Abstract
BackgroundNeighbourhood has risen as a relevant determinant of health. While there is substantial evidence that environmental factors affect health, far less evidence of the role of social mechanisms in the causal chain between neighbourhood characteristics and health is available.MethodTo evaluate the role of social cohesion as a mediator between four different neighbourhood characteristics and health using data from German Socio-Economic-Panel (SOEP), a longitudinal mediation analysis was performed. Multilevel linear regression models adjusted for socio-economic variables involved three time points and two measures of physical and mental health (physical and mental component scores (PCS and MCS) of the SF12 Questionnaire. Participants were followed-up for 4 and 10 year starting in 2004.ResultsA total of 15,518 measures of MCS and PCS on 10,013 participants living in 4985 households were included. After adjusting for values of MCS and PCS at baseline and demographic/socio-economic variables, social cohesion was a significant positive predictor of both MCS and PCS (β-coefficient MCS: 1.57 (0.27); PCS: 1.50 (0.24)). Interaction between social cohesion and follow-up were significant for PCS. The effect of environmental and built characteristics on health was consistently mediated by social cohesion with proportion varying between 10 and 23%.DiscussionWe show that social cohesion is part of the causal chain between environmental and built characteristics of a neighbourhood and health, with increasing mediation effect over time for physical health. Social mechanisms should be considered when studying the effect of neighbourhood characteristics on health inequalities making social cohesion as a legitimate target of public health interventions at neighbourhood level.
Highlights
Neighbourhood has risen as a relevant determinant of health
A total of 15,518 measures of Mental component score (MCS) and Physical component score (PCS) on 10,013 participants living in 4985 households were included
Interaction between social cohesion and follow-up were significant for PCS
Summary
Neighbourhood has risen as a relevant determinant of health. While there is substantial evidence that environmental factors affect health, far less evidence of the role of social mechanisms in the causal chain between neighbourhood characteristics and health is available. A neighbourhood can be considered as a small-area unit in which inhabitants are exposed to similar contextual environmental characteristics, and in which they interact socially [1]. Van Ham and Manley [5] have pointed out the necessity of explaining what is in the “black box” of neighbourhood effects moving away from association studies to studies which elucidate the causal mechanisms connecting neighbourhood and health. Improving the understanding of the complex aetiology of neighbourhood effects on health could have implications in terms of public health interventions toward the reduction of health inequalities [6]. Several studies indicate a mediating role between socio-economic status and mental health [11]
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