Neighbourhood context and its contribution to urban health inequalities

The neighbourhood environment in which people live has gained increasing attention in epidemiological research. This dissertation investigated relationships between contextual neighbourhood factors and individual health with a focus on the built environment and its contribution to health inequalities on the neighbourhood level. Furthermore, this dissertation developed new approaches and applied new statistical methods to analyse environmental inequalities in an urban context with a particular focus on public green space and its distribution by socioeconomic neighbourhood characteristics. Firstly, in a systematic review multilevel studies which considered both neighbourhood socioeconomic position (SEP) and objectively measured factors of the built environment were assessed in order to disentangle their independent and interactive effects on individual health outcomes and health behaviours. Secondly, two multilevel analyses of cross-sectional data in the city of Munich investigated whether neighbourhood SEP, public playground and park space, and parentally perceived environmental exposures were independently associated with overweight in preschool aged children while simultaneously considering individual child and family factors. Thirdly, two ecological neighbourhood studies in the city of Dortmund and Munich were conducted to assess whether air and noise pollution and public green space were disproportionately distributed by the degree of neighbourhood deprivation. The systematic review identified a great heterogeneity of definitions applied and metrics being used for measuring built and socioeconomic neighbourhood variables. Mostly mixed results across multilevel studies on how built and socioeconomic neighbourhood environments were associated with health and health-related behaviours were found. Furthermore, the review identified several interactions between contextual neighbourhood factors and individual factors, mostly concerning sex or individual SEP. The two multilevel studies showed that in the case of childhood overweight individual factors, such as parental education or parental overweight, were the most important determinants. However, perceived and objective built environmental factors additionally explained overweight variance between neighbourhoods. The two ecological case studies found out that deprived neighbourhoods were more exposed to air pollution and low public green space availability than more affluent neighbourhoods. This dissertation recommends that apart from individual determinants policies and interventions targeting health promotion should consider the neighbourhood environment additionally. Moreover, a socioeconomic unequal distribution of environmental burdens and resources may result in amplifications of health inequalities within cities. There is a need for further studies considering multiple neighbourhood dimensions in order to analyse interactive and mediating pathways between contextual factors and individual health. The development of new approaches and methods for analysing and assessing environmental health inequalities will contribute to the reconnection of urban planning and public health.