Regional and Urban–Rural Variations in the Association of Neighbourhood Deprivation with Community Resource Access: A National Study

Abstract

Recent work has identified growing geographical inequalities in health between deprived and nondeprived areas in a number of countries. Despite the plethora of studies monitoring these trends, the explanations for this growing spatial divide remain unclear. This lack of clarity has been a hindrance to the implementation of strategies by policymakers to reduce health inequalities. One explanation for the noted spatial differences in health is that geographical access to a range of community resources, such as health care facilities, supermarkets, and recreational amenities, is lower in deprived areas. However, the evidence base for this explanation is low. In our previous work we noted a strong relationship at the national level between community resource accessibility and social deprivation, with access tending to be better in more deprived neighbourhoods. Other research suggests that the relationship between community resources varies at a subnational scale. Here, we consider whether the relationship of better access to community resources in more deprived areas persists for all regions of New Zealand, urban and rural. Using geographical information systems, we calculate levels of geographical access to sixteen types of community resources in 38350 small census areas across the country and, using an index of deprivation, examine whether access varies between deprived and nondeprived areas of the country. The results suggest that access to community resources in New Zealand is to some extent context specific. In urban areas, access is better in more deprived neighbourhoods, and the same is true of intermediate urban/rural areas although the gradient is considerably more pronounced. However, for rural areas, the relationship between com- munity resource access and deprivation is more mixed, with access to the majority of resources being worse in more deprived areas. Similarly, there are regional variations in the relationship between deprivation and community resource access. These results challenge some aspects of neomaterial interpretations of geographical inequalities in health.