The evaluation of an urban renewal program and its effects on health and health inequalities in Barcelona (Spain)
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The evaluation of an urban renewal program and its effects on health and health inequalities in Barcelona (Spain)

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Presentation by Roshanak Mehdipanah at the International Conference on Urban Health, Manchester 5th of March 2014. ...

Presentation by Roshanak Mehdipanah at the International Conference on Urban Health, Manchester 5th of March 2014.
Results from the Sophie project.
Video on the evaluation results: https://vimeo.com/92917895

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  • Diseño: Estudio cuasi-experimental <br /> Periodo pre y post-intervención <br /> Un grupo de comparación de barrios no intervenidos con características socioeconómicas similares según indicadores del Censo 2001 <br /> Fuente de información y Población estudiada: <br /> Encuesta de Salud de Barcelona de los años 2001, 2006 y 2011 <br /> La población de estudio fueron los mayores de 15 años <br />
  • Diseño: Estudio cuasi-experimental <br /> Periodo pre y post-intervención <br /> Un grupo de comparación de barrios no intervenidos con características socioeconómicas similares según indicadores del Censo 2001 <br /> Fuente de información y Población estudiada: <br /> Encuesta de Salud de Barcelona de los años 2001, 2006 y 2011 <br /> La población de estudio fueron los mayores de 15 años <br />

The evaluation of an urban renewal program and its effects on health and health inequalities in Barcelona (Spain) The evaluation of an urban renewal program and its effects on health and health inequalities in Barcelona (Spain) Presentation Transcript

