1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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”

10. 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

11. 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

12. 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.

13. 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

14. 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.

15. Comparison neighbourhoods
Intervened neighbourhoods
Map of Comparison & Intervened Neighbourhoods
Comparison neighbourhoods were selected
based on indicators from the 2001 Census.

16. 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.

17. 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

18. 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

19. 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

20. 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.

21. 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.

22. If you have any questions please contact:
rmehdipa@aspb.cat
@sophieproject
www.sophie-project.eu