Social Justice in Public Health for Public Health Professionals. Renee Walker, DrPH, MPH

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Justice in Public Health for Public Health Professionals Slide 1 Neighborhood

of Wisconsin-Milwaukee This week we will look at neighborhood environment and health.

Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging

1 Justice in Public Health for Public Health Professionals Slide 1 Neighborhood Environment & Health Renee Walker, DrPH, MPH Zilber School of Public Health University of Wisconsin-Milwaukee This week we will look at neighborhood environment and health. This part of the course presents a brief review of the emerging issues in neighborhood research. Slide 2 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities One of the emerging issues in neighborhood research is social selection versus social causation in terms of residential preference.

Selection Causation Although some of the geographic

residential preferences, it is also overwhelmingly

live. It is common to hear of banks that refused

routinely exercise their veto power to prevent

on class, color, or other discriminatory grounds.

2 Justice in Public Health for Public Health Professionals Slide 3 1. Selection Causation Although some of the geographic patterning of health undoubtedly reflects residential preferences, it is also overwhelmingly true that many people have no choice about where to live. It is common to hear of banks that refused mortgage loans to minority applicants who wish to purchase new homes. Homeowner associations in gated communities routinely exercise their veto power to prevent families from moving in their neighborhoods based on class, color, or other discriminatory grounds. Very seldom do people with means deliberately choose to move into disadvantaged neighborhoods. So in other words, context determines people s choices. 2

Justice in Public Health for Public Health Professionals Slide 4 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative

3 Justice in Public Health for Public Health Professionals Slide 4 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities Another issue in neighborhood research is the need to distinguish the contextual effects of neighborhood from compositional effects. The reason we study the differences is to convince decision makers that the characteristics of places where people live have an influence on health independent of the characteristics of the people in them, somewhat related to residential selection we just talked about. 3

Justice in Public Health for Public Health Professionals Slide 5 2.

To take a simple example, many researchers have controlled for personal income when looking for the

If a residual and statistically significant effect of neighborhood income persists after such a procedure,

by which individuals end up being sorted into low and high incomes.

high-paying jobs. That s why it has been quoted people make places and places make people.

control for a host of individual level risk factors as confounders of neighborhooddisease association.

It may be reported that grocery owners stock a limited range of foods in response to limited local demands

4 Justice in Public Health for Public Health Professionals Slide 5 2. Contextual Compositional Effects Few personal characteristics are truly exogenous to the social environment. To take a simple example, many researchers have controlled for personal income when looking for the contextual effect of neighborhood income on mortality risk. If a residual and statistically significant effect of neighborhood income persists after such a procedure, then it can be concluded that area-level income exerts an independent contextual effect on individual mortality risk. However, the procedure just described overlooks the fact that residential segregation is a powerful mechanism by which individuals end up being sorted into low and high incomes. Where one lives affects both the quality of one s education as well as access to labor markets and high-paying jobs. That s why it has been quoted people make places and places make people. The type of statistical over-adjustment just described applies also to multilevel analyses that attempt to control for a host of individual level risk factors as confounders of neighborhooddisease association. A low-quality diet is often the consequence of limited food choices available in poor neighborhoods. It may be reported that grocery owners stock a limited range of foods in response to limited local demands for healthy foods, but even if that is the case, an individual resident expressing a preference to eat a healthy diet is nonetheless denied the opportunity to eat well, because of the decisions made by others. This is an example of a contextual effect. While policy makers may wish to know whether they should intervene on people or the places where people live, very likely the correct answer is BOTH. 4

5 Justice in Public Health for Public Health Professionals Slide 6 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities The third issue in neighborhood research is the need to distinguish the psychosocial from materials explanations. 5

Justice in Public Health for Public Health Professionals Slide 7 3.

to crime, the loss of the reputation of a neighborhood, and a loss of self-esteem.

For both researchers and policy makers, it would be helpful to identify which mechanism (psychosocial

Some problems, such as cognitive impairment due to lead-contaminated housing, have everything to do

Other problems, such as the contagion effects of high smoking prevalence within an area among

6 Justice in Public Health for Public Health Professionals Slide 7 3. Psychosocial Material Explanations Broken windows and abandoned vehicles can lead to crime, exposure to crime, the loss of the reputation of a neighborhood, and a loss of self-esteem. In turn, crime and social disorder can lead to the flight of commercial facilities and banks. For both researchers and policy makers, it would be helpful to identify which mechanism (psychosocial or material) would more effectively address specific health problems. Some problems, such as cognitive impairment due to lead-contaminated housing, have everything to do with materials living conditions and nothing to do with psychosocial mechanisms. Other problems, such as the contagion effects of high smoking prevalence within an area among adolescents, have a significant psychosocial component. Therefore, a successful neighborhoodbased intervention might involve networks of peer counselors to help boost levels of self-efficacy to resist peer pressure to smoke. 6

7 Justice in Public Health for Public Health Professionals Slide 8 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities The fourth issue in neighborhood research is the need to distinguish the subjective assessment from objective assessment. Actually this is related to materials versus psychosocial differences we just discussed. 7

Justice in Public Health for Public Health Professionals Slide 9 4.

environment frequently display less variation than objective assessments do.

can result in a misleading impression of sameness, leading researchers to falsely

transport services or the range of foods available in local grocery stores) often

Why does this subjective-objective discrepancy happen?

