Place-based Interventions Research Articles

Co-creating nature-based solutions for healthy and sustainable cities: Urban public health approach

Abstract Issue Urban green spaces are necessary for developing healthy and sustainable cities. Benefits of Nature-based solutions (NBS) that increase the amount and quality of urban green go beyond environmental aspects (noise/air pollution mitigation) and have positive impact on mental health, active lifestyles and social cohesion. However, there is a need for the transdisciplinary co-creation processes including multidisciplinary partners and local community to ensure that different population groups use NBS and that health, social and environmental benefits are maximised. The Horizon2020 project CLEVER Cities (2018-2023) focuses on the development of NBS in deprived areas to address health, socio-economic and ecological challenges in a transdisciplinary co-creation approach. Description The three pilot cities, Hamburg, London and Milan, have formed Urban Innovation Partnerships (UIP) based on the stakeholder mapping. Each UIP involves citizens, companies, universities and local authorities to support CLEVER Action Labs (CAL) as alliances of local actors involved in the co-creation and assessment of place-based NBS interventions. The Theory of Change method (impact chain) was used to structure the transdisciplinary process, by initially determining the desired long-term outcomes related to the above-mentioned challenges. Proceeding from the identification of the local conditions, the necessary “outputs” were identified to achieve short-term and intermediate outcomes, which themselves lead to the determined long-term outcomes. Results/lessons Preliminary results show that Theory of Change provides a good structure for transdisciplinary discussions as well as an overview of a complex transformative change, underlying assumptions and unintended negative effects. Involving urban public health experts is essential to determine the relationship between different NBS and health outcomes, to maximize health benefits for all population groups and to reduce potential side effects. Key messages Inclusion of local community in the collaborative co-creation process is essential to ensure that NBS is adapted to their needs and that the desired health and wellbeing outcomes are achieved. The involvement of urban public health experts in the Theory of Change is essential to raise the awareness about the relationship between NBS interventions, their use and multiple health outcomes.

Let’s talk about place: Considerations for future spatial stigma research

ABSTRACT A growing body of research has considered how spatial stigma can affect the health of individuals who reside in or relocate from stigmatized locales. However, no research has considered ways to mitigate spatial stigma’s effects on health. We consider four possibilities. First, to reduce spatial stigma, we must evaluate policies and initiatives that may perpetuate it. Second, challenging spatial stigma requires acknowledging the limitations of place-based interventions. Third, to reduce the perpetuation of spatial stigma we must actively work to change perceptions about stigmatized places. Lastly, scholars must reconcile how spatial stigma is used as a tool to appropriate space.

Spatial clustering of food insecurity and its association with depression: a geospatial analysis of nationally representative South African data, 2008\u20132015

While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Study (years 2008–2015). Geographical clusters (“hotpots”) of food insecurity were identified using Kulldorff spatial scan statistic in SaTScan. Regression models were fitted to assess association between residing in food insecure hotspot communities and depression. Surprisingly, we found food insecurity hotspots (p < 0.001) in high-suitability agricultural crop and livestock production areas with reliable rainfall and fertile soils. At baseline (N = 15,630), we found greater likelihood of depression in individuals residing in food insecure hotspot communities [adjusted relative risk (aRR) = 1.13, 95% CI:1.01–1.27] using a generalized linear regression model. When the panel analysis was limited to 8,801 participants who were depression free at baseline, residing in a food insecure hotspot community was significantly associated with higher subsequent incidence of depression (aRR = 1.11, 95% CI:1.01–1.22) using a generalized estimating equation regression model. The association persisted even after controlling for multiple socioeconomic factors and household food insecurity. We identified spatial heterogeneity of food insecurity at a national scale in SA, with a demonstrated greater risk of incident depression in hotspots. More importantly, our finding points to the “Food Security Paradox”, food insecurity in areas with high food-producing potential. There is a need for place-based policy interventions that target communities vulnerable to food insecurity, to reduce the burden of depression.

The association between blighted property remediation and domestic crime by alcohol availability.

