A proper place to live: health inequalities, agency and the normative dimensions of space

• Published in: Social science & medicine (1982) 2003-07, Vol.57 (1), p.55-69
• Main Authors: Popay, Jennie, Thomas, Carol, Williams, Gareth, Bennett, Sharon, Gatrell, Anthony, Bostock, Lisa
• Format: Article
• Language: English
• Subjects: Agency; Analysis. Health state; Biological and medical sciences; Disadvantaged; England; Epidemiology; Everyday Life; General aspects; Health; Health Behavior; Health inequalities; Health inequalities Place Normative guidelines Ontological identity Agency Narratives England; Health Services Accessibility; Health Services Needs and Demand; Humans; Inequality; Interviews as Topic; Knowledge; Lay people; Medical sciences; Medicine; Narratives; Normative expectations; Normative guidelines; Norms; Ontological identity; Place; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Residential location; Social Action; Social Class; Social Environment; Social Inequality; Social Justice; Social sciences; Social Space; Space; United Kingdom; Urban Areas; Urban Population; Urban Poverty
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(02)00299-X

This paper explores the links between lay knowledge, place and health related social action (or agency) at the individual and collective level. It is based on an analysis of in-depth interviews and neighbourhood survey data across four localities in two cities in the North West of England. The qualitative analysis has identified ‘guidelines’ that we argue provide socially shared understandings of the normative contours of ‘proper places’ which shape the way people respond to the everyday lived reality of places. The quantitative findings suggest that a substantial minority of people, particularly in disadvantaged areas, are exposed to significant dissonance between the normative dimensions and lived experience of place. The analysis points to potential interactions between individual and collective action which may affect the health of individuals and populations and ‘ontological fit’—people's ability to (re) construct a positive identity despite living in what they and others perceive to be an ‘improper’ place. This is linked to their biographical connections with particular places and the extent to which they can localise problems and people in places at a distance from themselves. The paper contributes to understanding about the processes that generate inequalities in the health experience of people living in sharply contrasting socio-economic circumstances as well as finer-grained health inequalities between the ‘poor’ and the ‘poorest’.