title: Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities.
abstract: Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.
authors.affiliation: Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: Matt.Egan@lshtm.ac.uk.
authors.forename: Matt
authors.initials: M
authors.lastname: Egan
authors.affiliation: Urban Studies, University of Glasgow, Glasgow, UK. Electronic address: Ade.Kearns@glasgow.ac.uk.
authors.forename: Ade
authors.initials: A
authors.lastname: Kearns
authors.affiliation: Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. Electronic address: Vittal.Katikireddi@glasgow.ac.uk.
authors.forename: Srinivasa V
authors.initials: SV
authors.lastname: Katikireddi
authors.affiliation: Urban Studies, University of Glasgow, Glasgow, UK. Electronic address: Angela.Curl@glasgow.ac.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Curl
authors.affiliation: College of Public Health, Medical & Vet Sciences, James Cook University, Queensland, Australia. Electronic address: Kenny.Lawson@ac.edu.au.
authors.forename: Kenny
authors.initials: K
authors.lastname: Lawson
authors.affiliation: Glasgow Centre for Population Health, Glasgow, UK. Electronic address: carol.tannahill@glasgow.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Tannahill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012606:Scotland; D006113:United Kingdom; D014506:Urban Renewal / Q000191:economics; D035862:Vulnerable Populations; D055815:Young Adult
keywords: Health inequalities; Natural experiment; Neighbourhood renewal; Proportionate universalism; UK