Perceived pathways between tourism gentrification and health: A participatory Photovoice study in the Gòtic neighborhood in Barcelona

Using Qualitative Methods to Understand the Interconnections Between Cities and Health: A Methodological Review

Objective: Using different perspectives and methods to investigate the links between the urban phenomenon and health is critical in an urbanizing world. This review discusses qualitative methods in the context of urban health research. Methods: We conducted a narrative review following these steps: We identified the qualitative data collection, analysis and sampling methods that could be more relevant for the problems researched in the urban health field. We conducted searches for methodological articles and other documents about those methods. We included some influential materials and examples of empirical urban health studies using those methods. Results: We included 88 studies and identified several qualitative data gathering, analysis and sampling methods relevant for urban health researchers. We present those methods, focusing their strengths and limitations, and providing examples of their use in the field of urban health. These methods are flexible and allow in-depth analysis of small samples by collecting and analyzing rich and nuanced data. Conclusion: This article should contribute to a better understanding of how, and when, qualitative methods may improve our knowledge on urban health.

A double-edged sword: Residents' views on the health consequences of gentrification in Porto, Portugal

Gentrification is currently shaping the urban environment in important ways. It also contributes to shaping the health of the inhabitants of gentrifying cities, although it is still unclear how. Gentrification processes are often linked to different drivers and have specific local translations, further complicating the study of the relationship between gentrification and health. We investigated this relationship in Porto, Portugal, a southern European city undergoing rampant transnational gentrification. In order to study how gentrification impacts health from the point of view of that city's residents, we conducted a study using photovoice with a sample of participants recruited from a population-based cohort, which was divided into three different groups: one from gentrifying areas of Porto, another from deprived non-gentrifying areas, and the other from affluent areas. The thematic analysis of data generated six themes, each referring to a change, or a set of connected changes, related to gentrification: increasing floating population, lack of housing access and displacement, construction and rehabilitation, changing local commerce, loss of place, and broader socioeconomic change. According to the accounts from participants, these changes affect health in different ways, both beneficial and harmful. Participants also reflected on how to act on this issue. This research adds to the knowledge about the relationship between gentrification and health by providing detailed and nuanced views about this relationship considering its city-wide impacts.

"The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area

While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.

Colombian Adolescents’ Perceptions of Violence and Opportunities for Safe Spaces Across Community Settings

During adolescence, access to safe environments is critical for healthy development. This study analyzed adolescents’ perceptions of safety in personal and public spaces in the semi-rural community of Santa Ana, Colombia on the Island of Barú (95.8% of inhabitants live in poverty). We used thematic analysis to explore adolescents’ experiences and reflections to identify the factors influencing their perception of safety across different community spaces. Four gender-segregated focus group discussions were held with 40 adolescents (20 male and 20 female) from ages 13 to 17 ( M = 14.4, SD = 1.2). Most of them self-identified as Black (86%). The more recurrent spaces in the adolescents’ conversations were the streets, the school, the local sports field, individual homes, and commercial sound system parties known as “Picos.” Adolescents perceived the school as the safest space, while the “Picos” were the most unsafe. The other spaces were considered mixed, meaning that their perceived safety shifts and depends on the presence of certain factors. These factors were risky behaviors, group affiliation, designated authority roles and the relevance of time. The authors discuss the importance of addressing the factors that inform adolescents’ safety perception, particularly within low resource settings cross-culturally.

Title: advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda

Background

Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader, dynamic context in which individuals live and in which health care systems function.

Purpose

The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-profit care, and the closure of less profitable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term “health care gentrification.“ In this commentary, we frame access to health care in the United States in the context of neighborhood gentrification and a concurrent process of changes to the health care system itself.

Conclusions

We describe the concept of health care gentrification, and the complex ways in which both neighborhood gentrification and health care gentrification may lead to inequitable access to health care. We then present a framework for understanding health care gentrification as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more effectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the effects of health care gentrification in the United States.

Fractured lives in fractured cities: Towards a critical understanding of urban violence in the context of market-driven urban restructuring processes in Bogotá and Rio de Janeiro

Based on a comparative case study on two neighborhoods in Bogota and Rio de Janeiro (2017-2019) and a comprehensive literature review, this article proposes a critical Public Health approach to urban violence and makes a case for understanding the phenomenon in the context of market-driven urban territorial restructuring processes that assume specific qualities in cities of the Global South. The case studies are based on focus groups and semi-structured interviews with residents, specialists and community leaders. It is argued that urban violence is a key public health challenge, particularly in Latin America, given its dimensions and its impact on the populations' life and health. In this regard it configures "fractured lives" in what urban scholars have termed "fractured cities" - essentially unequal and polarized cities that are not merely sites of urban violence but, as we argue in this article, fundamentally shape urban violence, its qualities, dynamics and dimensions. The study is informed by a unique theoretical articulation between Latin American Social Medicine and Collective Health, critical (Latin American) geographical theory and authoritarian neoliberalism literature and shows how urban violence is directly implied in the territorial making and un-making of the cities, driven by commodification as well as both legal and illegal capitalist market logics, that include but are not limited to drug trade. The cases reflect the violence implied in permanent threats of eviction and displacement, "necropolitical" police/military interventions and what is described as a silent imposition of a "slow death" on infrastructure, the neighborhood and ultimately also its residents, which "fracture" the lives of significant parts of the urban population, produce "ill-being" and bring about health consequences that are rarely considered in relation to urban violence.

