What do we know about the health and socio-economic impacts of neighbourhood renewal?

1. What do we know about the health and socio-economic impacts of neighbourhood renewal? Hilary Thomson MRC Social & Public Health Sciences Unit, Glasgow

2. Socio-economic impacts urban regeneration & neighourhood renewal • National (UK) ABI programmes 1980 to 2004: Start date • Urban Programme 1969 • Urban Development Corporations 1981 • New Life for Urban Scotland 1988 • Estate Action 1991 • City Challenge 1992 • Small Urban Renewal Initiatives 1993 • Single Regeneration Budget 1995 • Social Inclusion Partnerships 1996 • New Deal for Communities 2001 (not included)

3. Impacts: unemployment @ 2-10 years • Improvement- but rarely in addition to national trend • Possibility of deteriorating effect

4. Impacts: educational achievement at school Pupils gaining ‘>4 GCSEs’ or ‘>2 Standard Grades’ • Improvement- but not in addition to national trend

5. Other impacts: housing & income • Housing quality: 1 evaluation • Improved • Rent: 1 evaluation • Rent increased in majority of case study areas • Household income <£100/week: 2 evaluations • Small improvement • Other impacts rarely assessed- both negative and positive impacts reported

6. Health impacts urban regeneration • National (UK) ABI programmes 1980 to date: Start date • Urban Programme 1969 • Urban Development Corporations 1981 • New Life for Urban Scotland 1988 • Estate Action 1991 • City Challenge 1992 • Small Urban Renewal Initiatives 1993 • Single Regeneration Budget 1995 • Social Inclusion Partnerships 1996 • New Deal for Communities 2001 • 4 most recent programmes included ‘health’ in at least one evaluation of impacts

7. Impacts: self-reported health • * No change or deterioration in comparison to control area • Little or no health impact- possibility of deteriorating health

8. Impacts: mortality @ 3-6 years • Possible improvement but: • Genuine improvement would have to be over and above national trend of ongoing improvements in mortality rates

9. Health impacts of neighbourhood renewal • National (UK) ABI programmes 1980 to date • Other evidence from smaller studies of housing-led neighbourhood renewal • Systematic review of available research (anywhere in the world)

10. Health impacts of housing-led neighbourhood renewal 11 studiessince 1995 • (9 from UK) • Little or no change in mental or physical health outcomes (mean follow-up time 1-2 years) • Little evidence of adverse health impacts

11. Summary of available evidence on impacts National urban regeneration programmes • socio-economic determinants of health? • Employment & education: small improvements but rarely in addition to wider trends • Adverse impacts a possibility • health? • Unclear: rarely assessed Housing-led renewal improvements • socio-economic circumstances determinants of health? • Unknown: rarely assessed • health? • Little or no change

12. Why are the reported health (and other) impacts of housing-led regeneration so small? Intervention issues • Not targeted according to individual need • Housing-led renewal likely to be diffuse across an area • Wide range of intervention type • Additional neighbourhood change/relocation • Potential for disruption related to improvement Evaluation issues • Difficult to detect • Diffuse intervention, mobile population….. • Timescale for health effect • Look at proximal effects • Difficult to attribute • Multiple confounding factors- wider economic influences etc

13. Room for improvement? • Need to generate better evidence on the actual impacts of regeneration investment • Improved evaluation • Reporting • Methods • Assessing direct impacts on socio-economic outcomes • Map out pathways for expected impacts

14. Room for improvement? • Health impacts may take many years to emerge • Small impacts difficult to detect • Assess change for people rather than place Need • Long term follow-up • Large samples • Need individual level data

15. Is new improved evaluation the answer? • Long term follow-up evaluation • Very costly • Response rates very low • Even with ideal long term evaluation • Introduces multiple confounders over time Need to agree realistic expectations of evaluations

16. Room for improvement? Criticisms of area based renewal programmes • Relatively modest investment • Not tackling societal causes of inequality • May only address one determinant of health e.g. housing quality Need for realistic expectations of investment

17. Neighbourhood renewal and health • Not grounds to abandon as a healthy investment • established links between poverty and health provide strong support • ‘impacts uncertain’ not ‘certainly no impact’ • At population level small impacts are important • Little evidence of harm • Need to remain open to the possibility of adverse effects

18. Economic and neighbourhood regeneration as a healthy investment: a solid foundation? • Strong evidence to support investment to improve socio-economic determinants of health • Keep open mind about possible impacts (+/-) • Scope to improve what is known about impacts on health and socio-economic determinants of health • Agree realistic expectations of what both investment and evaluation can achieve