There is increasing evidence that place-based interventions reduce crime and interpersonal violence in urban settings. However, evidence concerning the impacts of these neighborhood interventions on domestic crime (crime between intimate partners, family, or household members) is inconclusive. We used data from a New Orleans, Louisiana, place-based blighted property remediation intervention to test the hypothesis that the intervention was associated with changes in domestic crime. Because there is evidence that alcohol availability is related to domestic crime, we also assessed whether this association was moderated by alcohol outlet density. We assessed overall associations using a difference-in-difference approach and assessed moderation using a triple-difference approach. The analytic sample consisted of 204 remediated lots and 612 non-remediated matched control lots over 84 months (2011-2017), for a total of 68,544 lot-months. In difference-in-differences analyses, the place-based intervention was associated with additional domestic crime incidence (β=0.311, 95% CI: 0.016, 0.605; p=0.039). In triple-difference analyses, on-premise bar density modified this association (β=-0.119, 95%CI: -0.147, -0.092; p<0.001): in areas with higher bar density, increases in domestic crime were lower near remediated lots compared with control lots. Place-based interventions to reduce blighted properties may have contributed to fewer domestic crime incidents in areas with more bars.

Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018).

Rapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a longitudinal study design (“primary evaluations”). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.

Geographically Targeted Place-Based Community Development Interventions: A Systematic Review and Examination of Studies’ Methodological Rigor

ABSTRACT Targeted interventions to improve specific geographic areas have been a significant policy and intervention tool for the past 50 years. However, few reviews provide a comprehensive examination of studies’ methodological rigor that assesses the effects of geographically targeted place-based community development interventions across intervention types. Accordingly, this review synthesizes research on geographically targeted place-based community development interventions to identify strategies utilized, outcomes measured, methodological strengths and limitations, and intervention effectiveness. A systematic search yielded 31 articles representing 29 unique studies for review. The methodological quality of each study was assessed, and intervention effects were examined. Workforce and economic development programs are the most commonly evaluated intervention in this review, whereas property value is the most common outcome measured. Geographically targeted interventions are effective at increasing property values but achieve mixed results across other indicators. Recommendations include measurement of consistent outcomes and conducting program-wide and site-specific analyses to assess intervention effectiveness.

Cities in polarised socio-economics space of Poland

The process of socio-economic development is subject to changes resulting from the interaction of contemporary socio-economic megatrends which modify the influence of development factors and affect the polarisation of development in space. The measures to date, adopted as part of the cohesion policy and intended to decrease the differences, have not produced the desired results. This leads to the search for new solutions which include place-based intervention. Here a special role is played by the largest cities performing the function of development poles. They can positively affect the development of the surrounding area. The work aims to identify the importance of cities in terms of socio-economic inequalities in Poland. The analysis is carried out at the local level and covers the years 2004-2016. The research includes three stages. What is discussed in the first is the role of cities as development poles. The second presents an analysis and classification of spatial differences in the level and dynamics of the development of the largest cities. The third stage determines the influence of these cities on the surroundings.

Measurement of Social Processes at the Neighborhood Level in Baltimore City.

Small-area ecological research is critical to inform place-based interventions at the neighborhood level; however, objective measurement of the social context has been limited. The current study extends the application of the Neighborhood Inventory for Environmental Typology (NIfETy) through the development and evaluation of measures of social context for a longer period of observation (3years) and at a larger area of aggregation (census tract clusters) compared to previous studies using measures at the block-face level from a single observation. Observations from the 172-item inventory were collected from a random sample of block faces (n=793) in Baltimore City annually over a three-year period. Through a multistep process including replication of previous measures, data reduction, and factor analysis, six unique neighborhood-level indices were generated to describe the environmental context: drug and alcohol use, violence, physical disorder, epicenter, youth activity, and improvements. An assessment of measurement consistency and validity provided support for some indices, while others had notable limitations. These indices can assist local policymakers and public health practitioners assessing the needs of individual neighborhoods and evaluating the effectiveness of place-based interventions designed to improve the neighborhood environment and population health outcomes.

The effects of supporting local business: Evidence from the UK

This paper assesses the effects of a significant place-based intervention that targeted local businesses in deprived areas in the UK. To gain identification, we use data at a fine spatial scale and a regression discontinuity design exploiting the eligibility deprivation rank rule based on a pre-determined deprivation index. We detect no overall effects on employment in treated areas but find a significant displacement of employment from nearby untreated areas, corresponding to around 10% of local employment. The results suggest that indirect displacement effects may substantially weaken the ability of local support programmes targeting the non-tradable sector to reduce economic inequality.

