Cited by 331Health disparities and outcomesUrban, Neighborhood, and Segregation StudiesUrban Transport and Accessibility

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Neighbourhood effects on health: Does it matter where you draw the boundaries?

Flowerdew, Robin, Manley, David J., Sabel, Clive E.·2008·Social Science & Medicine

DOI 10.1016/j.socscimed.2007.11.042

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Abstract

There has been considerable discussion in health geography and related areas of neighbourhood effects on health: the idea that people's health in one geographical area may be influenced not only by the composition of that area's population, but also by the area's geographical context. Hence, the healthiness or otherwise of the neighbourhood may have an important effect on local people's health. Although neighbourhoods and their boundaries are sometimes obvious to local residents, it is more common to find considerable disagreement on the size and contents of a neighbourhood. In this paper, we use British census Enumeration Districts as building blocks to construct alternative zonal systems, and experiment to see if neighbourhoods defined in different ways have similar implications for health. The well known modifiable areal unit problem shows that analytical conclusions may differ substantially according to how data are aggregated. Boundaries can be drawn to maximize equality of size, compactness of shape, homogeneity in social composition, accordance with 'natural' boundaries, and probably many other factors; which of these criteria are more effective in defining zones relevant to health? One conclusion is that the effect of neighbourhood conditions should be looked at using several different ways to define neighbourhoods, and that the size and composition of these neighbourhoods may be different in different parts of a study area.

