Affluent Wards Research Articles

Pediatric Oral Health Service Access in Racial/Ethnic Minority Neighborhoods: A Geospatial Analysis in Washington, D.C., USA.

Oral health plays a crucial role in overall well-being. One of the goals set by the US Department of Health and Human Service, Healthy People 2030 is to reducing dental caries in children and adolescents. The study aims to investigate the accessibility of pediatric dental care in neighborhoods with mixed-race and predominantly African American populations in the Washington District of Columbia (DC) area. Our objective is to uncover and highlight the disparities that exist in pediatric dental care within these communities. We have specifically examined the geographic and socio-demographic aspects of pediatric dental care facilities, utilizing geospatial tools such as modeling and mapping, as well as data from the clinical database at Howard University College of Dentistry. The detailed analysis of dental care access revealed significant disparities among various Wards in the region. Specifically, Wards 5, 7, and 8 stood out as having both the highest concentrations of African American residents and the lowest availability of pediatric dentistry providers when compared to the more affluent Wards 1, 2, and 3. Howard University College of Dentistry's pediatric dentistry department played a crucial role in providing dental care services to the community. Over the course of the year 2022, they recorded a total of 3,855 visits from residents of the DC area. Notably, a substantial portion of these visits, specifically 1,566 visits, were from individuals residing in Wards 5, 7 and 8. This data underscores the significant demand for pediatric dental services in these underserved communities and highlights the importance of addressing the disparities in access to care.

Spatial pattern of environmental perception and place attachment in a diverse socio-economic context: the case of Gauteng province, South Africa

There is limited consensus among researchers on whether the spatial distribution of environmental perceptions and place attachment is influenced by socio-economic factors. This study aimed to determine if environmental perceptions and place attachment concepts in our study area (within Gauteng province, South Africa) showed specific spatial patterns. Hot spot, cluster-outlier analysis, and geographically weighted regression (GWR) were used to depict the spatial patterns of environmental perceptions and place attachment. Results showed a pattern where the central, generally affluent wards of the province hold more positive environmental perceptions and place attachment than those in the periphery. This is in line with dependency and other models that associate lower socio-economic status with lower levels of environmental awareness but is incongruent with other findings that have associated lower socio-economic status with pro-environmental behaviour being more prominent. Geographically weighted regression results revealed the combined importance of numbers of people with above-average income, college-level education, age below 50 years, female proportion, formal dwelling residence and African race in explaining the numbers of people with positive views on place attachment and environmental perceptions. Further, the GWR modelling allowed for the spatial dependence of the relationship between place attachment and environmental perceptions on the one hand and socio-economic factors on the other. These results have significant implications for environmental sustainability, planning and policy formulation in the province.

Using GIS to Analyze Inequality in Access to Dental Care in the District of Columbia.

Access to dental care in mixed-race and predominantly African American wards in the District of Columbia (DC) was investigated in relation to community development. This study used high-resolution geographic information system (GIS) tools to map all general dentistry and periodontal practice locations in DC wards. The spatial analysis contextualized each ward's land use and demographic data obtained from DC government reports. The analysis revealed inter-ward inequity in dental care access, which was measured by proximity to and number of dental clinics in each DC ward. Residents in affluent wards had access to many dental practices and superior amenities. Residents in wards poorly served by public transportation and with few resources had few, if any, dental clinics. Dental practices are inequitably distributed across DC wards. DC policy should prioritize community development-specifically, resource allocation and community outreach-to promote health equity and improve access to and quality of dental care among residents of color.

Exploring the migration of Muslims, Hindus and Sikhs in Birmingham by ward concentration and deprivation

This paper explores the migration within as well as migration to Birmingham of Muslims, Hindus and Sikhs. It provides analysis and reflection on the relationship between migration, faith group concentration and deprivation. The findings demonstrate how Muslim, Hindu and Sikh migration trends differ for specific wards characterised by contrasting levels of both socio-economic disadvantage and faith group clustering. Hindus are shown to migrate to more affluent areas, however this does not necessarily translate to moving away from wards where there are clusters of the same faith group, as discussion on Hall Green illustrates. Muslims, on the other hand, displayed a greater propensity to move away from wards with high concentrations of the same faith group, yet this did not also result in moving to more affluent wards.

