Industrial restructuring and physical activity in England

In recent decades, the prevalence of physical activity has declined considerably in many high-income countries, and this has been linked to rising levels of obesity and several weight-related medical conditions such as coronary heart disease, diabetes and cancer. There is some evidence that areas experiencing the lowest levels of physical activity tend to be those which have undergone a particularly strong transition away from employment in physically demanding occupations. It is proposed that such processes of industrial restructuring may be causally linked to unexplained geographical variations in activity patterns. Although the socio-cultural correlates of activity behaviours have been well studied, none have explicitly attempted to identify components of industrial change that may impact physical activity. This thesis addresses the gap in knowledge surrounding the socio-cultural context of industrial restructuring by investigating where, how and why dimensions of industrial change may impact current levels of physical activity in England. The research applies a mixed methods approach using GIS techniques, multilevel modelling and qualitative research interviewing. Firstly, the current literature on socio-cultural correlates of health behaviours is reviewed to present a novel conceptual framework that hypothesises how processes between physical activity and industrial restructuring may be linked in context. Subsequently, measures of industrial restructuring as well as physical activity are developed to analyse spatial variations in activity patterns across England. The analyses focus on how employment decline in physically demanding occupations may affect current levels of physical activity across different activity domains and relevant macroeconomic time periods. Finally, this research aims to get an insight in the mechanisms underlying the relationship between physical activity and industrial restructuring. Results from this research showed geographical variations with distinctive urban-rural disparities in levels of predominantly recreational physical activity across England. Processes of industrial restructuring appeared to be associated with patterns of physical activity, although the nature of the association differed across areas, time periods and employment types. The results also highlighted the plausible impact of inherited cultures and regional identities on health-related behaviours. Socio-cultural factors relevant in the context of industrial restructuring are likely to provide valuable context in activityrelated research

"I used to be as fit as a linnet" - beliefs, attitudes, and environmental supportiveness for physical activity in former mining areas in the North-East of England.

Studies of geographical variations in physical activity behaviours have suggested that activity levels are particularly low in areas that have undergone employment loss associated with the decline of industry. This is of concern given that affected populations are already at risk of poor health. Applying focus group methodology amongst 19 participants in four groups, this study aims to unpack how broader societal and environmental changes associated with industrial decline affect beliefs and attitudes towards physical activity in ex-mining communities in the North-East of England. Identified core themes comprise the direct impact of deindustrialisation on social and physical environments. Based on our findings, we provide evidence for mechanisms that operate via loss of occupational physical activity as well as the progressive development of environments that are not fit to support population activity levels. Particularly important was the loss of recreational facilities, public green spaces and sports facilities that were owned and organised by the miners themselves with support from the mining companies. Attitudes and beliefs directly related to the areas' industrial past were also seen to be key. We suggest that the development of interventions considering the socio-cultural history and socio-economic reality of communities could be a promising route to encourage more active lifestyles in deprived areas with particularly low levels of physical activity.Esther Rindwas a doctoral candidate and funded by a joint MRC/ ESRC Interdisciplinary Studentship and a Scholarship from the School of Environmental Sciences, University of East Anglia. The work of Esther Rind and Andy Jones was supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Many thanks to the representatives of the Working Men's Club and Institute Union of the Durham Branch for their support, and we particularly thank all study participants for their warm welcome and contributions.This paper was originally published in Social Science & Medicine (Rind E, Jones A, Social Science & Medicine 126 (2015) 110-118, http://dx.doi.org/10.1016/j.socscimed.2014.12.002

Are income-related differences in active travel associated with physical environmental characteristics? A multi-level ecological approach

Background: Rates of active travel vary by socio-economic position, with higher rates generally observed among less affluent populations. Aspects of both social and built environments have been shown to affect active travel, but little research has explored the influence of physical environmental characteristics, and less has examined whether physical environment affects socio-economic inequality in active travel. This study explored income-related differences in active travel in relation to multiple physical environmental characteristics including air pollution, climate and levels of green space, in urban areas across England. We hypothesised that any gradient in the relationship between income and active travel would be least pronounced in the least physically environmentally-deprived areas where higher income populations may be more likely to choose active transport as a means of travel.<p></p> Methods: Adults aged 16+ living in urban areas (n = 20,146) were selected from the 2002 and 2003 waves of the UK National Travel Survey. The mode of all short non-recreational trips undertaken by the sample was identified (n = 205,673). Three-level binary logistic regression models were used to explore how associations between the trip being active (by bike/walking) and three income groups, varied by level of multiple physical environmental deprivation.<p></p> Results: Likelihood of making an active trip among the lowest income group appeared unaffected by physical environmental deprivation; 15.4% of their non-recreational trips were active in both the least and most environmentally-deprived areas. The income-related gradient in making active trips remained steep in the least environmentally-deprived areas because those in the highest income groups were markedly less likely to choose active travel when physical environment was ‘good’, compared to those on the lowest incomes (OR = 0.44, 95% CI = 0.22 to 0.89).<p></p> Conclusions: The socio-economic gradient in active travel seems independent of physical environmental characteristics. Whilst more affluent populations enjoy advantages on some health outcomes, they will still benefit from increasing their levels of physical activity through active travel. Benefits of active travel to the whole community would include reduced vehicle emissions, reduced carbon consumption, the preservation or enhancement of infrastructure and the presentation of a ‘normalised’ behaviour