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“Smith et al. (1995), Sobal et al. (1996), Krieger et al. (1999), Reijneveld et al. (2000), Lorant et al. (2001), Auchincloss and Hadden (2002), Flowerdew et al. (2008), and Lovasi et al (2008) are all examples of work where using a Wald test statistic to test equality of estimates across different…”
Longitudinal effects of physical and social neighbourhood change on suicide mortality: A full population cohort study among movers and non-movers in the Netherlands.
Hagedoorn, P., & Helbich, M. (2021) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2021.114690 · Cited by 13
Longitudinal exposure assessments of neighbourhood effects in health research: What can be learned from people's residential histories?
Hagedoorn, P., & Helbich, M. (2021) · Health and Place · doi:10.1016/j.healthplace.2021.102543 · Cited by 13
Spatial risk adjustment between health insurances: using GWR in risk adjustment models to conserve incentives for service optimisation and reduce MAUP
Wende, D. (2019) · European Journal of Health Economics · doi:10.1007/s10198-019-01079-6 · Cited by 13
Contextual characteristics associated with the perceived neighbourhood scale in a cross-sectional study in a large urban centre in Brazil
Célio, F. D. A., Friche, A. A. D. L., Jennings, M., Andrade, A. C. D. S., Xavier, C., Proietti, F., Coulton, C., & Caiaffa, W. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-021445 · Cited by 13
Type 2 diabetes care in North Karelia Finland: Do area-level socio-economic factors affect processes and outcomes?
Sikiö, M., Tykkyläinen, M., Tirkkonen, H., Kekäläinen, P., Dunbar, J., & Laatikainen, T. K. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.09.023 · Cited by 13
“[37] Flowerdew R, Manley DJ, Sabel CE.”
Background
Uso de indicadores socioeconómicos del área de residencia en la investigación epidemiológica: experiencia en España y oportunidades de avance
Domínguez-Berjón, M. F., Rodríguez-Sanz, M., Marí-Dell'Olmo, M., Esnaola, S., Prieto-Salceda, M. D., Duque, I., & Rodrigo, M. P. (2014) · doi:10.1016/j.gaceta.2014.04.011 · Cited by 13
“Áreas sanitarias 0 3 (33,3) 0 6 (23,1) 0 7 (17,1) 1 (14,3) 0”
Background
Do infrastructure deserts exist? Measuring and mapping infrastructure equity: A case study in Dallas, Texas, USA
Li, Z., Wang, X.-L., Zarazaga, J., Smith-Colin, J., & Minsker, B. (2022) · Cities · doi:10.1016/j.cities.2022.103927 · Cited by 12
Neighborhood: A Conceptual Analysis.
Milbrath, G., & DeGuzman, P. (2015) · Public Health Nursing · doi:10.1111/phn.12197 · Cited by 12
Neighborhood racial composition and trajectories of child self-rated health: An application of longitudinal propensity scores
Root, E. D., & Humphrey, J. L. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.09.006 · Cited by 9
“It is fairly well established in the literature that choice of neighborhood scale can affect the statistical results of neighborhood effects studies (Flowerdew et al., 2008; Root, 2012; Root & Humphrey, 2014; Weiss et al., 2007).”
Background
Neighborhood Scale and Collective Efficacy: Does Size Matter?
Stein, R. E. (2014) · doi:10.1111/soc4.12127 · Cited by 12
Spatially Weighted Context Data and Their Application to Collective War Experiences
Elcheroth, G., Penić, S., Fasel, R., Giudici, F., Glaeser, S., Joye, D., Goff, J.-M. L., Morselli, D., & Spini, D. (2013) · doi:10.1177/0081175013486757 · Cited by 12
Defining Socially-Based Spatial Boundaries in the Region of Peel, Ontario, Canada
Drackley, A., Newbold, K. B., & Taylor, C. (2011) · International Journal of Health Geographics · doi:10.1186/1476-072x-10-38 · Cited by 9
Geographic variation in preventable hospitalisations across Canada: a cross-sectional study
Wilk, P., Ali, S., Anderson, K., Clark, A., Cooke, M., Frisbee, S., Gilliland, J., Haan, M., Harris, S., Kiarasi, S., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037195 · Cited by 11
Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes
Wentz, A. E., Messer, L. C., Nguyen, T. D., & Boone‐Heinonen, J. (2014) · Health & Place · doi:10.1016/j.healthplace.2014.08.010 · Cited by 13
Variations in Objective Quality of Urban Life Across a City Region: The Case of Phoenix
Guhathakurta, S., & Cao, Y. (2011) · doi:10.1007/978-94-007-1742-8_6 · Cited by 11
The effect of the modifiable areal unit problem (MAUP) on spatial aggregation of COVID-19 wastewater surveillance data.
Zhu, Y.-F., Hill, D., Zhou, Y., & Larsen, D. A. (2024) · Science of the Total Environment · doi:10.1016/j.scitotenv.2024.177676 · Cited by 10
Incorporating diminishing returns to opportunities in access: Development of an open-source walkability index based on multi-activity accessibility
Roper, J., Ng, M., & Pettit, C. (2023) · Journal of Transport and Land Use · doi:10.5198/jtlu.2023.2308 · Cited by 10
“Sometimes neighborhood boundaries are used, but defining neighborhoods is a classic example of the modifiable areal unit problem (Flowerdew et al., 2008), and perceived neighborhoods vary widely (Jenks & Dempsey, 2007).”
Background
Meal frequency and vegetable intake does not predict the development of frailty in older adults
Johannesson, J., Rothenberg, E. M., Gustafsson, S., & Slinde, F. (2018) · Nutrition and Health · doi:10.1177/0260106018815224 · Cited by 10
Importance of the Geocoding Level for Historical Demographic Analyses: A Case Study of Rural Parishes in Sweden, 1850–1914
Hedefalk, F., Pantazatou, K., Quaranta, L., & Harrie, L. (2018) · Spatial Demography · doi:10.1007/s40980-017-0039-7 · Cited by 10
“Several studies have shown the effects of spatial resolution on the aggregation of synthetic point data (e.g., Kang et al. 2014) and real data (e.g., Flowerdew et al. 2008).”
Background
Neighborhood determinants of vulnerability to heat for cardiovascular health: a spatial analysis of Milan, Italy
Nawaro, J., Gianquintieri, L., Pagliosa, A., Sechi, G., & Caiani, E. (2024) · Population and environment · doi:10.1007/s11111-024-00466-3 · Cited by 9
“Therefore, the NIL application may exemplify the Modifiable Areal Unit Problem (Flowerdew et al., 2008) in relation to socio-urban features and CV vulnerability which indeed did not differ significantly across clusters.”
A positive neighborhood walkability is associated with a higher magnitude of leisure walking in adults upon COVID-19 restrictions: a longitudinal cohort study
Spoelder, M., Schoofs, M. C. A., Raaphorst, K., Lakerveld, J., Wagtendonk, A. J., Hartman, Y., van der Krabben, E., Hopman, M. T. E., & Thijssen, D. H. J. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01512-3 · Cited by 10
“Therefore, we were able to reduce the bias of residential self-selection often reported in cross-sectional observational studies [15, 17, 47–49].”
Method
Exploring the Spatial Relative Risk of COVID-19 in Berlin-Neukölln
Lambio, C., Schmitz, T., Elson, R., Butler, J., Roth, A., Feller, S., Savaskan, N., & Lakes, T. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20105830 · Cited by 9
A method for measuring spatial effects on socioeconomic inequalities using the concentration index
Kim, S. W., Haghparast-Bidgoli, H., Skordis-Worrall, J., Batura, N., & Petrou, S. (2020) · International Journal for Equity in Health · doi:10.1186/s12939-019-1080-5 · Cited by 9
“The definition of the neighbourhood is determined at the cluster level due to data availability [63].”
Background
Empirical Zoning Distributions for Small Area Data
Burden, S., & Steel, D. (2016) · doi:10.1111/gean.12104 · Cited by 9
Selecting Spatial Scale of Covariates in Regression Models of Environmental Exposures
Grant, L. P., Gennings, C., & Wheeler, D. (2015) · Cancer Informatics · doi:10.4137/cin.s17302 · Cited by 9
Pre-end-stage renal disease care not associated with dialysis facility neighborhood poverty in the United States
Plantinga, L., Kim, M., Goetz, M., Kleinbaum, D., Mcclellan, W., & Patzer, R. (2014) · American Journal of Nephrology · doi:10.1159/000358067 · Cited by 9
“However, even with census tracts, the true impact on estimated effects by how neighborhood boundaries are drawn (the “modifiable areal unit problem”) remains unknown [34, 35].”
Background
The neighbourhood effect on mental well-being in the Global South
Roy, S., & Sowgat, T. (2024) · Cities & Health · doi:10.1080/23748834.2024.2303565 · Cited by 8
“Community attachment, social unity and close relationships improve mental health since people feel mentally secure and safe (Sampson and Groves, 1989, Flowerdew et al .”
Linking Individuals to Areas: Protecting Confidentiality While Preserving Research Utility
Norman, P. D., Colbert, J. L., & Exeter, D. (2023) · Spatial Demography · doi:10.1007/s40980-023-00121-9 · Cited by 8
“The ‘Modifiable Areal Unit Problem’ (MAUP) warns that different conclusions may be drawn depending on which geographical zones are used in a study (Flowerdew et al., 2008; Openshaw, 1981).”
Background
Perceptions of control over different causes of death and the accuracy of risk estimations
Brown, R., Sillence, E., & Pepper, G. V. (2023) · Journal of public health · doi:10.1007/s10389-023-01910-8 · Cited by 8
“The topography of an area, and whether residential areas are within walking distance of essential services is likely to influence aerobic activity (Flowerdew et al. 2008).”
Neighborhood and Child Development at Age Five: A UK–US Comparison
Buttaro, A., Gambaro, L., Joshi, H. E., & Lennon, M. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910435 · Cited by 8
Individual and contextual predictors of overweight or obesity among women in Uganda: a spatio-temporal perspective
Amegbor, P. M., Yankey, O., Davies, M., & Sabel, C. E. (2021) · GeoJournal · doi:10.1007/s10708-021-10466-7 · Cited by 11
Self-citation
Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study
Kim, M. H., Foverskov, E., Frøslev, T., White, J. S., Glymour, M., Hainmueller, J., Pedersen, L., Sørensen, H., & Hamad, R. (2022) · SSM: Population Health · doi:10.1016/j.ssmph.2022.101312 · Cited by 7
“Fourth, studies have shown that estimates of neighborhood effects may be sensitive to how neighborhood boundaries are defined (Flowerdew, Manley, & Sabel, 2008; Jakobsen, 2021; Lund, 2018).”
Development of a biking index for measuring Mediterranean cities mobility
Ros-McDonnell, L., de-la-Fuente, M., Ros-McDonnell, D., & Cardós, M. (2020) · doi:10.4995/ijpme.2020.10834 · Cited by 7
“physical activity, with findings that people who live in more walkable neighbourhoods walk more, have lower rates of obesity and chronic disease, and travel less by car (Ewing et al., 2003 & 2006; Pucher & Dijkstra, 2003; Forsyth et al, 2007; Flowerdew et al., 2008; Dill, 2009; Frank et al., 2009).”
Background
Indicadores de desigualdade para financiamento urbano de cidades saudáveis
Leite, C., Acosta, C., Herling, T., Barrozo, L., & Saldiva, P. (2019) · Estudos Avançados · doi:10.1590/s0103-4014.2019.3397.003 · Cited by 7
Residential environments and smoking behaviour patterns among young adults: A prospective study using data from the Interdisciplinary Study of Inequalities in Smoking cohort.
Ghenadenik, A. E., Gauvin, L., & Frohlich, K. (2019) · Preventive Medicine · doi:10.1016/j.ypmed.2019.03.003 · Cited by 7

