Deprivation a poor predictor of health
An AUT study shows that the perceived amenity of your neighbourhood is a better predictor of health-related quality of life than socioeconomic status.
The study was led by Associate Professor Daniel Shepherd, Senior Lecturer in Psychology at the AUT School of Clinical Sciences.
“Social position may have less influence on a person’s physical, psychological and social wellbeing than the restorative characteristics of their own neighbourhood – those things that make them feel happy, healthy and strong,” says Shepherd.
The findings of the study, published in the International Journal of Community Wellbeing, are particularly relevant as New Zealand’s public health system is being restructured.
Research into health determinants is a central aim of most governing agencies, but there is no gold standard. Efforts to date have focused on the relationship between socioeconomic or ‘social position’ and objective measures of health. The New Zealand Deprivation Index (NZDep) guides most health research, policy and funding.
However, the drive for objective measures of social position and health can sometimes obscure the reality of people’s lives as they unfold in their neighbourhoods.
This study is important, in part, because it shows that perceptions of amenity mediate the relationship between deprivation and health. And that health outcomes depend on perceived amenity, rather than absolute wealth.
Shepherd says more research is needed to compare the influence of social determinants, like the conditions in the environments where people live, on both objective and subjective measures of health.
A subjective measure like Health-Related Quality of Life (HRQOL) – encompassing physical, psychological and social wellbeing – can provide new insights into relationships between health determinants and outcomes, by going beyond ‘what can be seen under the microscope’.
Shepherd and colleagues sought to establish relationships between HRQOL, social position (or deprivation), and perceptions of one’s own neighbourhood. A central aim of the study was to identify social determinants (or neighbourhood measures) that may predict health outcomes.
Almost 750 people were surveyed. The participants of the survey lived in one of six neighbourhoods located in Auckland or Wellington – some affluent and others socioeconomically disadvantaged – each with a different Deprivation Index score between two and nine.
Researchers found a significant link between HRQOL and perceptions of one’s own neighbourhood. Participants in wealthier neighbourhoods reported higher HRQOL overall. However, there was no significant difference in self-reported illness or medical conditions across deprivation, which suggests that even though wealthier people benefit from better access to healthcare, they may still be equally vulnerable to illness.
People with lower physical-HRQOL were more likely to report neighbourhood problems, irrespective of deprivation.
Three characteristics were strongly linked to higher physical-HRQOL – being European or Pākehā, having fulltime or part-time employment, and no reported illness or medical conditions.
Shepherd says the finding that employment type predicts HRQOL is interesting, as previous research shows that occupation-based measures are not representative of social position.
“The results indicate that health-related quality of life would have greater associations with ‘an ability to work’ rather than occupation. We also found that education, which is a common proxy for wealth, did not significantly predict health outcomes,” he says.
There was also a positive association between advanced age and higher psychological-HRQOL, most likely explained by a wider range of coping strategies alongside a reduction in stressors as one ages.
Shepherd says, the type of residential environment, be it urban, suburban or rural, may be more influential in the assessment of one’s own neighbourhood than social position.
Participants living in affluent rural Wellington (NZDep3) ranked among the highest for neighbourhood problems, including public transport, traffic safety and poor street lighting. They were second only to participants living in the South Auckland suburb of Oranga (NZDep9), whose main concerns were vandalism, safety and traffic safety.
“Neighbourhood facilities may be less important that a person’s ability to adapt to their environment and optimise it,” says Shepherd.
While the Deprivation Index focuses on the consequences of social position, a mixed approach would yield better insights into relationships. It also aligns with the World Health Organisation (WHO) definition of health as ‘a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity’.