Integrating environmental justice and socio-ecological models of health to understand population-level physical activity

The uneven geographical distribution of environmental pathogens and salutogens, as well as the political, social, and cultural antecedents leading to this sociospatial arrangement, have been posited as a partial explanation for the stark inequalities in health across many high-income nations. Whilst there is significant international evidence for the maldistribution of health-related environmental features, few studies have examined the material outcomes (including health) of this unequal environmental ‘exposure’. In this paper we utilise the theoretical stances offered by work in the fields of environmental justice and socioecological models of health to consider the pathway between physical environmental deprivation and health. We consider the influence of multiple aspects of the ‘natural’ physical environment on individual-level levels of physical activity—both utilitarian and physical activity for leisure. We found that, for physical activity conducted for recreational purposes, there is a strong relationship with the natural physical environment: those living in the least deprived physical environments are most likely to engage in physical activity. However, for utilitarian physical activity, physical activity whose primary purpose is not the activity itself, we observed increased levels in the most environmentally deprived areas. Finally, the important role that the environment may play in shaping capabilities, particularly during the current economic and political climate, is recognised. Our results show that the environment matters and that rhetoric regarding ‘lifestyle choice’ needs to be viewed in a broader environmental context

Tobacco retail environments and social inequalities in individual-level smoking and cessation among Scottish adults

Introduction: Many neighborhood characteristics may constrain or enable smoking. This study investigated whether the neighborhood tobacco retail environment was associated with individual-level smoking and cessation in Scottish adults, and whether inequalities in smoking status were related to tobacco retailing. Methods: Tobacco outlet density measures were developed for neighborhoods across Scotland using the September 2012 Scottish Tobacco Retailers Register. The outlet data were cleaned and geocoded (n = 10 161) using a Geographic Information System. Kernel density estimation was used to calculate an outlet density measure for each postcode. The kernel density estimation measures were then appended to data on individuals included in the 2008–2011 Scottish Health Surveys (n = 28 751 adults aged ≥16), via their postcode. Two-level logistic regression models examined whether neighborhood density of tobacco retailing was associated with current smoking status and smoking cessation and whether there were differences in the relationship between household income and smoking status, by tobacco outlet density. Results: After adjustment for individual- and area-level confounders, compared to residents of areas with the lowest outlet densities, those living in areas with the highest outlet densities had a 6% higher chance of being a current smoker, and a 5% lower chance of being an ex-smoker. There was little evidence to suggest that inequalities in either current smoking or cessation were narrower in areas with lower availability of tobacco retailing. Conclusions: The findings suggest that residents of environments with a greater availability of tobacco outlets are more likely to start and/or sustain smoking, and less likely to quit

Life course, green space and health: incorporating place into life course epidemiology

Researchers interested in the relationships between place and health have been slow to incorporate a life course perspective, probably due to the lack of readily available historical environmental data. This hinders the identification of causal relationships. It also restricts our understanding as to whether there are accumulative effects over the life course and if there are critical periods in people’s lives when places are particularly pertinent. This study considers the feasibility of constructing longitudinal data on the availability of urban green space. The suitability of various historical and contemporary data sources is considered, including paper maps, aerial photographs and tabular land use data. Measures of urban green space are created for all neighbourhoods across the Edinburgh region of Scotland at various points during the past 100 years. We demonstrate that it is feasible to develop such measures, but there are complex issues involved in doing so. We also test the utility of the measures via an analysis of how accessibility to green space might alter over the life course of both people, and their residential neighbourhoods. The findings emphasise the potential for utilising historical data to significantly enhance understanding of the relationships between nature and health, and between health and place more generally. We encourage researchers to use data from other locations to consider including a longitudinal perspective to examine relationships between people’s health and their environment

Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)