Authors: Flowerdew, R., Manley, D. J., & Sabel, C. E.
Affiliations: University of St Andrews (GB)
Imperial College London (GB)
Corresponding author: Flowerdew, Robin
ORCID: Manley, David J.
Sabel, Clive E.
Venue: Social Science & Medicine
Publisher: Elsevier BV
Published: 2008-03
Volume: 66
Issue: 6
Pages: 1241-1255
ISSN: 0277-9536 (ISSN-L)
DOI: 10.1016/j.socscimed.2007.11.042
OpenAlex: W1967823327
Cited by: 331
References: 0
Citations by year: 2026: 9 · 2025: 11 · 2024: 14 · 2023: 13 · 2022: 15 · 2021: 20 · 2020: 19 · 2019: 22 · 2018: 20 · 2017: 17 · 2016: 34 · 2015: 17 · 2014: 25 · 2013: 26 · 2012: 21
FWCI: 17.00
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Social Science & Medicine (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Explore Bristol Research (submittedVersion)
Bristol Research (University of Bristol) (submittedVersion)
Funders: Joint Information Systems Committee
Economic and Social Research Council
Topics: Social Sciences › Health › Health disparities and outcomes
Social Sciences › Sociology and Political Science › Urban, Neighborhood, and Segregation Studies
Social Sciences › Transportation › Urban Transport and Accessibility
Keywords: neighbourhood boundaries, modifiable areal unit problem, spatial aggregation, neighborhood composition, geographic context, health disparities
MeSH terms: Data Collection, Data Interpretation, Statistical, Environment, Geography, United Kingdom, Health Services Accessibility, Health Status, Humans, Residence Characteristics, Socioeconomic Factors, Small-Area Analysis, Censuses

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Neighbourhood effects on health: Does it matter where you draw the boundaries?

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