0148 Using the UK Biobank study to estimate occupational causes of chronic disease: comparability with the UK national population and adjustment for bias

ObjectivesThe UK Biobank study is a sample of 502,682 people aged 40–70, clustered around 22 assessment centres. As part of a project to investigate the causes of COPD and estimate...

RELATIVE DEPRIVATION BETWEEN NEIGHBOURING WARDS IS PREDICTIVE OF CORONARY HEART DISEASE MORTALITY AFTER ADJUSTMENT FOR ABSOLUTE DEPRIVATION OF WARDS

Backgrounds and aims: An association between income inequality and health has been widely reported, as has an association between levels of income inequality and poor health. Here we are interested in whether, at a small area level, health is affected by the relative deprivation of a ward compared to its neighbours. We aim to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates, and assess whether this provides evidence of an association between area-level and individual-level risk. Methods Mortality rates for all wards in England were calculated using all CHD deaths 2001 - 2006. Ward-level deprivation was measured using the Carstairs index. Deprivation inequality within local authorities was measured by the interquartile range of deprivation for wards within the local authority. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards. Results Deprivation inequality within local authorities was positively associated with CHD mortality rates after adjustment for absolute deprivation (p < 0.001 for all models). Relative deprivation for wards was positively associated with CHD mortality rates after adjustment for absolute deprivation (p < 0.001 for all models). Sub-group analyses showed that relative deprivation was independently associated with CHD mortality rates in both affluent and deprived wards. Conclusions Rich wards surrounded by poor areas have higher CHD mortality rates than rich wards surrounded by rich areas. Poor wards surrounded by rich areas have worse CHD mortality rates than poor wards surrounded by poor areas. Local deprivation inequality has a similar adverse impact on both rich and poor areas, supporting the hypothesis that income inequality of an area has an impact on individual-level health outcomes.

Avoiding the danger that stop smoking services may exacerbate health inequalities: building equity into performance assessment

BackgroundThe UK is the only developed country to have established a nation-wide stop smoking treatment service. Apart from addressing tobacco dependence, which is the leading preventable cause of ill health and premature death, smoking cessation has been identified by the UK department of health as a service priority for reducing gaps in health between disadvantaged groups and the country as a whole. However smoking cessation tends to be more successful among affluent than disadvantaged groups. This means that for stop smoking services there is a trade-off to be had in terms of maximising the number of quitters and reducing socioeconomic inequalities in smoking prevalence. Current performance targets for the national stop smoking services in the UK are set only in terms of numbers of quitters, which does not encourage the adoption of strategies to reduce socioeconomic inequalities in smoking prevalence.DiscussionThis paper proposes an assessment framework, which allows the two dimensions of overall reduction in smoking prevalence and reductions of inequalities in smoking prevalence to be assessed together. The framework is used to assess the performance over time of a stop smoking service in Derwentside, a former Primary Care Trust in the North East of England, both in terms of meeting targets for the overall number of quitters and in terms of reducing socioeconomic inequalities in smoking prevalence.The example demonstrates how the proposed assessment framework can be applied in practice given existing records kept by stop smoking services in England and the available information on smoking prevalence at small area level. For Derwentside it is shown that although service expansion was successful in increasing the overall number of quitters, the service continued to exacerbate inequality in smoking prevalence between deprived and affluent wards.SummaryThe Secretary of State for Health in the UK has warned about the dangers of health promotion services and messages being taken up more readily by the better-off, thus exacerbating health inequalities. Because smokers from affluent backgrounds are more successful at quitting than those living in deprived circumstances, it is important to build an equity element into the monitoring of individual stop smoking services. Otherwise the danger highlighted by the Secretary of State for Health will go undetected and unaddressed.

