Chapter 15 Health promotion in neighbourhoods

Overview

As we have seen in other chapters in this part, healthy settings are physical and social settings, which serve as supportive environments for health and health promotion activities. This chapter examines the concept of neighbourhood and how different factors – physical, social and economic – contribute to the concept. The linked concept of social capital to describe neighbourly relationships and networks is explored. The popularity of neighbourhood in different policy and practice arenas in recent years, and the usefulness of the neighbourhood as a setting for health promotion, are discussed. Neighbourhoods include different levels or structures such as the neighbourhood environment, services and people, which may all be used as a springboard for health promotion. Examples of various initiatives which focus on the neighbourhood setting are given as examples of good practice. Evaluating such a multidimensional strategy poses many challenges, and issues regarding the evaluation and evidence base for neighbourhood health promotion are discussed.

Healthy Cities are arguably the best known and largest of the settings approaches. The programme is a long-term international development initiative that aims to place health high on the agendas of decision-makers and to promote comprehensive local strategies for health improvement and sustainable development. The Healthy Villages programme addresses similar directives as the Healthy Cities programme in rural areas. Health is again defined by the area’s residents; however, the generally accepted definition of a healthy village includes a community with low rates of infectious diseases, access to basic health care services, and a stable, peaceful social environment (see http://www.who.int/healthy_settings/types/en/index.html). In addition, the holistic and multifaceted linking of activities that characterizes the settings approach is used in schools, workplaces, hospitals (discussed in other chapters in this part) and also universities, markets, islands and homes. The neighbourhood provides a link between these and the other settings explored in this part. Neighbourhoods have been identified as important settings for health promotion in a number of English policy documents.

The environment we live in, our social networks, our sense of security, socio-economic circumstances, families and resources in our local neighbourhood can affect individual health

(Department of Health 2004, p. 77).

BOX 15.1

The terms neighbourhood and community are frequently used. Are they the same thing?

Defining neighbourhoods

BOX 15.2

• How would you define your neighbourhood?

• In what ways does your neighbourhood support health?

• In what ways does it compromise health?

Neighbourhoods are defined as small localities with a distinct identity forged by a community of people who know each other and the provision of essential services such as post offices, shops and health centres. Lay networks and support systems are an important element. Neighbourhoods will often be bounded by geographical features such as major roads, railways or green areas and may be urban or rural. The key factor is that residents define their local neighbourhood themselves and feel they have an investment in its future, the services provided and its appearance. In the modern world where transactions are increasingly fragmented and anonymous, and where the overarching symbols of community, such as religion and nationhood, are less cohesive and meaningful, the role of the neighbourhood in promoting identity and self-esteem is more important. Neighbourhoods provide the immediate environment where people live, work and play, and for many more vulnerable groups, such as older people and those on low income, most of their lives are lived in one neighbourhood.

A recent research study (Robertson et al 2008) found that neighbourhood identity is established at an early stage in each neighbourhood’s history and is resilient to change. Neighbourhood identity is largely based on residents’ social class and status, which in turn is often based on men’s employment patterns, as well as physical characteristics such as housing. Neighbourhoods are often internally differentiated and the sense of community is based on everyday social interactions and networks of friends, families and neighbours. Neighbourhoods therefore combine objective and subjective components.

There are many ways to get to know neighbourhoods, ranging from the objective gathering of statistics to the subjective collection of people’s thoughts, feelings and memories. Local statistics on topics such as housing and crime are collected (see www.statistics.gov.uk) and can be used to compare different neighbourhoods. Community profiles or observation walks, where notes are taken of local facilities, the physical environment, transport routes and social networking opportunities, provide a more holistic picture of neighbourhoods.

Why neighbourhoods are a key setting for health promotion

BOX 15.3

The public health White Paper Choosing Health: Making Healthy Choices Easier (Department of Health 2004) dedicates a chapter to communities (focusing on neighbourhoods) and makes a commitment to working through local communities to reduce inequalities in health. Why might neighbourhoods be identified as a key route through which to tackle health inequalities?

Neighbourhoods are a key setting for health promotion because they provide the infrastructure for health. Neighbourhoods are where the physical and social environments interact with service provision to provide an overall environment which has enormous potential to support people’s health. Neighbourhoods include:

• The physical environment, e.g. the degree of air and noise pollution, quality of housing, amount of traffic and the availability of green space

• The social environment – the amount of social interaction between residents, the number of community or voluntary groups or organizations operating in the area and the extent of mutual self-help activities. The concept of social capital, which refers to relationships of trust and regard between people, and organizations they have contact with, is relevant to both the social environment and services provided

• Services provided in neighbourhoods include places such as shops, post offices, health services, places of worship, sports facilities, community halls, transport systems or outreach workers from statutory agencies, e.g. housing and welfare officers’ weekly sessions held in the community hall.

Identifying what exactly it is about neighbourhoods that has an impact on well-being is difficult. Research suggests that people value neighbourhoods for their effect on quality of life, reflected through aspects such as friendliness, safety and quiet (Bowling et al 2006; Office of National Statistics 2007). In addition to providing the context for health, neighbourhoods are a popular setting because they are seen as a means to engage people in addressing their own health needs. A neighbourhood focus therefore fosters empowerment and independence, which are themselves health-promoting.

BOX 15.4