  • The evaluation of an urban renewal program and its effects on health and health inequalities in Barcelona (Spain) Roshanak Mehdipanah, Davide Malmusi, Maica Rodriguez-Sanz, Carles Muntaner, Carme Borrell
  • Urban Renewal • Urban renewal initiatives aim to improve physical infrastructures, promote social integration and increase economical gain in an area (Spaans 2004). • Through a health perspective, specific projects have highlighted the importance of investment in various areas including increased accessibility through transportation, green spaces and the promotion of physical activity and improvements in sewage systems (Rydin et al. 2012). • However, the evidence remains sparse due to limitations in the evaluations completed including inappropriate methods selected for complex interventions, inadequate health indicators and short follow up periods (Rhodes et al. 2002; Thomson et al. 2006). • In addition, evaluation of urban renewal programs have centers on the impacts on specific health conditions, while there is a need to better understand their potential impacts on health inequalities (Thomson
  • Conceptual Framework: Urban renewal and health/health inequality SOCIAL INTEGRATION POPULATION TURNOVER HEALTH & HEALTH INEQUALITY PHYSICAL INFRASTRUCTURE LIVEABILITY ECONOMIC GROWTH URBAN RENEWAL INTERVENTION CONTEXT SOCIO- ECONOMIC MAKEUP
  • The Llei de Barris (Neighbourhood Law) Goal: to improve the physical, economic and social status of deprived neighbourhoods in Catalonia, Spain. • The initiative consists of partial funding (approximately 50%) from the regional government to selected municipal governments with urban renewal proposals. • 143 neighbourhoods across Catalonia have participated in the initiative with Approximately 1.3billion euros invested. City of Barcelona: • 15 of 73 neighbourhoods have participated. • 10% of Barcelona’s population (1.6million) directly affected.
  • PUBLIC SPACES Conceptual Framework: The effects of the Neighbourhoods Law on health and health inequality POPULATION TURNOVER LIVEABILITY - Walkability - Safety and security - Aesthetics SOCIO-ECONOMIC MAKE-UP -Employment - Economic gains - Social class REGENERATION EQUIPMENT INSTALLATION NEW TECHNOLOGY GREEN SUSTAINABILITY GENDER EQUALITY SOCIAL PROGRAMS EMPLOYMENT IN NEIGHBOURHOODS HEALTH IN NEIGHBOURHOODS N E I G H B O U R H O O D S L A W PHYSICAL INFRASTRUCTURAL IMPROVEMENTS ECONOMIC GROWTH SOCIAL INTEGRATION HEALTH & HEALTH INEQUALITIES
  • PUBLIC SPACES Conceptual Framework: The effects of the Neighbourhoods Law on health and health inequality POPULATION TURNOVER LIVEABILITY - Walkability - Safety and security - Aesthetics SOCIO-ECONOMIC MAKE-UP -Employment - Economic gains - Social class REGENERATION EQUIPMENT INSTALLATION NEW TECHNOLOGY GREEN SUSTAINABILITY GENDER EQUALITY SOCIAL PROGRAMS EMPLOYMENT IN NEIGHBOURHOODS HEALTH IN NEIGHBOURHOODS N E I G H B O U R H O O D S L A W PHYSICAL INFRASTRUCTURAL IMPROVEMENTS ECONOMIC GROWTH SOCIAL INTEGRATION HEALTH & HEALTH INEQUALITIES
  • Part 1 • To determine the perception of neighbours towards the importance and effects of recent changes in their neighbourhoods on their wellbeing, using concept mapping. Part 2 • To analyze the effects of the Neighbourhoods Law on health and health inequality, using a quasi-experimental design. Study Objectives
  • Concept Mapping • Concept Mapping is a non-traditional qualitative approach developed in the late 80s by William M. K. Trochim as a management tool in organization and later adapted for public health. • The method provides a conceptual framework that depicts how a group or a population perceives a particular situation. • Six steps carried out in three sessions with participants. BRAINSTORMINGBRAINSTORMING STRUCTURING OF IDEAS STRUCTURING OF IDEAS INTERPRETATION OF MAPS INTERPRETATION OF MAPS
  • Concept Mapping: Participants Inclusion criteria: • Neighbours who have lived in the area for more than 5 years • 18 years or older • 3 groups in 2 of the first intervened neighbourhoods. (Total N=45) Focus question: “One change that has occurred in my neighbourhood that has affected mine and my family’s well-being is…” Rating questions: “Please rate each change in function of its importance and whether it has had a positive or negative effect on you or your family’s wellbeing”
  • Concept Mapping: Cluster Rating Maps Decrease of economic activity Abandoned areas Sense of insecurity Accessibility by car Cleaning and repair of streets Neighbourhood relations Reform of buildings and plazas Public events and spaces Community and senior centers POPULATION & SOCIAL CHANGE URBAN RENEWAL PROJECTS Average cluster rating map of the importance of each change as perceived by participants in the Casc Antic senior group R. Mehdipanah et al. Health & Place 2013 Somewhat negative Very negative Very positive Somewhat positive
