Factors which nurture geographical resilience in Britain: a mixed methods study

OBECTIVES: To identify plausible mechanisms by which resilience (low mortality rates despite persistent economic adversity) was achieved in some areas in Britain between 1971 and 2001 METHODS: Mixed method observational study, combining quantitative analyses of cause and age group specific mortality rates, and area socio-demographic and environmental characteristics, with case studies of resilient areas which included in-depth interviews. RESULTS: The causes of death, and age groups, contributing most to resilience varied markedly between the 18 resilient areas; since disease aetiology varies, a range of protective processes must be in operation. Four area characteristics, which plausibly contributed to resilience, emerged from the in-depth interviews: population composition; retaining or attracting population; environment and housing; and social cohesion. Quantitative analyses demonstrated significant difference between resilient and non-resilient areas in retaining or attracting population only. CONCLUSIONS: Whilst we identified plausible area characteristics through which resilience was achieved, there does not appear to be a definitive set which reliably produces resilience, and resilient and non-resilient areas did not differ significantly in their possession of most of these characteristics. If such characteristics do have a role in creating resilience, but are present both in resilient and non-resilient areas, further work is needed to explore what makes them 'successful' in some areas, but not in others

The Neoadjuvant Rectal (NAR) score and a novel MRI-based NAR score are stage independent predictors of long-term outcome in locally advanced rectal cancer

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