Background: A high prevalence of poor job satisfaction and high chronic stress is documented for general practitioners (GPs) and non-physician practice staff from various countries. The reasons are multifactorial and include deficits in leadership, communication and workflows. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among GPs and practice personnel. Here, we report the baseline characteristics of the participating GPs and practice assistants, focusing on job satisfaction and perceived chronic stress. Methods: The IMPROVEjob study was performed as a cluster-randomised, controlled trial (cRCT) with German GP practices in the North Rhine Region. The IMPROVEjob intervention comprised two leadership workshops (one for practice leaders only; a second for leaders and practice assistants), a toolbox with supplemental printed and online material, and a nine-month implementation phase supported by IMPROVEjob facilitators. The intervention addressed issues of leadership, communication, and work processes. During study nurse visits, participants completed questionnaires at baseline and after nine months follow up. The primary outcome was the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (German COPSOQ, version 2018). Perceived chronic stress was measured using the Trier Inventory of Chronic Stress (TICS- SSCS). Results: Recruitment of 60 practices was successful: 21 were solo, 39 were group practices. At baseline, n = 84 practice owners, n = 28 employed physicians and n = 254 practice assistants were included. The mean age of all participants was 44.4 (SD = 12.8). At baseline, the job satisfaction score in the total sample was 74.19 of 100 (±14.45) and the perceived chronic stress score was 19.04 of 48 (±8.78). Practice assistants had a significantly lower job satisfaction than practice owners (p < 0.05) and employed physicians (p < 0.05). In the regression analysis, perceived chronic stress was negatively associated with job satisfaction (b= -0.606, SE b = 0.082, p < 0.001, ICC = 0.10). Discussion: The degree of job satisfaction was similar to those in other medical professionals published in studies, while perceived chronic stress was markedly higher compared to the general German population. These findings confirm the need for interventions to improve psychological wellbeing in GP practice personnel

Navigating the Future of Organisational Health Services Research in Germany and beyond:a Position Paper

Background Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community.Methods In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field’s development.Results The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified.Conclusions This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries

Investigating the spatial distribution of campylobacteriosis in New Zealand

Background Infection with Campylobacter is thought to account for about 5% - 14% of all food and waterborne diarrhoea cases worldwide. By international standards, New Zealand has extremely high rates of campylobacteriosis which are thought to be the highest reported rates worldwide. The incidence has been steadily increasing since 1980 (when the disease became notifiable), reaching a peak of cases in 2003 (396/100,000). Although different surveillance systems complicate international comparisons, New Zealand's particularly high rate still lacks a conclusive explanation. Aims This study investigates the geographical distribution of campylobacteriosis in New Zealand and the relative importance of factors assumed to be affecting the distribution of this disease, including those related to climate, landuse, water and food. The approach aims to explain why certain areas might increase the probability of becoming infected. Methodology A Geographical Information System (GIS) is used to visualise the disease rate, investigate potential disease clustering and identify outliers. Hierarchical regression, including the analysis of residuals, is applied to analyse the variables in their complex interrelation and to investigate whether there is statistical evidence explaining the geographical variation in campylobacteriosis. This study is undertaken at the territorial local authority level, as all required data are available at this spatial scale and covers the period 1997 to 2005. Results and conclusion There is a large geographical variation in campylobacteriosis across New Zealand, ranging from an average annual rate of 97/100,000 to 526/100,000 per territorial local authority (TLA). Generally, there is statistical evidence for global and local clustering of the disease rate. There are upper and lower outliers of campylobacteriosis in New Zealand; however, higher rates primarily appear in the South Island. The hierarchical modelling confirms statistical significance for some of the environmental and sociodemographic variables. The final model explains about 58% of the variation in campylobacteriosis, and the residuals reflect this variation relatively accurately in approximately 75% of all TLAs. Although the evaluation of the results is confronted with a number of challenges, it is concluded that socioeconomic and demographic factors are crucial factors in explaining the observed spatial patterns in the notification data

Declining Physical Activity and the Socio-Cultural Context of the Geography of Industrial Restructuring:A Novel Conceptual Framework

BACKGROUND: At the population level, the prevalence of physical activity has declined considerably in many developed countries in recent decades. There is some evidence that areas exhibiting the lowest activity levels are those which have undergone a particularly strong transition away from employment in physically demanding occupations. We propose that processes of deindustrialisation may be causally linked to unexplained geographical disparities in levels of physical activity. Whilst the socio-cultural correlates of physical activity have been well studied, and prior conceptual frameworks have been developed to explain more general patterns of activity, none have explicitly attempted to identify the components of industrial change that may impact physical activity. METHODS: In this work we review the current literature on socio-cultural correlates of health behaviours before using a case study centred on the United Kingdom to present a novel framework that links industrial change to declining levels of physical activity. RESULTS: We developed a comprehensive model linking socio-cultural correlates of physical activity to processes associated with industrial restructuring and discuss implication for policy and practice. CONCLUSIONS: A better understanding of socio-cultural processes may help to ameliorate adverse health consequences of employment decline in communities that have experienced substantial losses of manual employment