An Investigation into the Link between UK Credit Union Characteristics, Location and their Success

Abstract**: The unique characteristics of credit unions reduces the information asymmetry that is prevalent in credit making decisions, enabling them to provide loans where other financial institutions cannot. This makes them a potential tool in the fight against financial exclusion. Yet, the UK credit union movement is not regarded as being successful, even though there is evidence of much financial exclusion. This study is cross sectional in form, and evaluates characteristics that may contribute to the success of the UK credit union movement at national and regional level, in 2000. The findings are used to consider the impact of recent regulatory changes on the movement. The key findings are that there is a significant relationship between the success of a credit union, its size and the deprivation of the ward from which it sources its members. More specifically, larger credit unions and those located in more affluent wards, are more successful. Affiliation to the Irish League of Credit Unions and having a common bond of occupation, are also found to be contributing factors to credit union success. These results are taken as providing support for the recent changes implemented by the Financial Services Authority (FSA), which is likely to result in the emergence of larger credit unions (through mergers), run by appropriately qualified persons, serving a more mixed‐income membership base. It is, however, noted that the history of the UK movement is one of missed opportunities and only time will tell whether credit unions have the wherewithal to accept current opportunities.

Socio-economic deprivation is associated with increased proximity to general practices in England: an ecological analysis

As health status is consistently negatively correlated with socio-economic deprivation, the need for health services is generally assumed to be greater in more deprived communities. The Inverse Care Law predicts that access to good quality primary care services in more deprived wards will be less than that in affluent wards. However, the relationship between deprivation and geographical proximity to health services has received little attention. We investigated the relationship between geographical proximity to general practices and a number of markers of socio-economic deprivation at the electoral ward level in the North East of England using various domains of the Index of Multiple Deprivation 2000 (IMD2000). More deprived wards, as measured by the employment, education and income domains of the IMD2000, had greater proximity to general practices, as measured by the access domain of the IMD2000, than affluent wards. This results held in both urban and rural wards. Contrary to our expectations and the predictions of the Inverse Care Law, geographical proximity to general practices was greater in more deprived, compared to more affluent wards. However, geographical proximity to services does not necessarily ensure that services will be accessed or that they are of good quality.

Do rates of hospital admission for falls and hip fracture in elderly people vary by socio-economic status?

Objective. To determine the relationship between hospital admissions for falls and hip fracture in elderly people and area characteristics such as socio-economic deprivation. Study design. Ecological study of routinely collected hospital admissions data for falls and hip fracture in people aged 75 years or over for 1992–1997, linked at electoral ward level with characteristics from census data. Methods. In total, 42,293 and 17,390 admissions were identified for falls and hip fracture, respectively, from 858 electoral wards in Trent. Rate ratios (RRs) for hospital admissions for falls and hip fracture were calculated by the electoral wards' Townsend score divided by quintiles. RRs were estimated by negative binomial regression and adjusted for the ward characteristics of age, gender, ethnicity, rurality, proportion of elderly people living alone and distance from hospital. Results. There was a small but statistically significant association at electoral ward level between hospital admissions for falls and the Townsend score, with the most deprived wards having a 10% higher admission rate for falls compared with the most affluent wards (adjusted RR 1.10, 95% CI 1.01–1.19). No association was found between hospital admission for hip fracture and deprivation (adjusted RR 1.05, 95% CI 0.95–1.16). Conclusion. There is some evidence of an association at electoral ward level between hospital admissions for falls and socio-economic deprivation, with higher rates in deprived areas. No such association was found for hip fracture. Further work is required to assess the impact of interventions on reducing inequalities in hospital admission rates for falls in elderly people.

Developing Community Involvement: Contrasting Local and Regional Participatory Cultures in Britain and their Implications for Policy