Lessons from educational psychology taught us to be wary of parental assessments of the

8 Justice in Public Health for Public Health Professionals Slide 9 4. Subjective Objective Assessments Residents self-reporting on their neighborhood environment frequently display less variation than objective assessments do. For example, asking residents to rate the adequacy of services within their neighborhoods can result in a misleading impression of sameness, leading researchers to falsely conclude that services do not matter in terms of explaining between-place variation in health outcomes. However, an objective count of the same services (for example, the number of local transport services or the range of foods available in local grocery stores) often provides a picture of much wider, and telling, variations. Why does this subjective-objective discrepancy happen? A well-known phenomenon of psychological adjustment is part of the reason to explain this. Lessons from educational psychology taught us to be wary of parental assessments of the quality of their children s day care because few parents would admit to sending their children to substandard day care. So can we cay, subjective rating of neighborhood environment is useless? No, we can t. Subjective rating of crime (and fear of crime) is a stronger predictor of behavior (that is, reluctance go to outdoors to exercise) than are actual crime rates. Subjective assessments therefore tell us something over and above objective data. Cleary, we need both. 8

9 Justice in Public Health for Public Health Professionals Slide 10 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities Following on the theme of subjective versus objective ways of knowing, a further tension in neighborhood research arises between qualitative versus quantitative approaches to study design and analysis. It is well known that qualitative and quantitative approaches offer complementary insights into neighborhood processes and how they affect health. 9

Justice in Public Health for Public Health Professionals Slide 11 5.

neighborhood processes within a historical context.

portraits of the realities of people s daily lives.

convincing story about HOW places can affect people s hope, aspirations, opportunities, and

Nevertheless, qualitative approaches are rarely sufficient enough to produce action because

10 Justice in Public Health for Public Health Professionals Slide Quantitative Qualitative Approaches Qualitative approaches offer the advantage of grounding neighborhood processes within a historical context. Thick descriptions of neighborhoods are uniquely suited for providing indepth, contextual portraits of the realities of people s daily lives. Therefore qualitative approaches are effective in communicating to decision makers a convincing story about HOW places can affect people s hope, aspirations, opportunities, and misery, as well as levels of wellbeing. Nevertheless, qualitative approaches are rarely sufficient enough to produce action because they are limited to observations of a relatively small number of individuals within a limited geographic location. So qualitative description usually lacks of generalizability and here quantitative approaches help to point to more generalized phenomena. 10

11 Justice in Public Health for Public Health Professionals Slide 12 Psychosocial Material Explanations Subjective Objective Assessments Contextual Compositional Effects Quantitative Qualitative Approaches Selection Causation Emerging issues in neighborhood research Neighborhoods Communities The final, and possibly most challenging, question concerns the distinction between neighborhoods and other forms of community. 11

Justice in Public Health for Public Health Professionals Slide 13 6.

of neighborhood or communities, do we use Census Tracts, blocks, or

And what components fall into the boundaries?

And if so, how do geographically defined neighborhood and virtually defined

Through the same mechanism or different mechanism?

These are all questions we need to think about more, and answer.

online mini-lectures that were originally offered as part of a fully online

interested in earning a Master of Public Health degree. Dr. Alice Yan and Dr.

12 Justice in Public Health for Public Health Professionals Slide Neighborhoods Communities The challenge lies in how do we define the boundaries of neighborhood or communities, do we use Census Tracts, blocks, or historically defined neighborhoods? And what components fall into the boundaries? Could neighborhoods or communities be multidimensional? Is the neighborhood more physical? Can a community be a virtual community since the rapid spread of the Internet? And if so, how do geographically defined neighborhood and virtually defined neighborhood influence health? Through the same mechanism or different mechanism? And how different could it be? These are all questions we need to think about more, and answer. Slide 14 Acknowledgements This presentation contains excerpts from several online mini-lectures that were originally offered as part of a fully online course in Justice in Public Health, offered to University of Wisconsin students interested in earning a Master of Public Health degree. Dr. Alice Yan and Dr. Renee Walker at the Zilber School of Public Health, University of Wisconsin-Milwaukee narrated the presentations and have taught the online course. The course was originally designed by Dr. Alice Yan and developed in collaboration with UW-Madison Division of Information Technology, Academic Technology and the Wisconsin Center for Public Health Education and Training, or WiCPHET. y (No narration) 12

Thomas Widd: Unit and Lessons Plans

1 - loststories.ca Thomas Widd: Unit and Lessons Plans Note to Teachers Terminology Thank you for your interest in the Lost Stories website. The lesson plans provided here are aimed at middle school and