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Explanatory models concerning the effects of small-area characteristics on individual health.
Autor | Voigtländer S,
Vogt V, Mielck A, Razum
O |
Verlag | International Journal of
Public Health 59: 427-38 |
Zusammenfassung
Objectives
Material and social living
conditions at the small-area level are assumed to have an effect on
individual health. We review existing explanatory models concerning
the effects of small-area characteristics on health and describe the
gaps future research should try to fill.
Methods
Systematic literature search for, and analysis of, studies that
propose an explanatory model of the relationship between small-area
characteristics and health.
Results
Fourteen
studies met our inclusion criteria. Using various theoretical
approaches, almost all of the models are based on a three-tier
structure linking social inequalities (posited at the macro-level),
small-area characteristics (posited at the meso-level) and
individual health (micro-level). No study explicitly defines the
geographical borders of the small-area context. The health impact of
the small-area characteristics is explained by specific pathways
involving mediating factors (psychological, behavioural,
biological). These pathways tend to be seen as uni-directional; often,
causality is implied. They may be modified by individual factors.
Conclusions
A number of issues need more attention in
research on explanatory models concerning small-area effects on
health. Among them are the (geographical) definition of the
small-area context; the systematic description of pathways comprising
small-area contextual as well as compositional factors; questions of
direction of association and causality; and the integration of a time
dimension.
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