Exceptions to the rule: Healthy deprived areas and unhealthy wealthy areas

• Published in: Social science & medicine (1982) 2007-03, Vol.64 (6), p.1326-1342
• Main Authors: van Hooijdonk, Carolien, Droomers, Mariël, van Loon, Jeanne A.M., van der Lucht, Fons, Kunst, Anton E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Biological and medical sciences; Child; Child, Preschool; Disadvantaged; Environment; Epidemiology; Female; General aspects; Geographical health inequalities; Geography; Health; Health behavior; Health inequalities; Health Problems; Health Status Indicators; Hospitalisation; Hospitalization; Hospitalization - statistics & numerical data; Humans; Income - classification; Income - statistics & numerical data; Inequality; Infant; Infant, Newborn; Male; Medical sciences; Medically Underserved Area; Middle Aged; Miscellaneous; Mortality; Mortality Hospitalisation Residential segregation Urbanisation Geographical health inequalities The Netherlands; Mortality Rates; Netherlands; Netherlands - epidemiology; Postal Service; Poverty Areas; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regional disparities; Residence Characteristics - classification; Residence Characteristics - statistics & numerical data; Residential Segregation; Sex Distribution; Small-Area Analysis; Social Class; Social classes; Social sciences; Socioeconomic factors; Socioeconomic Status; The Netherlands; Urbanisation; Urbanization
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2006.10.041

In general, inhabitants of low socio-economic areas are unhealthier than inhabitants of high socio-economic areas, but some areas are an exception to this rule. These exceptions imply that other factors besides the socio-economic level of an area contribute to the health of the inhabitants of an area, e.g. environmental factors. In our study we concentrate on areas within the Netherlands that are healthier or unhealthier than could be expected based on their socio-economic level. This study first identifies these areas and secondly determines which area characteristics distinguish these areas from those areas where the level of health is in agreement with their socio-economic level. We used nation-wide data on neighbourhood differences in population composition (gender, age, marital status and ethnicity), urbanisation and two health indicators: mortality and hospitalisation rates. In the Netherlands, many areas are healthier or unhealthier than could be expected based on their income level alone. Areas with higher mortality rates than expected are mainly urban areas with high percentages of elderly people and persons living alone. Similar but opposite associations are observed for areas with lower mortality rates than expected, which are further characterised by a low percentage of non-western immigrants. Areas with lower hospitalisation rates than expected are mainly rural areas with few non-western immigrants. From these results, we conclude that urbanisation and residential segregation based on age, ethnicity and marital status might be important contributors to geographical health inequalities.