Health inequalities and place: a theoretical conception of neighbourhood

Abstract

In the past 10 years, interest in studying the relationship between area of residence and health has grown. During this period empirical relations between place and health have been observed at a variety of spatial scales, from census tracts to administrative units in metropolitan areas to whole regions, and for a variety of health outcomes. Despite the richness of the data, there are relatively few publications offering theoretical explanations for these observations, and a sound conception of place itself is still lacking. Using place as a relational space linked to where people live, work and play, this paper conceptualises the nature of neighbourhoods as they contribute to the local production of health inequalities in everyday life. In reference to Giddens' structuration theory, we propose that neighbourhoods essentially involve the availability of, and access to, health-relevant resources in a geographically defined area. Taking inspiration from the work of Godbout on informal reciprocity, we further propose that such availability and access are regulated according to four different sets of rules: proximity, prices, rights, and informal reciprocity. Our theoretical framework suggests that these rules give rise to five domains, the physical, economic, institutional, local sociability, and community organisation domains which cut across neighbourhood environments through which residents may acquire resources that shape their lifecourse trajectory in health and social functioning.