title: Grim up North or Northern grit? Recessions and the English spatial health divide (1991-2010).
abstract: BACKGROUND
  Previous research suggests that the health effects of recessions are mixed and vary spatially between countries. Using the North-South English health divide as an example, this paper examines whether there are also spatial variations within countries.
  
  
  METHODS
  Cross-sectional data on self-reported 'not good health' was obtained from the British Household Panel Survey and the Health Survey for England from 1991 to 2010. Age-adjusted generalized linear models were used to examine the effects of recessions (1990/91 and 2008/09) on self-reported health in the four English NHS Commissioning Regions (North, South, Midlands and London) with stratification by gender.
  
  
  RESULTS
  Over the 20-year study period, the North had consistently higher rates of 'not good health' than the South [OR 1.50 (1.46-1.55) outside recessions and OR 1.29 (1.19-1.39) during recessions]. However, during periods of recession, this health divide narrowed slightly with a 2% decrease in the prevalence of 'not good health' in the North [OR 0.91 (0.86, 0.96)].
  
  
  CONCLUSIONS
  This study is evidence of spatial variations in the health effects of recessions within England and the North-South divide appears to slightly reduce during recessions. Health in the North remains worse than the South.
authors.affiliation: Department of Geography, Durham University, Durham, UK Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Copeland
authors.affiliation: Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK.
authors.forename: Adetayo
authors.initials: A
authors.lastname: Kasim
authors.affiliation: Department of Geography, Durham University, Durham, UK Wolfson Research Institute for Health and Wellbeing, Durham University, Durham, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Bambra
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057172:Economic Recession / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: North South divide; economics; public health; recessions; social determinants