Abstract
Background Recommendations to reduce health inequalities emphasise environmental determinants of health, and have argued that improvements to these determinants should be allocated proportionately to population need. However, empirical evaluations of the impact of ‘proportionate universalism’ on health inequalities are lacking. We studied a city-wide (Glasgow, UK) housing-led renewal programme to test whether investment was allocated to need and whether this reduced health inequalities. Methods Quasi-experimental study of a natural experiment . We studied a longitudinal cohort (n = 1006) through data linkage across two cross-sectional surveys of adult residents from 14 neighbourhoods interviewed in 2006 and 2011. We measured residents’ health status using a validated self-reported instrument (SF12v2). Using data provided by deliverers of housing-led renewal, we grouped the areas by mean investment per household. Baseline deprivation and health characteristics of areas receiving high, medium and low levels of investment were compared. Using a difference-in-differences approach, change in SF12v2 scores in medium and higher investment areas were compared to those of lower investment areas. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Results Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in areas receiving higher investment relative to those receiving lower investment (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). A dose-response relationship was suggested, with relative improvements to mean health scores in the medium (compared to the lower) investment group not statistically significant. Conclusion Social interventions such as housing-led urban renewal can contribute to reductions in health inequalities when allocated according to need.
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