  • Reform of buildings and plazas Cluster: Reform of buildings and plazas ABSOLUTE VALUE POSITIVE VALUE NEGATIVE VALUE The installation of elevators in some residential buildings. 4.29 4.29 0 The replacement of sheds for new apartments. 4 3.14 0.86 The improved liveability throughout the neighbourhood. 3.86 2.57 1.29 The reform of the Community Center – Sant Agustí 3.71 3.71 0 The repair of some building facades. 3.71 3.71 0 The reurbanization of sidewalks and streets. 3.71 3.29 0.43 The reform and re-opening of the Santa Caterina market. 3.57 3.43 0.14 The reform of the central plaza, Pou de la Figuera. 2.71 1.71 1 The replacement of old benches with new single-person benches. 2.29 1.14 1.14 AVERAGE 3.51 3.03 0.49 MEDIAN 3.71 3.29 0.29 Concept Mapping: Cluster Rating Maps (Highlighted statements are those that formed part of the Neighbourhood Law projects). Table. Statements within the cluster, reform of buildings and plazas with corresponding rating values and effect
  • Conclusions from qualitative section • The majority of projects within the Neighbourhood Law were perceived as having both positive and important effects on the well-being of participants. • The division in the map indicating urban renewal changes and those of population and social change correspond with the proposed conceptual framework. • The study also highlights the importance of incorporating participants with different characteristics (age, gender, socioeconomic positions, etc.) in order to better understand the effects of the intervention on different populations.
  • Part 1 • To determine the perception of neighbours towards the importance and effects of recent changes in their neighbourhoods on their wellbeing, using concept mapping. Part 2 • To analyze the effects of the Neighbourhoods Law on health and health inequality, using a quasi-experimental design. Study Objetives
  • Study Design & Population  A quasi-experimental design.  Pre- & post-intervention periods.  A comparison group consisting of non-intervened neighbourhoods with similar socio-economic indicators based on Census 2001. N PRE POST Neighbourhoods 2001 2006* 2011 Intervened 998 274 398 Comparison 1881 504 824  Data from Barcelona Health Surveys 2001, 2006, 2011.  Population consisted of individuals over the age of 15.
  • Comparison neighbourhoods Intervened neighbourhoods Map of Comparison & Intervened Neighbourhoods Comparison neighbourhoods were selected based on indicators from the 2001 Census.
  • Methods Variables  Dependent:  Poor self-rated health (poor, fair)  Poor mental health status (GHQ-12>=3)  Independent:  Survey year (pre, post) and group (intervened, comparison)  Age, gender, social class (manual/non-manual) Analysis  Poor self-rated health and mental health prevalences were described for each sex by neighbourhood group and survey year.  Poisson Regression robust models were used to estimate prevalance ratios and their 95% confidence intervals, introducing the interaction between survey year and group.
  • Poor Self-rated Health In both men and women we see a significant drop in poor self-rated health within intervened neighbourhoods while no significant changes are observed in the control neighbourhoods. 0.74*(0.56 0.97) 1.07 (0.85 1.35) 0.53*** (0.36 0.78) 1.04 (0.77 1.41) WOMEN (2006 ref) MEN (2006 ref) Intervened Comparison R. Mehdipanah et al. J Epidemiol Community Health, 2014
  • Poor Mental Health In women we see a significant drop in poor mental health within intervened neighbourhoods while no significant changes are observed in the control neighbourhoods. In men we see a significant rise in poor mental health within control neighbourhoods while no significant changes are observed in the intervened neighbourhoods. Intervened Comparison 1.25 (0.69 2.27) 1.93*(1.23 3.01) 0.95 (0.69 1.31) 0.86 (0.58 1.27) WOMEN (2006 ref) MEN (2006 ref) R. Mehdipanah et al. J Epidemiol Community Health, 2014
  • Poor Self-rated health and Social Class In both sexes, a decrease in the inequalities of poor self-rated health in the intervened neighbourhoods is observed due to the bettering of the manual social class. In the comparison group, although there was a decrease in inequalities, it was mostly due to the worsening conditions of the non-manual social class. 1.25 (0.69 2.27) 1.93* (1.23 3.01) 0.72*(0.53 0.97) 0.45***(0.29 0.69) R. Mehdipanah et al. J Epidemiol Community Health, 2014
  • Conclusions from quantitative analysis • In areas intervened by the Neighbourhoods Law, self-rated health improved amongst residents of both sexes and especially those in the manual social classes. • Similar observations were made for mental health status in women, while in men, the Neighbourhoods Law appeared to prevent the increase in poor mental health observed in men from the comparison group.
  • Conclusions • These findings are aligned with our hypothesis that the Neighbourhood Law did improve self-rated health and mental health outcomes compared to the control groups. • Results from this analysis will be used to support potential theories of how urban renewal programs affect the health and wellbeing of neighbours. • Findings contribute to the limited evidence on urban renewal intervention and their effects on well-being.
  • If you have any questions please contact: rmehdipa@aspb.cat @sophieproject www.sophie-project.eu