Edinburgh Napier University

  Background: Ecological public health encompasses the complex relationship between environment and health - protecting the physical environment and its inhabitants from contamination, building health-promoting and nurturing environments that foster social capital, wellbeing, resilience and health equity, sustainability of communities and protection of the planet. Findings from previous research suggest an association between spatial patterning and health outcomes (Hagedoorn et al. 2016; Meijer et al. 2012; Pritchard and Evans 1997; Tunstall et al. 2012). It remains unclear whether this is a result of concentration of risk within the built environment and/or socio-environmental relations within and across communities. The purpose of this paper is to build on Curtis (2004) conceptual framework for socially unequal environmental risk by proposing a new way to challenge health inequalities through an exploration of socio-environmental relations.
Methods: Even though there is a plethora of research investigating health inequalities and place, there is a lack of research focusing on socio-environmental relations from a public health perspective. Situated within the context of community, we define socio-environmental relations as the interaction between socio-environmental determinants and the values, attitudes and behaviours of residents (our spatial and social neighbours). Drawing on the work of Fitzpatrick and LaGory (2003) and environmental justice scholarship, we propose further examination of spatial patterning and health outcomes within the context of Scotland and the need for further exploration into how socio-environmental relations influence these outcomes. The most densely populated area of Scotland is situated in Greater Leith, Edinburgh (12,900 per km2) ranking highly in some domains of the Scottish Index of Multiple Deprivation (2015). However, it is not known whether there is a relationship between these two factors (population density and health status), nor whether population density impacts on resident concerns about health differences and support for health policy interventions. It will be necessary to conduct a geo-spatial analysis within Edinburgh and a sociological analysis at community level to answer these questions.
Discussion: If health outcomes are associated with population density then further exploration will be required to address health inequalities. Pursuing environmental justice implies gaining recognition of worth from neighbouring communities (Honneth 1992). However, it is also important to examine recognition of worth within discrete neighbourhoods. Does spatial patterning impact upon intra-community attitudes? We could begin by exploring political and moral dimensions of place such as mutuality and equality at community level. Previous research has linked living in denser neighbourhoods to increased support for distribution of wealth by less altruistic individuals or those on higher incomes (Bailey et al. 2013). Are there psychological gaps between spatial and social neighbours impeding or exacerbating health inequalities? Attitudes towards income inequality may mirror or reflect attitudes towards health inequalities. It will be necessary to question whether spatial characteristics of a neighbourhood influence the attitudes of residents towards neighbourhood health and whether attitudes towards health inequalities and the right to health might be influenced by “place”. Such an exploration of health inequalities will require the inclusion of residents from across the socio-economic spectrum.
Conclusion: Further investigation is required to determine the impact of population density on local area health. In order to tackle health inequalities, the built environment, as a determinate of urban health, requires further examination. It is not only important to examine the social and spatial distribution of key aspects of environmental quality but to explore socio-environmental relations within these neighbourhoods where beliefs and interests are embedded. Even though a “rights-based” approach to community health remains a contentious issue, fundamental questions arise regarding if, and how, individual attitudes to health are influenced by the spatial characteristics of their neighbourhood. If residents’ health and attitudes are influenced by spatial patterning and spatial relationships, these relationships could perpetuate and support health equalities within the urban environment. Opportunities exist for inter-disciplinary researchers from Urban Studies, the Built Environment, and Public Health to explore socio-environmental relations traversing population density, health status, socio-economic position and community attitudes towards health and social inequalities. Further examination of the interplay between spatial and economic determinants is required to illuminate mechanisms and dynamics that contribute to socio-environmental relations and consequently on attitudes towards health entitlement and gradients of health within one geographical area.