Neighborhood Environments and Socioeconomic Inequalities in Mental Well-Being.
BACKGROUND
It has been suggested that socioeconomic inequalities in health might be reduced among populations with good access to green space. However, the potential for other neighborhood characteristics to reduce socioeconomic health inequalities, or to confound the effects of green space, has not been well explored. Therefore, this study investigates which, if any, neighborhood characteristics are associated with narrower socioeconomic inequalities in mental well-being in a large, international sample of urban residents.


METHODS
The 2012 European Quality of Life Survey provided data on 21,294 urban residents from 34 European nations. Associations between mental well-being (captured by the WHO-5 scale) and level of financial strain were assessed for interaction with five different neighborhood characteristics, including reported access to recreational/green areas, financial services, transport, and cultural facilities. Multilevel regression models allowed for clustering of individuals within region and country in this cross-sectional, observational study. Data were analyzed in 2014.


RESULTS
Socioeconomic inequality in mental well-being was 40% (8.1 WHO-5 points) narrower among respondents reporting good access to green/recreational areas, compared with those with poorer access. None of the other neighborhood characteristics or services were associated with narrower inequality.


CONCLUSIONS
If societies cannot, or will not, narrow socioeconomic inequality, research should explore the so-called equigenic environments-those that can disrupt the usual conversion of socioeconomic inequality to health inequality. This large, international, observational study suggests that access to recreational/green areas may offer such a disruption.
Centre for Research on Environment, Society and Health, University of Glasgow, Glasgow. Electronic address: richard.mitchell@glasgow.ac.uk.
Richard J
RJ
Mitchell
Centre for Research on Environment, Society and Health, University of Edinburgh, Edinburgh, United Kingdom.
Elizabeth A
EA
Richardson
Centre for Research on Environment, Society and Health, University of Edinburgh, Edinburgh, United Kingdom.
Niamh K
NK
Shortt
Centre for Research on Environment, Society and Health, University of Edinburgh, Edinburgh, United Kingdom.
Jamie R
JR
Pearce
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004777:Environment; D005060:Europe; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011788:Quality of Life; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D055815:Young Adult