Advertisement

Neighborhood Environments and Socioeconomic Inequalities in Mental Well-Being

      Introduction

      It has been suggested that socioeconomic inequalities in health might be reduced among populations with good access to green space. However, the potential for other neighborhood characteristics to reduce socioeconomic health inequalities, or to confound the effects of green space, has not been well explored. Therefore, this study investigates which, if any, neighborhood characteristics are associated with narrower socioeconomic inequalities in mental well-being in a large, international sample of urban residents.

      Methods

      The 2012 European Quality of Life Survey provided data on 21,294 urban residents from 34 European nations. Associations between mental well-being (captured by the WHO-5 scale) and level of financial strain were assessed for interaction with five different neighborhood characteristics, including reported access to recreational/green areas, financial services, transport, and cultural facilities. Multilevel regression models allowed for clustering of individuals within region and country in this cross-sectional, observational study. Data were analyzed in 2014.

      Results

      Socioeconomic inequality in mental well-being was 40% (8.1 WHO-5 points) narrower among respondents reporting good access to green/recreational areas, compared with those with poorer access. None of the other neighborhood characteristics or services were associated with narrower inequality.

      Conclusions

      If societies cannot, or will not, narrow socioeconomic inequality, research should explore the so-called equigenic environments—those that can disrupt the usual conversion of socioeconomic inequality to health inequality. This large, international, observational study suggests that access to recreational/green areas may offer such a disruption.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brulle R.J.
        • Pellow D.N.
        Environmental justice: human health and environmental inequalities.
        Annu Rev Public Health. 2006; 27: 103-124https://doi.org/10.1146/annurev.publhealth.27.021405.102124
        • Morgan A.
        • Ziglio E.
        Revitalising the evidence base for public health: an assets model.
        Glob Health Promot. 2007; 14: 17-22
        • Scottish Government.
        Good Places, Better Health: A New Approach to Environment and Health in Scotland.
        Scottish Government, Edinburgh2009
        • Frumkin H.
        Healthy places: exploring the evidence.
        Am J Public Health. 2003; 93: 1451-1456https://doi.org/10.2105/AJPH.93.9.1451
        • Africa J.
        • Logan A.
        • Mitchell R.
        • et al.
        The Natural Environments Initiative: Illustrative Review and Workshop Statement.
        Center for Health and the Global Environment at the Harvard School of Public Health, Boston2014
        • Mitchell R.
        What is equigenesis and how might it help narrow health inequalities?.
        CRESH Blog Series. 2013;
        • Park B.
        • Tsunetsugu Y.
        • Kasetani T.
        • Kagawa T.
        • Miyazaki Y.
        The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan.
        Environ Health Prev Med. 2010; 15: 18-26https://doi.org/10.1007/s12199-009-0086-9
        • Lee J.
        • Park B.J.
        • Tsunetsugu Y.
        • Ohira T.
        • Kagawa T.
        • Miyazaki Y.
        Effect of forest bathing on physiological and psychological responses in young Japanese male subjects.
        Public Health. 2011; 125: 93-100https://doi.org/10.1016/j.puhe.2010.09.005
        • Tsunetsugu Y.
        • Park B.
        • Miyazaki Y.
        Trends in research related to “Shinrin-yoku” (taking in the forest atmosphere or forest bathing) in Japan.
        Environ Health Prev Med. 2010; 15: 27-37https://doi.org/10.1007/s12199-009-0091-z
        • Selhub E.M.
        • Logan A.C.
        Your Brain on Nature: The Science of Nature׳s Influence on Your Health, Happiness and Vitality.
        John Wiley & Sons, Mississauga, Ontario, Canada2012
        • Barton J.
        • Pretty J.
        What is the best dose of nature and green exercise for improving mental health? A Multi-Study Analysis.
        Environ Sci Technol. 2010; 44: 3947-3955https://doi.org/10.1021/es903183r
        • Pretty J.
        • Peacock J.
        • Sellens M.
        • Griffin M.
        The mental and physical health outcomes of green exercise.
        Int J Environ Health Res. 2005; 15: 319-337https://doi.org/10.1080/09603120500155963
        • Nilsson K.
        • Sangster M.
        • Gallis C.
        • et al.
        Forests, Trees and Human Health.
        Springer Science, New York2011https://doi.org/10.1007/978-90-481-9806-1
        • Hartig T.
        • Mitchell R.
        • De Vries S.
        • Frumkin H.
        Nature and health.
        Annu Rev Public Health. 2014; 35: 207-228https://doi.org/10.1146/annurev-publhealth-032013-182443
