Voigtländer S, Vogt V, Mielck A, Razum O. Int. J. Public Health 2014; 59(3): 427-438.
Affiliation
Section 'Quality of Health Care, Health Economics, Health System Analysis' (GE 6), Bavarian Health and Food Safety Authority (LGL), Schweinauer Hauptstraße 80, 90441, Nürnberg, Germany, sven.voigtlaender@lgl.bayern.de.
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.