Developing Summary Measures of Health-Related Multiple Physical Environmental Deprivation for Epidemiological Research

Abstract

Socioeconomic deprivation accounts for much of the spatial inequality in health in the UK, but a significant proportion remains unexplained. It is highly likely that the physical environment is a key factor in this unexplained variation. The role of the socioeconomic environment in health inequalities has been studied using small-area measures of multiple socioeconomic deprivation that capture the burden of socioeconomic adversity. Although similar composite measures of the physical environment would greatly assist investigations of environmental determinants of health no such measures are available. In this study we developed two small-area measures of health-related multiple physical environmental deprivation for the UK. A thorough review and evidence appraisal process was used to identify health-relevant dimensions of physical environmental deprivation. As a result we selected both health-detrimental (air pollution, cold climate, industrial facilities) and health-beneficial (ultraviolet radiation and green space) dimensions. Datasets describing each of the selected dimensions were acquired, and rendered to UK Census Area Statistics wards ( n = 10 654, average population = 5518). We developed two summary measures: the multiple environmental deprivation index (MEDIx) and classification (MEDClass). MEDIx, on an ordinal scale, can be used to distinguish areas exposed to greater or lesser environmental deprivation. MEDClass groups areas with similar environmental characteristics and will be useful for exploring health effects of specific types of environment. Mapping these measures demonstrated a wide variation in physical environmental deprivation across the UK. MEDIx revealed greater environmental deprivation in urban and industrial areas, and at more northerly latitudes. Although created using a different methodology MEDClass also differentiated these environmental types. We concluded that it is possible to capture and characterise multiple attributes of health-related physical environmental deprivation in the UK, at a small area level. The measures we developed offer opportunities to researchers and policy makers for developing our understanding of the role of exposure to multiple dimensions of physical environmental deprivation on health outcomes.