Does Context Matter for the Relationship between Deprivation and All-Cause Mortality? The West vs. the Rest of Scotland

Background A growing body of research emphasizes the importance of contextual factors on health outcomes. Using postcode data for Scotland (UK), this study tests the hypothesis of spatial heterogeneity in the relationship between area-level deprivation and mortality to determine if contextual differences in the West vs. the rest of Scotland influence this relationship. Research into health inequalities frequently fails to recognise spatial heterogeneity in the deprivation-health relationship, assuming that global relationships apply uniformly across geographical areas. In this study, exploratory spatial data analysis methods are used to assess local patterns in deprivation and mortality. Spatial regression models are then implemented to examine the relationship between deprivation and mortality more formally. Results The initial exploratory spatial data analysis reveals concentrations of high SMR and deprivation values (hotspots) in the West of Scotland and concentrations of low values (coldspots) for both variables in the rest of the country. The main spatial regression result is that deprivation is the only variable that is highly significantly correlated with all-cause mortality in all models. However, in contrast to the expected spatial heterogeneity in the deprivation-mortality relationship, this relation does not vary between regions in any of the models. This result is robust to a number of specifications, including weighing for population size, controlling for spatial autocorrelation and heteroskedasticity, assuming a non-linear relationship between mortality and deprivation, breaking the dependent variable into male and female SMRs, and distinguishing between West, North and Southeast regions. The rejection of the hypothesis of spatial heterogeneity in the relationship between deprivation and mortality complements prior research on the stability of the deprivation-mortality relationship over time. Conclusions The obtained homogeneity in the deprivation-mortality relationship across the regions of Scotland and the absence of a contextualized effect of region highlights the importance of taking a broader strategic policy that can combat the toxic impacts of deprivation on health. Focusing on a few specific places (e.g. 15% of the poorest areas) to concentrate resources might be a good start but the impacts of deprivation on mortality is not restricted to a few places. A comprehensive strategy that can be sustained over time might be needed to interrupt the linkages between poverty and mortality.

Does Context Matter for the Relationship between Deprivation and All-Cause Mortality? The West vs. the Rest of Scotland

One of the assumptions that is often made in modeling the relationship between deprivation and mortality is that this relationship will remain the same across space. There is little justification presented in the literature as to why the deprivation-mortality relationship will be homogenous across space. The homogeneity of this relationship over space is an empirical question and most of the published literature does not formally test this relationship. Using postcode data for Scotland (UK), this study addresses this research gap and tests the hypothesis of spatial heterogeneity in the relationship between area-level deprivation and mortality. Research into health inequalities frequently fails to recognise spatial heterogeneity in the deprivation-health relationship, assuming that global relationships apply uniformly across geographical areas. In this study, exploratory spatial data analysis methods are used to assess local patterns in deprivation and mortality. A variety of spatial regression models are then implemented to examine the relationship between deprivation and mortality. The hypothesis of spatial heterogeneity in the relationship between deprivation and mortality is rejected. Implications of the homogeneity of the deprivation-mortality relationships for addressing health inequities are discussed in light of the inverse care law.

Does context matter for the relationship between deprivation and all-cause mortality? The West vs. the rest of Scotland

abstract: Background A growing body of research emphasizes the importance of contextual factors on health outcomes. Using postcode sector data for Scotland (UK), this study tests the hypothesis of spatial heterogeneity in the relationship between area-level deprivation and mortality to determine if contextual differences in the West vs. the rest of Scotland influence this relationship. Research into health inequalities frequently fails to recognise spatial heterogeneity in the deprivation-health relationship, assuming that global relationships apply uniformly across geographical areas. In this study, exploratory spatial data analysis methods are used to assess local patterns in deprivation and mortality. Spatial regression models are then implemented to examine the relationship between deprivation and mortality more formally. Results The initial exploratory spatial data analysis reveals concentrations of high standardized mortality ratios (SMR) and deprivation (hotspots) in the West of Scotland and concentrations of low values (coldspots) for both variables in the rest of the country. The main spatial regression result is that deprivation is the only variable that is highly significantly correlated with all-cause mortality in all models. However, in contrast to the expected spatial heterogeneity in the deprivation-mortality relationship, this relation does not vary between regions in any of the models. This result is robust to a number of specifications, including weighting for population size, controlling for spatial autocorrelation and heteroskedasticity, assuming a non-linear relationship between mortality and socio-economic deprivation, separating the dependent variable into male and female SMRs, and distinguishing between West, North and Southeast regions. The rejection of the hypothesis of spatial heterogeneity in the relationship between socio-economic deprivation and mortality complements prior research on the stability of the deprivation-mortality relationship over time. Conclusions The homogeneity we found in the deprivation-mortality relationship across the regions of Scotland and the absence of a contextualized effect of region highlights the importance of taking a broader strategic policy that can combat the toxic impacts of socio-economic deprivation on health. Focusing on a few specific places (e.g. 15% of the poorest areas) to concentrate resources might be a good start but the impact of socio-economic deprivation on mortality is not restricted to a few places. A comprehensive strategy that can be sustained over time might be needed to interrupt the linkages between poverty and mortality.The electronic version of this article is the complete one and can be found online at: https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-10-3

Introdution to evaluation : the role of potential use in developing evaluations; day 1

PowerPoint presentationThe presentation provides leading questions towards understanding the role of evaluation in health care and in health policy and how these might apply and have impact on health care in China. Policy resistance is the tendency for interventions to be defeated by the system’s response to the intervention itself. The presentation reminds its audience that interventions are embedded in social systems and shaped by this context. Evaluation can be conceived of as an intervention with short- and long-term goals. One of the intermediate goals is to influence policy. The long-term goal is to improve individual lives

Introdution to evaluation : the role of potential use in developing evaluations; day 1

PowerPoint presentationThe presentation provides leading questions towards understanding the role of evaluation in health care and in health policy and how these might apply and have impact on health care in China. Policy resistance is the tendency for interventions to be defeated by the system’s response to the intervention itself. The presentation reminds its audience that interventions are embedded in social systems and shaped by this context. Evaluation can be conceived of as an intervention with short- and long-term goals. One of the intermediate goals is to influence policy. The long-term goal is to improve individual lives

Steps Toward Evaluation as Decluttering: Learnings from Hawaiian Epistemology

This paper discusses one of the more contemporary challenges in development and in global health--lots of good ideas from well-meaning insiders and outsiders that end up cluttering both the physical and mental spaces of what can be loosely termed as “attempts” at development. Given the place-based nature of indigenous thought, we turn to Hawaiian epistemology at looking to insights for clarity on how one can negotiate interactions to declutter place and also confuse identity.  We believe that evaluation as a field can help in bringing greater recognition of the need for models of development and learning that respect the importance of de-cluttering.  Implications for a decolonized approach to evaluation are discussed