The Impacts of Tourism Stays on Residents’ Self-Reported Health: A Pan-European Analysis on the Role of Age and Urbanization Level

Understanding the impacts of tourism on the quality of life of residents is a priority for the sustainable tourism agenda, and is especially relevant to the COVID-19 recovery period. However, the evidence is poor, and it is not clear whether the outcomes vary among sociodemographic groups. This study fills this gap by proposing a pan-European analysis of the effects of tourism stays per 1000 residents (as a measure of tourism pressure) on self-perceived health at a regional level, based on data from Eurostat, the EU-SILC (European Union Statistics on Income and Living Conditions survey), and the LFS (Labor Force Survey). Multilevel models with random effects were used, including three levels: region, time, and region–time. Results show that tourism pressure may benefit self-reported health but only among residents aged over 50 years old living in rural contexts, or over 65 living in low density urban areas. As for younger groups (under 50) living in high density cities, tourism is longitudinally associated with worsened self-reported health. These results, which are supported by instrumental-variable estimations, suggest that urban residents and younger groups do not benefit from tourism. This might be due to a number of side effects related to increased living costs, precarious labour, and conflicts related to public space. Therefore, our findings challenge the narrative that urban tourism universally improves residents’ quality of life. Considering the global urgency of creating healthier and more equitable post-COVID-19 cities and societies, tourism should be considered together with health and equity dimensions.

Gentrification pathways and their health impacts on historically marginalized residents in Europe and North America: Global qualitative evidence from 14 cities

As global cities grapple with the increasing challenge of gentrification and displacement, research in public health and urban geography has presented growing evidence about the negative impacts of those unequal urban changes on the health of historically marginalized groups. Yet, to date comprehensive research about the variety of health impacts and their pathways beyond single case sites and through an international comparative approach of different gentrification drivers and manifestations remains scarce. In this paper, we analyze qualitative data on the pathways by which gentrification impacts the health of historically marginalized residents in 14 cities in Europe and North America. We build on 77 interviews with key neighborhood stakeholders. Data analysis indicates four main concurrent processes: Threats to housing and financial security; Socio-cultural displacement; Loss of services and amenities through institutional gentrification; and Increased risks of criminal behavior and compromised public safety. Gentrification is experienced as a chain of physical and emotional community and individual traumas - an overall shock for historically marginalized groups - because of permanent pressures of insecurity, loss, state of displaceability, and the associated exacerbation of socio-environmental disadvantages.

Confined Students: A Visual-Emotional Analysis of Study and Rest Spaces in the Homes

Confinement was adopted globally as a containment measure to face the COVID pandemic declared by WHO on March 2020. In Spain, the State of Alarm was established for three months. This implied the interruption of educational activities, having a higher incidence for children, since teaching would not be resumed until the following academic year, in September. This, together with the confusing initial information about COVID-19 transmission between children and their families, has made them one of the groups most vulnerable. In this study, a qualitative approach is made to secondary school students (aged 12). They were asked to share their experiences about confinement from the perspective of the home spaces, in relation to two main tasks relevant in this period: the tele-study and their relaxing time and well-being. Using images and narratives with an abstract and emotional description, the response of 46 children was obtained. A sentiment analysis was carried out from their testimonies. Results suggest a greater availability of tele-study spaces with daylighting, mainly in bedrooms, with laptops. For leisure and rest spaces, sofas, beds, and cohabitant gathering were preferred. Written testimonials were mainly positive. Housing features and family cohesion condition their resilience in situations of uncertainty, like confinement.

Breaking Down and Building Up: Gentrification, Its drivers, and Urban Health Inequality

Purpose of Review

Many neighborhoods which have been unjustly impacted by histories of uneven urban development, resulting in socioeconomic and racial segregation, are now at risk for gentrification. As urban renewal projects lead to improvements in the long-neglected built environments of such neighborhoods, accompanying gentrification processes may lead to the displacement of or exclusion of underprivileged residents from benefiting from new amenities and improvements. In addition, gentrification processes may be instigated by various drivers. We aimed to discuss the implications of specific types of gentrification, by driver, for health equity.

Recent Findings

Several recent articles find differential effects of gentrification on the health of underprivileged residents of gentrifying neighborhoods compared to those with greater privilege (where sociodemographic dimensions such as race or socioeconomic status are used as a proxy for privilege). Generally, studies show that gentrification may be beneficial for the health of more privileged residents while harming or not benefiting the health of underprivileged residents. Very recent articles have begun to test hypothesized pathways by which urban renewal indicators, gentrification, and health equity are linked. Few public health articles to date are designed to detect distinct impacts of specific drivers of gentrification.

Summary

Using a case example, we hypothesize how distinct drivers of gentrification—specifically, retail gentrification, environmental gentrification, climate gentrification, studentification, tourism gentrification, and health care gentrification—may imply specific pathways toward reduced health equity. Finally, we discuss the challenges faced by researchers in assessing the health impacts of gentrification.

A Mixed Approach on Resilience of Spanish Dwellings and Households during COVID-19 Lockdown

The confinement by COVID-19 has meant a re-reading of housing for Spanish households, resulting in the only available and safe space to carry out daily activity. This complex phenomenon has generated a completely different way of inhabiting it, as well as of relating to domestic spaces. For this reason, the home perception and its characteristics must be evaluated, highlighting those perceived as deficiencies, or as preferences in such an unusual context as lockdown, where the experience was different depending on the dwelling characteristics, and the family in question. To deepen in this double perception home-dwelling, a mixed method was used, with two online forms. The first is a quantitative questionnaire, while the second asks the participants for photographs and narratives about such images. More than 1800 surveys and 785 qualitative responses were obtained. From both approaches, the joint discourse arose, allowing an exploratory analysis of the current situation of the Spanish residential park, and the resilience demonstrated in this period by both households and their usual dwellings. This study should facilitate the development of new proposals on housing in contexts similar to the COVID-19 pandemic.