W ILLIAMS C. C. (2003) Developing community involvement: contrasting local and regional participatory cultures in Britain and their implications for policy, Reg. Studies 37 , 531-541. This paper evaluates critically the implications and legitimacy of the current UK government policy towards nurturing community involvement that seeks to encourage participation in community-based groups (formal community involvement) and neglects the cultivation of one-to-one acts of good neighbourliness (informal community involvement). Analysing data from the 2000 General Household Survey (GHS), this policy approach is shown to not only privilege the cultures of community participation of regions such as London and the South East as well as affluent wards but also to seek to impose it on northern regions and deprived wards that possess different cultures of community engagement. W ILLIAMS C. C. (2003) Développer un esprit communautaire: contraster les esprits communautaires local et régional en Grande-Bretagne et leurs retombées pour la politique, Reg. Studies 37 , 531-541. Cet article cherche à évaluer d'un oeil critique les retombées et le bien-fondé de la politique en vigueur du gouvernement britannique envers le développement d'un esprit communautaire qui cherche à encourager la participation aux groupes d'intérêt communautaire (participation communautaire officielle) et qui ne fait aucune attention au dé veloppement des actes de bon voisinage du type face à face (participation communautaire officieuse). A partir d'une analyse des données provenant de l'enquête générale de 2000 auprès des ménages (2000 General Household Survey; GHS), on démontre que cette façon de formuler la politique non seulement favorise l'esprit de participation communautaire dans les régions telles Londres et le Sud-est ainsi que dans les circonscriptions électorales plus riches, mais aussi cherche à l'imposer sur les régions du nord et sur les circonscriptions électorales défavorisées dont l'esprit de participation communautaire est différent. W ILLIAMS C. C. (2003) Zur Entwicklung der Beteiligung am Gemeinschaftswesen: eine Gegenüberstellung örtlich und regional beteiligter kultureller Gruppen Großbritanniens und ihrer Bedeutung für die Politik, Reg. Studies 37 , 531-541. Dieser Aufsatz legt eine kritische Bewertung der Implikationen und der Berechtigung der gegenwärtigen britischen Regierungspolitik zur Förderung der Beteiligung am Gemeinschaftswesen, die darauf abzielt, Beteiligung an Gemeinschaftsgruppen (formale Beteiligung am Gemeinschaftswesen) zu fördern, und die Pflege gutnachbarlicher Einzelbeziehungen (informale Beteiligung am Gemeinschaftswesen) vernachlässigt. Gestützt auf Daten der algemeinen Erhebung von Haushalten (General Household Survey=GHS) des Jahres 2000 wird aufgezeigt, daß dieser politische Ansatz nicht nur die Beteiligung am Gemeinschaftswesen bestimmter Regionen, z.B. Londons und des Sü dostens, und wohlhabender Wahlbezirke überhaupt bevorzugt, sondern auch bestrebt ist, sie nördlichen Regionen und weniger wohlhabenden Wahlbezirken aufzuzwingen, die andersartige Formen der Beteiligung am Gemeinschaftswesen pflegen.

Primary school accident reporting in one education authority

Background: Studies have shown a correlation between increased accident rates and levels of deprivation in the community. School accident reporting is one area where an association might be expected. Aims:...

Conceptualizing ‘social capital’ for health promotion in small local communities: a micro‐qualitative study

AbstractThis paper reports on a micro‐qualitative case study of peoples' experiences of local community life in a south‐east English town. This material is used as the basis for a critical discussion of the suitability of Putnam's notion of social capital as a conceptual tool for the design and evaluation of ‘community strengthening’ policies and interventions. The study was motivated by a concern that too much debate about social capital has been conducted by academics and policy‐makers in a top‐down manner, with inadequate attention to the realities of life in the local communities that they refer to. Three‐hour semi‐structured interviews were conducted with 37 residents in two less affluent wards in our town of interest. Informants—half men and half women, and spread across the 15–75 age group—were encouraged to talk about their personal experiences of local community life. Interview findings are presented within the ‘norm’ categories of trust, neighbourliness and reciprocal help and support, and the ‘network’ categories of participation in informal networks, voluntary groupings and community activist groupings. Our case study points to a number of ways in which Putnam's concept needs to be refined if it is to inform ‘community strengthening’ policies and interventions in England. Far more notice needs to be taken of the role played by informal networks of friends and neighbours in the construction of local community life. Attention also needs to be given to the complex and shifting geographical spread of peoples' significant social networks. Putnam's conceptualization of cohesive local communities and his unitary notions of trust and local identity may also be unduly essentialist. In our particular communities of interest, they failed to capture the fluidity of local community norms and networks in a rapidly changing society. They also failed to do justice to the extent to which social distinctions—such as age, gender, ethnicity and housing tenure—shape and constrain the way in which people create, sustain and access social capital. Copyright © 2001 John Wiley & Sons, Ltd.

