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Deprivation amplification revisited; or, is it always true that poorer places have poorer access to resources for healthy diets and physical activity?

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The International Journal of Behavioral Nutrition and Physical Activity

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      It has commonly been suggested (including by this author) that individual or household deprivation (for example, low income) is amplified by area level deprivation (for example, lack of affordable nutritious food or facilities for physical activity in the neighbourhood).


      The idea of deprivation amplification has some intuitive attractiveness and helps divert attention away from purely individual determinants of diet and physical activity, and towards health promoting or health damaging features of the physical and social environment. Such environmental features may be modifiable, and environmental changes may help promote healthier behaviors. However, recent empirical examination of the distribution of facilities and resources shows that location does not always disadvantage poorer neighbourhoods. This suggests that we need: a) to ensure that theories and policies are based on up-to-date empirical evidence on the socio-economic distribution of neighbourhood resources, and b) to engage in further research on the relative importance of, and interactions between, individual and environmental factors in shaping behavior.


      In this debate paper I suggest that it may not always be true that poorer neighbourhoods are more likely to lack health promoting resources, and to be exposed to more health damaging resources. The spatial distribution of environmental resources by area socioeconomic status may vary between types of resource, countries, and time periods. It may also be that the presence or absence of resources is less important than their quality, their social meaning, or local perceptions of their accessibility and relevance.

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        Place effects on health: how can we conceptualise, operationalise and measure them?

        In this paper we highlight what we consider to be a lack of adequate conceptualisation. operationalisation and measurement of "place effects". We briefly review recent historical trends in the study of the effects of place on health in industrial countries, and argue that "place effects" often appear to have the status of a residual category, an unspecified black box of somewhat mystical influences on health which remain after investigators have controlled for a range of individual and place characteristics. We note that the distinction between "composition" and "context" may be more apparent than real, and that features of both material infrastructure and collective social functioning may influence health. We suggest using a framework of universal human needs as a basis for thinking about how places may influence health, and recommend the testing of hypotheses about specific chains of causation that might link place of residence with health outcomes.
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          Investigating neighborhood and area effects on health.

          The past few years have witnessed an explosion of interest in neighborhood or area effects on health. Several types of empiric studies have been used to examine possible area or neighborhood effects, including ecologic studies relating area characteristics to morbidity and mortality rates, contextual and multilevel analyses relating area socioeconomic context to health outcomes, and studies comparing small numbers of well-defined neighborhoods. Strengthening inferences regarding the presence and magnitude of neighborhood effects will require addressing a series of conceptual and methodological issues. Many of these issues relate to the need to develop theory and specific hypotheses on the processes through which neighborhood and individual factors may jointly influence specific health outcomes. Important challenges include defining neighborhoods or relevant geographic areas, identifying significant area or neighborhood characteristics, specifying the role of individual-level variables, incorporating life-course and longitudinal dimensions, combining a variety of research designs, and avoiding reductionism in the way in which "neighborhood" factors are incorporated into models of disease causation and quantitative analyses.analyses.

            Author and article information

            [1 ]MRC Social and Public Health Sciences Unit, Glasgow, G12 8RZ, UK
            Int J Behav Nutr Phys Act
            The International Journal of Behavioral Nutrition and Physical Activity
            BioMed Central (London )
            7 August 2007
            : 4
            : 32
            Copyright © 2007 Macintyre; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


            Nutrition & Dietetics


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