resolving stakeholder conflicts and provide practical guidance for integrating stakeholders, which is important to ensuring the sustainability of urban regeneration.

A New Framework for the Regeneration Process of Mediterranean Historic City Centres

For thousands of years, cities have evolved with changing needs. Cities are like living organisms, which are exposed to transformations as a result of changing needs and requirements. City centres are one of the attractive, essential, and vital parts of the city that are also affected by these changes. Specifically, historic city centres, which refer to the origins of the city, will be discussed within this context. Urban design aims to shape our cities with better quality and provide better places for everyday life. In addition, urban regeneration can be utilized as generic public policy for solving problems and providing physical improvements for these cities. Although the problems that emerge in each city are similar, sometimes they change circumstantially. As a result, the planning, implementation, and management of urban regeneration projects as well as their sustainability can produce serious complications. This article focuses on the process of urban regeneration, historic city centres, and the Mediterranean region and aims to develop an applicable regeneration framework for historic city centres limited to the Mediterranean region. First, the main problems of these cities are described. Next, characteristics of historic city centres and associated problems of the Mediterranean region are explained. Subsequently, the concept of urban regeneration is clarified, and the processes involved are discussed. Finally, an applicable urban regeneration framework for historic Mediterranean city centres, developed by the authors, is explained with the goal to reduce social segregation while incorporating the contributions of views from both local inhabitants and stakeholders in the process. The methodology of the overall research presented in this article is mainly based on a critical review of primary and secondary documents from the literature through a comparative and exploratory approach.

Health Benefits of Physical Activity Related to an Urban Riverside Regeneration

The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and meta-analysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure.

The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment

Background

There is limited evidence for public health policy-makers on the health impacts of urban regeneration programmes.

Objectives

To assess whether or not the London 2012 Olympic and Paralympic Games, and related urban regeneration, were associated with an increase in physical activity and mental health and well-being; to assess whether or not any benefits were sustained over time; and to capture the experiences of residents of the Olympic host boroughs.

Design

Quasi-experimental prospective cohort study of adolescents and their parents/carers, with a nested qualitative longitudinal study of families.

Setting

London boroughs of Newham, Barking and Dagenham, Tower Hamlets and Hackney.

Participants

A cohort of 2254 adolescents in 25 schools; a repeat cross-sectional study of parents/carers and a sample of 20 families for the qualitative study.

Intervention

The London 2012 Olympic and Paralympic Games, and urban regeneration primarily associated with the redevelopment of the Olympic Park for legacy use.

Primary outcome measures

Change in the proportion of respondents meeting physical activity recommendations (using self-reported physical activity); change in the proportion of respondents reporting depression and anxiety and change in well-being score.

Main results

At 6 months, adolescents who became inactive were less likely to come from the intervention borough (Newham) than from comparison boroughs [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.51 to 0.93]. At 18 months, there were no statistically significant differences between intervention and comparison boroughs for all adolescent physical activity and screen-time transitions. Those who visited the Olympic Park more than once a month were the least likely to remain inactive (RR 0.11, 95% CI 0.02 to 0.48) and the least likely to become inactive (RR 0.38, 95% CI 0.24 to 0.60) compared with those who were active at baseline and at the 18-month follow-up. No impacts on parental/carer physical activity were observed. Adolescents who were ‘no longer depressed’ (RR 1.53, 95% CI 1.07 to 2.20) or ‘remained depressed’ (RR 1.78, 95% CI 1.12 to 2.83) at 6 months were more likely to be from the intervention borough. For well-being, there was no association between boroughs and change in well-being between baseline and the 6-month follow-up. At 18 months’ follow-up, adolescents who ‘remained depressed’ (RR 1.93, 95% CI 1.01 to 3.70) were more likely to be from the intervention borough than from comparison boroughs. No associations were observed for well-being at 18 months. There was limited evidence of change for parental mental health and well-being. The qualitative study found that residents generally welcomed the unexpected chance to live in a cleaner, safer and more unified environment. The findings suggested that the Games temporarily alleviated certain stressors in the social and physical environment. Overall, the Games lessened participants’ sense of social exclusion and appeared to generate a sense of inclusion and respite, even if this was only temporary. Study limitations include the potential for adolescents to not be assigned the correct level of exposure to urban regeneration and the effect of reductions in central and local public budgets owing to the UK Government’s deficit reduction programme.

