The effects upon health inequalities of allocating renewal investment

Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health, but to reduce socially patterned inequalities in health those improvements must result in greater benefits for those who are in the greatest need.

The Marmot Review and others have therefore advocated ‘Proportionate universalism’, arguing that “To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportional to the level of disadvantage”. To date, few studies have attempted to evaluate how and whether proportionate universalism strategies result in reduced health inequalities. Glasgow’s large scale renewal programme, though not universal, does involve different levels of investment to different neighbourhoods of the city following assessments of housing, community and neighbourhood ‘need’. We tested whether this investment was allocated to ‘need’ and whether this reduced health inequalities over time.

Using GoWell resident surveys from 2006 and 2011 we identified 1006 people who had lived in different regeneration neighbourhoods during this period and took part in both surveys. We used investment data from Glasgow Housing Association (part of Wheatley Group) to determine which neighbourhoods received relatively ‘high’, ‘medium’ and ‘low’ levels of investment per household.

We found that areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. We also found that compared with the low investment neighbourhoods, the residents of higher investments experienced greater improvements in average mental health scores measured using the SF-12 version 2 instrument. Over the five years, the cohort experienced a decrease in physical health scores, possibly linked to an ageing effect, but residents of the high investment area experienced less decline compared with those of the low investment areas.

These findings suggest that the investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years.

The research is available in this open access article in Social Science and Medicine: Proportionate universalism in practice? A quasi-experimental study of a UK neighbourhood renewal programme’s impact on health inequalities.