Poor Health and Violent Crime Hot Spots: Mitigating the Undesirable Co-Occurrence Through Focused Place-Based Interventions

The geographic overlap of violence and poor health is a major public health concern. To understand whether and how place-based interventions targeting micro-geographic places can reduce this undesirable co-occurrence, the study addresses 2 important questions. First, to what extent are deteriorated health conditions associated with living at violent crime hot spots? Second, through what mechanisms can focused place-based interventions break the association between living with violence and deteriorated health? This study used survey data from 2,724 respondents living on 328 street segments that were categorized as violent crime hot spots (181 segments with 1,532 respondents) versus non-hot spots (147 segments with 1,192 respondents) in 2013-2014 in Baltimore, Maryland. Propensity score analysis assessed whether individuals living at violent crime hot spots had lower general health perceptions than people living at non-hot spots. Marginal structural models estimated the proportion of total effects mediated by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019. Respondents living at violent crime hot spots had a lower level of self-rated general health (b= -0.096, 95% CI= -0.176, -0.015) and higher levels of health limitations (b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those living at non-hot spots. Enhanced perceptions of safety, collective efficacy, and police legitimacy may break the association between living in places with extremely high levels of violence and deteriorated health. Indicated or selective strategies are urgently needed to target micro-geographic locations with known increased risks, supplementing universal strategies applied to a broader community.

State governments as financiers of technology startups: Evidence from Michigan's R&D loan program

State governments in the United States often fund and support technology startups within their borders. Yet little is known about the magnitude with which these place-based policy interventions shift the performance trajectories of entrepreneurial firms. We provide new evidence based on 241 startups that compete for advanced research and technology commercialization loans between 2002 and 2008 through a Michigan-based program. Among applicants with project scores near the threshold required for funding, we find that award recipients are 20%–30% more likely to remain in business four years after the competition relative to similar companies that seek but fail to receive funding. We also find that award receipt stimulates follow-on venture capital (VC) investments in surviving companies. The VC stimulus effect is, however, disproportionately driven by subsets of firms that are very young, relatively inexperienced at external fundraising, or located outside the dominant hub of entrepreneurial activity within the state. This distinctive pattern of heterogeneous effects remains visible for follow-on R&D financing from federal government sources, and for supplemental outcome measures that use news articles to track shifts in financing and business development activities. These findings are consistent with the view that public R&D programs are particularly beneficial when frictions in private resource markets are more severe.

Creating place-based health and wellbeing networks in rural and remote communities.

Creating place-based health and wellbeing networks in rural and remote communities.

Addressing Challenges to Coordinating the Implementation of Place-Based Chronic Disease Prevention Interventions in Los Angeles.

Chronic disease prevention initiatives have traditionally been structured to address a single disease, potentially limiting the scope of health impacts. In the past decade, initiatives have increasingly adopted a coordinated approach, in which multiple interventions are intended to work synergistically-often in a bounded geographic area-to address interrelated risk factors and diseases. However, despite increased interest in this coordinated approach, few examples exist of how coordination has been operationalized in local public health practice. In 2014, the Los Angeles County Department of Public Health launched the 4-year Chronic Disease Prevention Strategy (CDPS). Through CDPS, the Los Angeles County Department of Public Health implemented a range of environmental, lifestyle change, and health system interventions intended to collectively reduce chronic disease among adults in Los Angeles, with concentrated implementation occurring in 1 high-need neighborhood. This case study examined the activities undertaken to coordinate across CDPS interventions and documented challenges to these efforts. Data were collected via a document review of programmatic materials and structured conversations with staff leading implementation of CDPS interventions. Document review and structured conversations with staff identified 3 primary coordination activities: (1) collaborating on outreach materials to unify messaging, (2) developing a network of common partners, and (3) investing in shared data collection. Operational challenges identified were disparate short-term objectives across interventions, minimal alignment between clinical practice and CDPS goals, restrictions around bidirectional referrals between organizations, and limited bandwidth among new partners to engage with multiple CDPS interventions. Contextual challenges identified were competing social and political issues, and geographic fluidity regarding where community members sought health resources. Developing an initiative-specific coordination plan prior to implementation may help reduce challenges to coordination. Modifications in how health initiatives are funded and structured may be needed: greater flexibility in how funding is administered, and the inclusion of coordination-specific metrics, may enable more robust coordination.