Conclusions

This study provided the highest quality data to date on the short- and medium-term social and health impacts of sporting mega-events. We found limited evidence that the London 2012 Olympic and Paralympic Games had a positive effect on adolescent or parental physical activity, mental health or well-being.

Funding

The National Institute for Health Research Public Health Research programme.

A qualitative study of disengagement in disadvantaged areas of the UK: 'You come through your door and you lock that door'

Health inequalities are a major concern in the UK. Power imbalances are associated with health inequalities and should be challenged through health promotion and empowering strategies, enabling individuals who feel powerless to take control over their own life and act on the determinants of health (Green and Tones, 2010). This study aimed to explore resident expectations of a community engagement programme that intended to empower communities to take action on pre-identified priorities. The programme targeted communities in deprived areas of a mid-sized city in the UK. A qualitative design was implemented. In-depth semi-structured interviews were undertaken with 28 adult residents at the start of the programme. Transcripts were analysed using an inductive approach to thematic analysis. Resident expectations were explored from a constructivist epistemological perspective. The qualitative inductive approach allowed a second research question to develop which led this paper to focus on exploring how disempowerment was experienced by individuals before taking part in a community engagement programme. Analysis of interviews revealed a 'process of deterioration' that provided insight into how communities might become (more) disadvantaged through disempowerment. Five master themes were identified: external abandonment at the institutional-level (master theme 1); a resulting loss of sense of community (master theme 2); this negatively affected psychological wellbeing of residents (master theme 3); who adopted coping strategies (e.g., disengagement) to aid living in such challenging areas; (master theme 4); disengagement further perpetuated the deterioration of the area (master theme 5). Distrust was identified as a major barrier to participation in community engagement programmes. Overall, our data suggested that community engagement approaches must prioritise restoration of trust and be accompanied by supportive policies to mitigate feelings of abandonment in communities.

A Critique of the Application of Neighborhood Sustainability Assessment Tools in Urban Regeneration

Neighbourhood Sustainability Assessment Tools (NSA tools) are fast becoming the principal framework for urban planners and developers for promoting urban sustainability. The majority of NSA tools promote a specific type of urban development that effectively excludes regeneration projects from the urban sustainability conversation. Given that the world’s megacities are mostly built, it is argued that it is essential that strategies for global sustainability consider that urban development is focussed internally to address existing, under-serviced communities in particular need of meaningful intervention and sustainable redevelopment frameworks. The paper uses existing knowledge on NSA tools to highlight the shortcomings of outcomes-based approaches to urban governance and builds the case that the technocratic “one-size-fits-all” approach adopted by many tools inadequately accounts for underlying institutional, social and economic arrangements that influence urban development, making them inappropriate for application in both planned and existing communities. The paper proposes that urban redevelopment strategies need to be derived from the urban realities of a particular place or context. Such strategies must be grounded in principles of urban governance, participatory action and an understanding of market dynamics. Without these collaborative procedural frameworks, urban regeneration projects will continue to inadequately transition towards more comprehensive sustainability.

Geographical inequalities in health in a time of austerity: Baseline findings from the Stockton-on-Tees cohort study

Stockton-on-Tees has the highest geographical inequalities in health in England with the life expectancy at birth gap between the most and deprived neighbourhoods standing at over 17 years for men and 11 years for women. In this study, we provide the first detailed empirical examination of this geographical health divide by: estimating the gap in physical and general health (as measured by EQ. 5D, EQ. 5D-VAS and SF8PCS) between the most and least deprived areas; using a novel statistical technique to examining the causal role of compositional and contextual factors and their interaction; and doing so in a time of economic recession and austerity. Using a stratified random sampling technique, individual-level survey data was combined with secondary data sources and analysed using multi-level models with 95% confidence intervals obtained from nonparametric bootstrapping. The main findings indicate that there is a significant gap in health between the two areas, and that compositional level material factors, contextual factors and their interaction appear to be the major explanations of this gap. Contrary to the dominant policy discourse in this area, individual behavioural and psychosocial factors did not make a significant contribution towards explaining health inequalities in the study area. The findings are discussed in relation to geographical theories of health inequalities and the context of austerity.