        • Maas J.
        • Verheij R.A.
        • Groenewegen P.P.
        • de Vries S.
        • Spreeuwenberg P.
        Green space, urbanity, and health: how strong is the relation?.
        J. Epidemiol Community Health. 2006; 60: 587-592https://doi.org/10.1136/jech.2005.043125
        • Lachowycz K.
        • Jones A.P.
        Does walking explain associations between access to greenspace and lower mortality?.
        Soc Sci Med. 2014; 107: 9-17https://doi.org/10.1016/j.socscimed.2014.02.023
        • Mitchell R.
        • Popham F.
        Effect of exposure to natural environment on health inequalities: an observational population study.
        Lancet. 2008; 372: 1655-1660https://doi.org/10.1016/S0140-6736(08)61689-X
        • Eurofound.
        Third European Quality of Life Survey—Quality of Life in Europe: Impacts of the Crisis.
        Publications Office of the European Union, Luxembourg2012
        • Eurofound.
        3rd European Quality of Life Survey—Technical Report.
        Eurofound, Luxembourg2012
        • WHO.
        Wellbeing Measures in Primary Health Care/The DEPCARE Project.
        Regional Office for Europe. WHO, Copenhagen1998
        • Bech P.
        • Olsen L.R.
        • Kjoller M.
        • Rasmussen N.K.
        Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five well-being scale.
        Int J Methods Psychiatr Res. 2003; 12: 85-91https://doi.org/10.1002/mpr.145
        • Primack B.A.
        The WHO-5 Wellbeing Index performed the best in screening for depression in primary care.
        Evid Based Med. 2003; 8: 155https://doi.org/10.1136/ebm.8.5.155
        • EUROSTAT OECD.
        Eurostat-OECD Methodological Manual on Purchasing Power Parities.
        Organisation for Economic Co-operation and Development, Luxembourg2007
        • Carle A.C.
        Fitting multilevel models in complex survey data with design weights: Recommendations.
        BMC Med Res Methodol. 2009; 9: 49https://doi.org/10.1186/1471-2288-9-49
        • Ord K.
        • Mitchell R.
        • Pearce J.
        Is level of neighbourhood green space associated with physical activity in green space?.
        Int J Behav Nutr Phys Act. 2013; 10: 127https://doi.org/10.1186/1479-5868-10-127
        • Jones A.
        • Hillsdon M.
        • Coombes E.
        Greenspace access, use, and physical activity: Understanding the effects of area deprivation.
        Prev Med. 2009; 49: 500-505https://doi.org/10.1016/j.ypmed.2009.10.012
        • Cohen D.A.
        • Lapham S.
        • Evenson K.R.
        • et al.
        Use of neighbourhood parks: does socio-economic status matter? A four-city study.
        Public Health. 2013; 127: 325-332https://doi.org/10.1016/j.puhe.2013.01.003
        • Hartig T.
        • Berg A.E.
        • Hagerhall C.M.
        • et al.
        Health Benefits of Nature Experience: Psychological, Social and Cultural Processes.
        in: Nilsson K. Sangster M. Gallis C. Forests, Trees and Human Health. Doredrecht. Springer, 2011: 127-168https://doi.org/10.1007/978-90-481-9806-1_5
        • Stigsdotter U.K.
        • Palsdottir A.M.
        • Burls A.
        • Chermaz A.
        • Ferrini F.
        • Grahn P.
        Nature-Based Therapeutic Interventions.
        in: Nilsson K. Sangster M. Gallis C. Forests, Trees and Human Health. Doredrecht. Springer, 2011: 309-342https://doi.org/10.1007/978-90-481-9806-1_11
        • Hartig T.
        • Evans G.W.
        • Jamner L.D.
        • Davis D.S.
        • Garling T.
        Tracking restoration in natural and urban field settings.
        J Environ Pyschol. 2003; 23: 109-123https://doi.org/10.1016/S0272-4944(02)00109-3
        • Staats H.
        • Hartig T.
        • Kieviets A.
        Restorative effects of outdoor environments.
        Int J Psychol. 2000; 35: 126
        • Hartig T.
        • Mang M.
        Restorative effects of natural environment experiences.
        Environ Behav. 1991; 23: 3-26https://doi.org/10.1177/0013916591231001
        • Gullón P.
        • Bilal U.
        • Franco M.
        Physical activity environment measurement and same source bias.
        Gac Sanit. 2014; 28: 344-345https://doi.org/10.1016/j.gaceta.2013.12.011
        • Diez Roux A.V.
        Neighborhoods and health: where are we and were do we go from here?.
        Rev Epidemiol Sante Publique. 2007; 55: 13-21https://doi.org/10.1016/j.respe.2006.12.003
        • McGinn A.
        • Evenson K.
        • Herring A.
        • Huston S.
        • Rodriguez D.
        Exploring associations between physical activity and perceived and objective measures of the built environment.
        J Urban Health. 2007; 84: 162-184https://doi.org/10.1007/s11524-006-9136-4
        • Bowler D.E.
        • Buyung-Ali L.M.
        • Knight T.M.
        • Pullin A.S.
        A systematic review of evidence for the added benefits to health of exposure to natural environments.
        BMC Public Health. 2010; 10: 456https://doi.org/10.1186/1471-2458-10-456