Health and mortality variations across the urban-rural continuum : context, composition or migration

Allan, R. L. (2019) Doctoral thesis. University of Liverpool. [ONS LS]

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Researchers and academics alike have long been interested in geographic inequalities in health within industrialised countries. Whilst many have attempted to investigate urban-rural variations, an important dimension of residential context, results have proved inconclusive with numerous theories emerging as a result (Teckle et al 2012). One theory to materialise is that of the positive urban-rural health gradient, with poor health tending to increase parallel to increasing levels of urbanisation (DEFRA, 2016, Chilvers, 1978). Others have offered the theory of a U-shaped health continuum, with major cities and remote rural contexts experiencing poorer health in comparison to their semi-urban and semi-rural counterparts (Barnett et al, 2001; Levin, 2003). Finally, some have contested the notion of a rural advantage altogether, proposing a negative urban-rural health gradient (e.g. Lankila et al, 2012). These urban-rural health variations are immersed in contentious debate regarding the causes of such disparities, whether they be contextual (the residential environment), compositional (the socio-demographic characteristics of the population at each location) or migratory (Macintyre et al 1993, Senior et al 2000, Bowler et al 2010, Coutts et al 2013, Higgins et al 2010, Lorenc et al 2012, Ruckerl et al 2011, Alirol 2011, Wallace and Kulu, 2014 Riva et al, 2009). Further, it is unclear if the rural-urban gradient exists/operates in the same way for all disease types or, indeed, in the same way for mortality and morbidity more generally. Nor is it clear at which spatial scale the urban-rural gradient is best studied. Consequently, while urban-rural health and mortality variations have been investigated within industrialised contexts, the rural advantage remains contested, and the reasons for such variations poorly understood. A further aspect of health variations across the continuum requiring attention is gender. Existing studies have for the most part ignored the influence of sex, have been labelled as gender blind, for the majority of studies fail to consider the ways in which health, composition and context interact with gender. Finally and most importantly, there is no universal definition of what constitutes rural or urban. Thus, academics are currently forced to take a pragmatic approach, and utilise a definition which best suits their research needs. Consequently, investigation have been criticised, suggesting that results are simply a 'data artefact', a consequence of the definition used. It is important for the influence of varying definitions upon results to be tested, in order to clarify if urban-rural health differences exist, or are simply a result of the classification utilised. Thus the main aims of this thesis are: 1 To explore health and mortality variations across the Urban-Rural continuum within England and Wales for males and females. 2 To study the sensitivity of results to differing rural-urban definitions and spatial scales utilised. 3 To investigate the underlying causes of health and mortality variations, namely to what extent such disparities are attributable to contextual (the environment) compositional (specifically socio-economic status, education, marital status and ethnicity) or migratory causes, and how these differ across the sexes.

Output from project: 0301790


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