"How the other half live": Lay perspectives on health inequalities in an age of austerity

This paper examines how people living in two socially contrasting areas of Stockton on Tees, North East England experience, explain, and understand the stark health inequalities in their town. Participants displayed opinions that fluctuated between a variety of converging and contrasting explanations. Three years of ethnographic observation in both areas (2014-2017) generated explanations which initially focused closely on behavioural and individualised factors, whilst 118 qualitative interviews subsequently revealed more nuanced justifications, which prioritised more structural, material and psychosocial influences. Findings indicate that inequalities in healthcare, including access, the importance of judgemental attitudes, and perceived place stigma, would then be offered as explanations for the stark gap in spatial inequalities in the area. Notions of fatalism, linked to (a lack of) choice, control, and fear of the future, were common reasons given for inequalities across all participants. We conclude by arguing for a prioritisation of listening to, and working to understand, the experiences of communities experiencing the brunt of health inequalities; especially important at a time of austerity.

Consequences of removing cheap, super-strength beer and cider: a qualitative study of a UK local alcohol availability intervention

OBJECTIVES

Increasingly, English local authorities have encouraged the implementation of an intervention called 'Reducing the Strength' (RtS) whereby off-licences voluntarily stop selling inexpensive 'super-strength' (≥6.5% alcohol by volume (ABV)) beers and ciders. We conceptualised RtS as an event within a complex system in order to identify pathways by which the intervention may lead to intended and unintended consequences.

DESIGN

A qualitative study including a focus group and semistructured interviews.

SETTING

An inner-London local authority characterised by a high degree of residential mobility, high levels of social inequality and a large homeless population. Intervention piloted in three areas known for street drinking with a high alcohol outlet density.

PARTICIPANTS

Alcohol service professionals, homeless hostel employees, street-based services managers and hostel dwelling homeless alcohol consumers (n=30).

RESULTS

Participants describe a range of potential substitution behaviours to circumvent alcohol availability restrictions including consuming different drinks, finding alternative shops, using drugs or committing crimes to purchase more expensive drinks. Service providers suggested the intervention delivered in this local authority missed opportunities to encourage engagement between the council, alcohol services, homeless hostels and off-licence stores. Some participants believed small-scale interventions such as RtS may facilitate new forms of engagement between public and private sector interests and contribute to long-term cultural changes around drinking, although they may also entrench the view that 'problem drinking' only occurs in certain population groups.

CONCLUSIONS

RtS may have limited individual-level health impacts if the target populations remain willing and able to consume alternative means of intoxication as a substitute for super-strength products. However, RtS may also lead to wider system changes not directly related to the consumption of super-strengths and their assumed harms.

Healthy Migrants in an Unhealthy City? The Effects of Time on the Health of Migrants Living in Deprived Areas of Glasgow

This paper examines the healthy immigrant effect in Glasgow, a post-industrial city where the migrant population has more than doubled in the last decade. Using data from a community survey in 15 communities across the city, the paper compares four health outcomes for the following three groups: British-born, social and economic migrants and asylum seekers and refugees. Migrants were found to be healthier than the indigenous population on all four measures, particularly in the case of adult households in both migrant groups and for older asylum seeker and refugee households. Health declines for social and economic migrants with time spent in the UK, but there is no clear pattern for asylum seekers and refugees. Health declined for refugees according to time spent awaiting a decision, whilst their health improved after a leave-to-remain decision. Indigenous and social and economic migrant health declines with time spent living in a deprived area; this was true for three health indicators for the former and two indicators for the latter. Asylum seekers and refugees who had lived in a deprived area for more than a year had slightly better self-rated health and well-being than recent arrivals. The study's findings highlight the role of destination city and neighbourhood in the health immigrant effect, raise concerns about the restrictions placed upon asylum seekers and the uncertainty afforded to refugees and suggest that spatial concentration may have advantages for asylum seekers and refugees.