Do attitude and area influence health? A multilevel approach to health inequalities.

This paper demonstrates an area effect on health and suggests improvements in research practice for work in this field. We use an area classification which can be related clearly to factors that influence the health of individuals and take account of people's differing propensities to draw influence from their area. Multilevel analysis demonstrates that the degree of deindustrialisation which an area experienced in Britain, in the 1980s, has an independent association with the health of resident individuals. A significant relationship between a person's attitude to their community and their health is shown to be independent of individual and area characteristics. We conclude that both individual and area characteristics influence health.

[1]  D. Massey,et al.  The Economy in Question , 1989 .

[2]  S. Macintyre,et al.  Area, Class and Health: Should we be Focusing on Places or People? , 1993, Journal of Social Policy.

[3]  H. Goldstein Multilevel Statistical Models , 2006 .

[4]  K. Jones,et al.  Analyzing perceived limiting long-term illness using U.K. Census Microdata. , 1996, Social science & medicine.

[5]  S. Curtis,et al.  Is There a Place for Geography in the Analysis of Health Inequality , 1998 .

[6]  I. Kawachi,et al.  Socioeconomic determinants of health : Health and social cohesion: why care about income inequality? , 1997 .

[7]  S. Fothergill,et al.  Labour Market Adjustment in Areas of Chronic Industrial Decline: The Case of the UK Coalfields , 1996 .

[8]  R. Wiggins,et al.  LIMITING LONG TERM ILLNESS: A QUESTION OF WHERE YOU LIVE OR WHO YOU ARE? A MULTILEVEL ANALYSIS OF THE 1971-1991 ONS LONGITUDINAL STUDY , 1998 .

[9]  A. Townsend,et al.  Contemporary Britain: A Geographical Perspective , 1991 .

[10]  M. Blaxter Health and lifestyles , 1990 .

[11]  K. Hunt,et al.  Gender differences in health: are things really as simple as they seem? , 1996, Social science & medicine.

[12]  D. Blane,et al.  Illness Behaviour and the Measurement of Class Differentials in Morbidity , 1996 .

[13]  L. Yen,et al.  Health action zones , 1998, IHRIM : the journal of the Institute of Health Record Information and Management.

[14]  R. Ecob,et al.  People, places and coronary heart disease risk factors: a multilevel analysis of the Scottish Heart Health Study archive. , 1997, Social science & medicine.

[15]  Peter Congdon,et al.  Modelling inequality in reported long term illness in the UK: combining individual and area characteristics. , 1996, Journal of Epidemiology and Community Health.

[16]  D. Cook,et al.  SOCIAL CLASS DIFFERENCES IN ISCHAEMIC HEART DISEASE IN BRITISH MEN , 1987, The Lancet.

[17]  J. Snow On the Mode of Communication of Cholera , 1856, Edinburgh medical journal.

[18]  J. Popay,et al.  Domestic conditions, paid employment and women's experience of ill‐health , 1992 .

[19]  P. Townsend,et al.  Widening inequality of health in northern England, 1981-91 , 1994, BMJ.

[20]  M. Marmot,et al.  Psychosocial Work Characteristics and Social Support as Predictors of SF-36 Health Functioning: The Whitehall II Study , 1998, Psychosomatic medicine.

[21]  P. Bourdieu La misère du monde , 1993 .

[22]  M. Haan,et al.  Poverty and health: Prospective evidence for the Alameda County Study , 1987 .

[23]  M. Kelly,et al.  Social capital and health , 1999 .

[24]  H. Joshi,et al.  Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study. , 1998, Journal of epidemiology and community health.

[25]  C Duncan,et al.  Health-related behaviour in context: a multilevel modelling approach. , 1996, Social science & medicine.

[26]  I. Kawachi,et al.  Social capital, income inequality, and mortality. , 1997, American journal of public health.

[27]  Peter Congdon,et al.  A multi-level perspective on small-area health and mortality: a case study of England and Wales. , 1997, International journal of population geography : IJPG.

[28]  I. Kawachi,et al.  Social capital: a guide to its measurement. , 1999, Health & place.

[29]  H. Joshi,et al.  Higher mortality in deprived areas: community or personal disadvantage? , 1994, BMJ.

[30]  G. Moon,et al.  Psychiatric morbidity: a multilevel approach to regional variations in the UK. , 1995, Journal of epidemiology and community health.

[31]  A. Ellaway,et al.  Does where you live predict health related behaviours?: a case study in Glasgow. , 1996, Health bulletin.

[32]  Hugh Davies,et al.  Is it Cash that the Deprived are Short of? , 1997 .

[33]  M. Bartley Unemployment and ill health: understanding the relationship. , 1994, Journal of epidemiology and community health.

[34]  P. West Health inequalities in the early years: is there equalisation in youth? , 1997, Social science & medicine.

[35]  C. Emslie,et al.  Problematizing gender, work and health: the relationship between gender, occupational grade, working conditions and minor morbidity in full-time bank employees. , 1999, Social science & medicine.