Is targeted early detection for melanoma feasible? Self assessments of risk and attitudes to screening.

To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. A population based cross sectional survey. A general practice with a broad mix of socioeconomic groups in one district health authority. A total of 1600 subjects aged 25-69 years stratified using the social deprivation score of wards were randomly selected from a population of 8000; 77% (1227) returned the questionnaire and 56% (896) attended for screening. Questionnaire measures of confidence in own ability to self assess risk factors for melanoma, attitudes to seeking medical help for skin abnormalities, and self assessment of relative risk of developing melanoma. Clinic attenders were less confident in their ability to self assess risk factors (p<0.005), more favourable towards seeking help (p<0.001), and more pessimistic about developing melanoma (p<0.001) than non-attenders. Those from more affluent wards were more willing to seek help (p<0.001). Those clinically assessed as at higher risk were more pessimistic about developing melanoma (p<0.001) but clinical assessments were inconsistently related to help seeking attitudes and self assessment confidence. Barriers to the uptake of screening included greater optimism about not developing melanoma, confidence in self assessment, and reluctance to seek professional help. Such reluctance was greater in more deprived social groups. Targeting screening at high risk groups cannot depend on self identification and self referral.

Standardized health check data from community-dwelling elderly people: the potential for comparing populations and estimating need.

The main aim of this study was to compare EASY-Care data obtained during nurse-administered annual health checks in two populations of older people. A secondary aim was to determine whether a standardized assessment system administered as part of routine practice by a trained nurse during the over-75 health check could generate useful information for comparing population health and functional status of community-dwelling-older people. One hundred and seventy-nine elderly people (aged 75 years and over) from the Woodstock ward, Belfast, having relatively high deprivation; and 238 elderly people from south Hampshire, ranging from affluent wards in New Forest to inner city wards, were assessed using the EASY-Care assessment system as part of their annual health check. There was a high response rate to the standardized assessment in both populations (75% and 79%). Compared to people in south Hampshire, the people in Belfast had higher relative risk of having fair/poor self-rated health, and lower relative risk of having good/sufficient accommodation and of having difficulty chewing. People in Belfast had a higher relative risk of being dependent for six of the seven IADL items and for continence of urine, bathing, grooming, use of the stairs and dressing among the ADL items. The results demonstrate the ability of data generated by assessment system to discriminate between populations of older people when used as part of routine practice. Differences in health and functional status may be associated with deprivation. Data collected during the annual health check about the health and functional status of older people could provide a useful adjunct to census and survey data to measure population needs and to support locality planning.

Variations in use of cardiology services in a health authority: comparison of coronary artery revascularisation rates with prevalence of angina and coronary mortality

Objective: To explore the relation between rates of coronary artery revascularisation and prevalence of angina to assess whether use of health services reflects need.Design: Prevalence of angina symptoms determined by...

Access to elective surgery at electoral ward level: the impact of the private sector

Purchasers of health care receive no routine information on the use of the private health sector by their residents, and are consequently unaware of any resulting differentials in access to health services. This information would assist in assessing need for services on a locality basis. For the period 1990-1992 surgical activity data from the single private hospital in Preston were examined by electoral ward of residence and compared with corresponding NHS data. For the procedures examined, the private sector contributed only 8 per cent to overall surgical activity within Preston. People from the more affluent wards were far more likely to use the private sector than those from deprived wards. The private sector did not introduce any inequity of access to surgery within Preston at electoral ward level. However, in districts with higher levels of private sector activity significant differentials in access may exist.

Health needs in a London district

The hospital admission rate in Inner London Is higher than for the country as a whole. This could be because more beds are available or because the local population has special needs. This paper considers admission rates by electoral wards within one Inner London District. The paper shows that the high admission rates are characteristic of electoral wards which exhibit severe social deprivation and that the more affluent wards do not have high hospitallsation rates despite the fact that residents of all electoral wards have equal access to hospital. Our conclusion is that the high hospitalisation rates in Inner London are at least In part due to social deprivation and that any allocation of health resources needs to make adequate and additional provision for the health needs of communities which are socially deprived.