Politically Connected Cities: Italy 1951–1991

The paper estimates the political connection premium for Italian cities tracked during the second half of the 1900s, when the role of the state in the economy was very widespread. It leverages the peculiar features of the gridlocked political landscape in place between the end of World War II and the fall of the Berlin wall, during which most influential politicians remained in charge for a very long time. We compare connected cities - small areas surrounding birthplaces of both prime ministers and leaders of the parties in power - with very similar, but unconnected municipalities, and find that politically connected cities gained a population premium of 8% over 40 years. When the connection ends, the difference in growth rate fades away. We document that birthplaces of powerful politicians benefited from both infrastructure investments and the location of plants by state-owned enterprises. Not surprisingly, the connection favored industrialization, raised employment and wages, but crowded out private entrepreneurship. Finally, our empirical evidence indicates that agglomeration economies in treated municipalities were not higher, thus suggesting that, if anything, place-based interventions linked to political connections have not been output-enhancing from a nationwide point of view.

Regenerating Our Place: Fostering a Sense of Place Through Rehabilitation and Place-Based Education

This study examines the effects of a place-based intervention program on the sense of place of Bedouin elementary school students. These students live on the banks of the polluted Hebron Stream in Israel, where a three-pronged restoration program has recently been established, including the stream’s rehabilitation, the establishment of local waste treatment, and an environmental education program. Our study follows groups of fifth-graders (n = 107) throughout a 2-year, place-based learning program in the Hebron Stream area. The program’s purpose is to teach students about authentic environmental phenomena in the stream’s surroundings, while fostering their sense of attachment to the stream. Data were gathered, before, during, and after the intervention, via drawings and individual interviews, and analyzed using quantitative and qualitative content analysis. The findings show that after the intervention, Hebron Stream became part of the students’ sense of place, with many students drawing a cleaner, more esthetically pleasing stream, and about a third drawing the stream as a “healthy” ecosystem. The students’ explanations of their drawings showed a rise in their awareness of the stream’s importance as a natural resource, and an increased awareness of the relationship between the stream, the community, and political-economic situation. Though they were openly critical of flaws in the current progress of the restoration process, they also expressed optimism regarding the improvement in the stream’s conditions that contrasted sharply with their earlier fatalistic attitudes. This change in attitude was also expressed in declared changes in the students’ personal environmental behaviors. The results of this study provide a comprehensive understanding of the relationship between people and their immediate environment. It offers both pedagogical and theoretical recommendations for studies of sense of place and place-based education initiatives undertaken in contaminated natural environments.

The power of place in public leadership research and development

PurposeThe purpose of this paper is to foreground place as a critical and central concern for public leadership research, development and practice.Design/methodology/approachThis invited essay draws on the author’s own research and development work engaging in collaborative place-based interventions with academics, policy makers and practitioners.FindingsPlace is one of six heuristic lenses in a Leadership Hexad that has been developed to interrogate and better understand leadership in a multi-dimensional manner. Place can provide an important theoretical and practical fulcrum for bridging both collaborative governance and collective leadership and public and political leadership as well as facilitating cross-sectoral leadership.Practical implicationsThis essay argues that more time and effort should be invested into researching and developing place leadership to complement the already extensive efforts to promote collaborative governance and place-based policy initiatives. Place leadership development should be genuinely cross-sectoral in its ambition and should focus on developing emerging and established leaders from the public, private, not-for-profit and indigenous sectors to tackle place-based problems and opportunities.Originality/valueThis essay draws on experience undertaking academic research and conducting leadership development that draws from and feeds into policy and practice. It utilises research from geography, leadership studies, public management, public policy and political science to gain a more sophisticated understanding of the relationship between place and public leadership and how this can be harnessed to improve economic and social impact.

Estimating Fine-Scale Heat Vulnerability in Beijing Through Two Approaches: Spatial Patterns, Similarities, and Divergence

High temperatures in urban areas cause a significant negative impact on the residents’ health. In a megacity such as Beijing, where both the land cover and social composition of residents are highly spatially heterogeneous, understanding heat vulnerability at a relatively fine scale is a prerequisite for place-based heat intervention actions. Both principal component analysis (PCA) and equal-weighted index (EWI) are commonly used in heat vulnerability studies. However, the extent to which the choice of these approaches may impact the results remains unclear. Our study aimed to fill this gap by estimating heat vulnerability at the jiedao scale (the smallest census unit) in Beijing based on socioeconomic characteristics, heat exposure, and the use of air conditioners. Our results show that the choice of methods had a considerable impact on the spatial patterns of estimated heat vulnerability. PCA resulted in a ring-like pattern (high in the central and low in the suburb), whereas EWI revealed a north–south discrepancy (low in the north and high in the south). Such a difference is caused by the weighting scheme used in the PCA. Our findings indicate that heat vulnerability pattern revealed by a single measure needs to be interpreted with caution because different measures may produce disparate results.

