Theoretical & methodological contributions to 'area and health' studies
Over the years we have contributed to academic and policy thinking about how one's area of residence might influence health and health related behaviours. We have argued that it is not enough to characterise areas as ‘socio-economically deprived', and that attention needs to be paid to features of areas (for example, resources and amenities) rather than just characteristics of the local population (for example their socio-economic status, as established from decennial censuses). We have suggested that researchers and policy makers need to think about what aspects of area of residence might influence what aspects of health (e.g. coronary heart disease or depression) or behaviour (e.g. diet or exercise) in which population groups (e.g. children, the elderly). We have proposed a way of thinking about how areas might influence health, based on a framework of human needs (what do people need in order to lead a healthy life, and how are these needs met by the local environment?).
We have also suggested that rather than avoiding taking an ecological approach to studying neighbourhoods, investigators should avoid taking too individualistic an approach, since features of neighbourhoods which might impact on health might be different from the sum of individual characteristics. We have shown that it is important to challenge, and empirically investigate, widespread assumptions about the distribution of resources (for example, that ‘food deserts', places where it is hard to buy nutritious and affordable food, are common and more often to be found in poor places). We have argued that how resources are distributed in places, and their impact on health, may be very dependent on the national or regional context; for example, supermarkets may be more concentrated in rich neighbourhoods in the USA, but in poor areas in the UK, and equitably distributed across areas in Australia.
Our main contribution to methods has been to explore how one can measure features of area, and at what spatial scale. We showed that on a national level it is difficult to obtain reliable data at the spatial scale one might consider appropriate (for example, amounts of litter, crime rates, policing, or religiosity at a neighbourhood level). For some potential environmental influences on health however, for example retail food stores or fast food outlets, it is more practicable to collect area level data for one city or region. We collected information about the location of 42 resources and amenities (for example, retail food stores, alcohol outlets, doctors' surgeries) in Glasgow City, and explored distribution by area deprivation. Findings showed that twelve resources had higher density in more deprived neighbourhoods (e.g. credit unions, bus stops, bingo halls, outdoor play areas etc), sixteen had higher density in more affluent neighbourhoods (e.g. private schools, railway stations, tennis courts, parks etc), and others had no clear pattern by deprivation (e.g. fire stations, public libraries, cafes etc). We have reviewed the importance of relational aspects of places. We explored the extent of agreement between self-reported and objective measures of the same variable (whether or not respondents lives within 0.5 miles of a public green open space), and if there was any socio-demographic variation. Findings showed that agreement was poor (62%, kappa 0.095), and was no higher than poor in any socio-demographic subgroup.
Cummins S, Macintyre S. Are secondary data sources on the neighbourhood food environment accurate? Case-study in Glasgow, UK. Preventive Medicine 2009;49:527-8pubmed open access
Macdonald L, Ellaway A, Macintyre S. The food retail environment and area deprivation in Glasgow City. International Journal of Behavioral Nutrition and Physical Activity 2009;6:52pubmed open access
Macintyre S, Macdonald L, Ellaway A. Lack of agreement between measured and self-reported distance from public green parks in Glasgow, Scotland. International Journal of Behavioral Nutrition and Physical Activity 2008;5:26pubmed open access
Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding and representing 'place' in health research: a relational approach. Social Science & Medicine 2007;65:1825-1838pubmed open access
Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation: substitution or concentration?. Appetite 2007;49:251-4pubmed open access
Macintyre S, Ellaway A, Cummins S. Place effects on health. In: Brown P, editor Perspectives in medical sociology. Fourth ed. Long Grove, Illinois: Waveland Press, 2007:125-137.
Macintyre S. Inequalities in health in Scotland: what are they and what can we do about them?. MRC/CSO Social and Public Health Sciences Unit Occasional Paper no. 17, Glasgow, 2007
Macintyre S. Deprivation amplification revisited: or, is it always true that poorer places have poorer access to resources for healthy diets and physical activity?. International Journal of Behavioral Nutrition and Physical Activity 2007;4:32pubmed open access
Cummins S, Macintyre S. Food environments and obesity: neighbourhood or nation?. International Journal of Epidemiology 2006;35:100-104.pubmed open access
Cummins S C, McKay L, Macintyre S. McDonald's restaurants and neighborhood deprivation in Scotland and England. American Journal of Preventive Medicine 2005;29:308-310pubmed open access
Cummins S, Macintyre S, Davidson S, Ellaway A. Measuring neighbourhood social and material context: generation and interpretation of ecological data from routine and non-routine sources. Health & Place 2005;11:249-260pubmed open access
Macintyre S, McKay L, Cummins S, Burns C. Out-of-home food outlets and area deprivation: case study in Glasgow, UK. International Journal of Behavioral Nutrition and Physical Activity 2005;2:16pubmed open access
Cummins S, Macintyre S. Food 'deserts': evidence and assumption in health policy making. BMJ 2002;325:436-438pubmed open access
Macintyre S, Ellaway A, Cummins S. Place effects on health: how can we conceptualise, operationalise and measure them?. Social Science & Medicine 2002;55:125-139pubmed
Cummins S, Macintyre S. The location of food stores in urban areas: a case study in Glasgow. British Food Journal 1999;101:545 - 553
Macintyre S, MacIver S, Sooman A. Area, class and health: should we be focusing on places or people?. Journal of Social Policy 1993;22:213-234open access