Academic journal article The Canadian Geographer

Health Hazards and Socio-Economic Status: A Neighbourhood Cohort Approach, Vancouver, 1976-2001

Academic journal article The Canadian Geographer

Health Hazards and Socio-Economic Status: A Neighbourhood Cohort Approach, Vancouver, 1976-2001

Article excerpt

Introduction

As students of health and health care, geographers have infused health research with a range of perspectives, approaches and techniques. An important contribution to the wider health community has been to shed light on the geographical patterning of disease, including the influence of place on health. The purpose of this paper is to lay the foundation for a long-term project concerned with the nature of places as evolving contexts of individual and population health.

A number of as yet disparate trends in social science health research lead us to consider the influence of neighbourhoods over health through time. First, the health inequalities literature features the role played by space and place in patterning and influencing health outcomes. Much of this work is at the neighbourhood scale, yet neighbourhoods have been used mainly to model health outcomes cross-sectionally, at single points in time. How do neighbourhoods themselves change in relative and absolute terms and how does their tracking present new research opportunities? Second, and related, is the emergent marriage of population and environmental health, two hitherto disparate literatures increasingly concerned with health and socio-economic inequalities. How do ambient health hazards and social stratification, separately and in combination, influence health? More generally, how do neighbourhood context and characteristics of residents interact to generate individual and community health outcomes? Focused on Vancouver, Canada, from 1976 to 2001, the objective is to develop a 'cohort' of neighbourhoods as the basis for a range of spatial epidemiologic study designs that incorporate explicitly the evolving spatial contexts of health.

Unlike other large cities, Vancouver's air quality record is very favourable: despite a 60 percent increase in total population and associated economic and transportation activities since 1976, all ambient criterion pollutants have steadily declined (GVRD 2003). It would seem Vancouver continues to earn its reputation as Canada's urban Eden (Wynn 1992). However, data from the regional air quality monitoring network--among the best the world over in terms of number and distribution of monitoring stations (Figure 1) and local studies underscore an emergent insight from air pollution epidemiology (Brauer et al. 2002; Henderson et al. 2004): that intra-urban variability in air pollution ranges as widely if not more so than between-city contrasts (Briggs et al. 1997; Brunekreef et al. 1997; Hoek et al. 2001; Brauer et al. 2003). Such variability within the region creates the potential for unequal exposures along neighbourhood socio-economic lines. How do these processes play out among Vancouver's neighbourhoods of affluence, despair and ethnocultural clustering?

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This project is built retrospectively from 1976 to 2001 by developing a geodatabase of neighbourhoods in the Vancouver CMA. These neighbourhoods will be followed prospectively with each census period (2006 onwards) in the future (Figure 1). A commensurate set of 195 census tracts, or neighbourhoods, are constructed from varying numbers of tracts in each of the six censuses over the study period. Our approach is to explore the relationships between ambient health hazards and socio-economic status (SES) as defining features of neighbourhoods. We focus on air pollution and a range of markers of socioeconomic status to highlight the neighbourhood-level processes that can generate health outcomes among their residents, as individuals and communities, and point the way forward for health studies.

Population and Environmental HealthGaps and Opportunities

Health inequalities

The literature on health inequalities grows out of foundational studies that demonstrated a correlation between health status and social structure. Among the most important, the 'Whitehall studies' of the British civil service (Marmot et al. …

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