Hotspots of childhood obesity in a large metropolitan area: does neighbourhood social and built environment play a part?

BackgroundEffective place-based interventions for childhood obesity call for the recognition of the high-risk neighbourhoods and an understanding of the determinants present locally. However, such an approach is uncommon. In this study, we identified neighbourhoods with elevated prevalence of childhood obesity (‘hotspots’) in the Porto Metropolitan Area and investigated to what extent the socio-economic and built environment characteristics of the neighbourhoods explained such hotspots.MethodsWe used data on 5203 7-year-old children from a population-based birth cohort, Generation XXI. To identify hotspots, we estimated local obesity odds ratios (OR) and 95% confidence intervals (95%CI) using generalized additive models with a non-parametric smooth for location. Measures of the socio-economic and built environment were determined using a Geographic Information System. Associations between obesity and neighbourhood characteristics were expressed as OR and 95%CI after accounting for individual-level variables.ResultsAt 7 years of age, 803 (15.4%) children were obese. The prevalence of obesity varied across neighbourhoods and two hotspots were identified, partially explained by individual-level variables. Adjustment for neighbourhood characteristics attenuated the ORs and further explained the geographic variation. This model revealed an association between neighbourhood socio-economic deprivation score and obesity (OR = 1.014, 95%CI 1.004–1.025), as well as with the presence of fast-food restaurants at a walkable distance from the residence (OR = 1.37, 1.06–1.77).ConclusionsIn our geographic area it was possible to identify neighbourhoods with elevated prevalence of childhood obesity and to suggest that targeting such high-priority neighbourhoods and their environmental characteristics may help reduce childhood obesity.

The Association of Unhealthy Diet with Socioeconomic Inequality in Children: A Study in Kurdistan, West of Iran

Background: The prevalence of obesity is an increasing public health problem. Objectives: The present study aimed at estimating the prevalence of unhealthy diet among children aged 10 - 12 years in Kurdistan, west of Iran and assessing the association of unhealthy diet with socioeconomic inequality. Methods: The present cross-sectional study was conducted on 2506 children living in Sanandaj city, west of Iran in 2015. The subjects were selected from the schools by multistage sampling method. The required data were collected using the food frequency questionnaire. The socioeconomic status (SES) was calculated by measuring household asset by using principal component analysis technique. The inequality was measured using concentration index, and Blinder-Oaxaca decomposition method was utilized to determine the proportion of different determinants causing inequality. Results: The prevalence of unhealthy diet was 50.75% (95% confidence interval (CI): 48.79 - 52.71). The concentration index for unhealthy diet was -0.14 (95% CI: -0.18, -0.09), indicative of concentration of unhealthy diet in the group with low SES (P < 0.001). The Blinder-Oaxaca decomposition analysis showed that the poor-rich gap in the prevalence of unhealthy diet was 27.77%, while 59.41% of the observed gap attributed to the explained component. The major causes of inequality were mother’s level of education and place of residence, respectively. Conclusions: The obtained results showed that the prevalence of unhealthy diet was higher in children with low SES. Increasing mothers’ awareness of health literacy and performing place-based interventions can be effective in decreasing socioeconomic inequalities in unhealthy diet and prevention of chronic diseases in children.

Creating Safe And Healthy Neighborhoods With Place-Based Violence Interventions.

Violence is a leading cause of death and disability in the United States and abroad, with far-reaching consequences for individuals and communities. Interventions that address environmental and social contexts have the potential for greater populationwide effects, yet research has been slow to identify and rigorously evaluate these types of interventions to reduce violence. Several urban communities across the US are conducting experimental and quasi-experimental community-based research to examine the effect of place-based interventions on violence. Using examples from Philadelphia, Pennsylvania; Flint, Michigan; Youngstown, Ohio; and New Orleans, Louisiana, we describe how place-based interventions that remediate vacant land and abandoned buildings work to reduce violence. These examples support the potential for place-based interventions to create far-reaching and sustainable improvements in the health and safety of communities that experience significant disadvantage. These interventions warrant the attention of community stakeholders, funders, and policy makers.