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Area-based policies (ABIs) aim to improve the quality of life and health of residents in socio-economically disadvantaged areas of cities. Although health impact evaluations of ABIs have proliferated in the last decade, several weaknesses have been identified in these evaluations. Inspired by the propositions of the fundamental cause theory (FCT), this paper attempts to address some of these weaknesses by investigating the possible impacts of different combinations of ABIs on premature mortality in vulnerable urban areas of Andalusia (Spain). We conducted a quasi-experimental cohort study, based on the longitudinal statistics on survival and longevity of a population aged 40–70 during the period from 2002 to 2016. Hazard ratios for individuals living in targeted areas relative to control areas were estimated using quasi-Poisson regressions, and the impact was evaluated using a difference-in-difference approach. Most of the ABIs studied do not seem to generate a visible impact on premature mortality. However, the combination of ARB and URBAN interventions is associated with a significant decrease in preventable and all-cause mortality in the targeted versus control areas. The flexible resources proposed by FCT can operate at both the contextual and individual levels, since more comprehensive interventions seem to contribute to achieving health impacts on vulnerable populations. Future evaluations should consider the nature of the intervened areas themselves in relation to the dynamics of the city and the degree of comprehensiveness of the policies, to elucidate what may constitute “fundamental interventions” to reduce health disparities between urban places.
Ángel Zapata-Moya; María Martín-Díaz; Francisco Viciana-Fernández. Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain). Sustainability 2021, 13, 8169 .
AMA StyleÁngel Zapata-Moya, María Martín-Díaz, Francisco Viciana-Fernández. Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain). Sustainability. 2021; 13 (15):8169.
Chicago/Turabian StyleÁngel Zapata-Moya; María Martín-Díaz; Francisco Viciana-Fernández. 2021. "Area-Based Policies and Potential Health Benefits: A Quasi-Experimental Cohort Study in Vulnerable Urban Areas of Andalusia (Spain)." Sustainability 13, no. 15: 8169.
Literature suggests that urban regeneration policies might contribute towards improving mental health of residents, but to date there is a lack of empirical research on how these policies and downward social mobility can interact and influence health outcomes. The current study aims to explicitly test whether regeneration policies implemented in deprived Andalusian urban places (southern Spain) moderate the use of anxiolytics and/or antidepressants, taking into consideration families’ downward social mobility during the recent period of economic crisis in Spain. We designed a post intervention survey to retrospectively compare the evolution of psychotropic drug consumption in target and comparison areas. We observe a general increase in the use of anxiolytics and/or antidepressants from 2008 to 2015, specifically for people in whose families the economic crisis had the greatest impact (odds ratio = 2.18; p value < 0.001). However, better evolution is observed among residents of the target areas compared with residents of similar urban areas where this kind of polices have been not in force (odds ratio = 0.50; p value < 0.05). Therefore, urban regeneration policies might act as moderators of the risk of mental health, particularly when people are subject to the loss of individual/family resources in urban vulnerable contexts.
Ángel R. Zapata Moya; Clemente J. Navarro Yáñez. Urban regeneration policies and mental health in a context of economic crisis in Andalusia (Spain). Journal of Housing and the Built Environment 2020, 36, 393 -405.
AMA StyleÁngel R. Zapata Moya, Clemente J. Navarro Yáñez. Urban regeneration policies and mental health in a context of economic crisis in Andalusia (Spain). Journal of Housing and the Built Environment. 2020; 36 (2):393-405.
Chicago/Turabian StyleÁngel R. Zapata Moya; Clemente J. Navarro Yáñez. 2020. "Urban regeneration policies and mental health in a context of economic crisis in Andalusia (Spain)." Journal of Housing and the Built Environment 36, no. 2: 393-405.
Understanding how health-related lifestyles are generated, distributed and reproduced is a priority issue to improve population health and reduce contemporary health inequalities. A great deal of research is currently available on how the characteristics of urban areas and neighbourhoods influence health and health inequality. However, studies based on the symbolic nature of place and its role in structuring health-related practices remain scarce. The aim of this chapter is to integrate recent theoretical knowledge in the field of health sociology and urban sociology to analyse contextual influencies on the social distribution of healthy lifestyles. Inspired by the cultural scenes approach, which offers a new analytical framework to explore the cultural dimension of place in a comparative perspective, we analyse whether the symbolic dimensions of urban areas shapes the adoption of healthy practices in Spain.
Ángel R. Zapata Moya; Cristina Mateos-Mora; Clemente J. Navarro-Yáñez. Urban Scenes, Cultural Context Exposure and Contemporary Health Lifestyles: A Multilevel Analysis of Spanish Sub-municipal Areas. Inequality and Uncertainty 2019, 273 -296.
AMA StyleÁngel R. Zapata Moya, Cristina Mateos-Mora, Clemente J. Navarro-Yáñez. Urban Scenes, Cultural Context Exposure and Contemporary Health Lifestyles: A Multilevel Analysis of Spanish Sub-municipal Areas. Inequality and Uncertainty. 2019; ():273-296.
Chicago/Turabian StyleÁngel R. Zapata Moya; Cristina Mateos-Mora; Clemente J. Navarro-Yáñez. 2019. "Urban Scenes, Cultural Context Exposure and Contemporary Health Lifestyles: A Multilevel Analysis of Spanish Sub-municipal Areas." Inequality and Uncertainty , no. : 273-296.
Fundamental Cause Theory suggests the replacement of mechanisms that produce the persistent relationship between socioeconomic status and health over time. Understanding how this process operates is central to explaining the reproduction of health inequality. We use data from the Onco-barometer survey (2010) to test a set of hypotheses derived from FCT, Diffusion Of Innovations theory and the intersection between these theories to examine how socioeconomic inequality emerges and evolves across the cycle of diffusion of six relevant preventive practices in Spain: faecal occult blood tests, prostate-specific antigen tests, Papanicolaou tests, mammograms, cholesterol readings and blood-pressure checks. Because these preventive measures are characterised by differing rates of spontaneous knowledge and use amongst the Spanish population, we assume that they are at different stages in the diffusion cycle. Results suggest that SES has a dynamic influence according to the diffusion stage of each preventive measure. We argue that the conjunction of these theories offers a dynamic ‘imagery’ that can help to explain the generation and diminishment of inequalities. Moreover, this integration has the potential to bring ‘social change’ back into the study of health inequalities, which is essential to understanding equitable (and inequitable) returns produced by preventive innovations.
Ángel R. Zapata Moya; Barbara Willems; Piet Bracke. The (re)production of health inequalities through the process of disseminating preventive innovations: the dynamic influence of socioeconomic status. Health Sociology Review 2019, 28, 177 -193.
AMA StyleÁngel R. Zapata Moya, Barbara Willems, Piet Bracke. The (re)production of health inequalities through the process of disseminating preventive innovations: the dynamic influence of socioeconomic status. Health Sociology Review. 2019; 28 (2):177-193.
Chicago/Turabian StyleÁngel R. Zapata Moya; Barbara Willems; Piet Bracke. 2019. "The (re)production of health inequalities through the process of disseminating preventive innovations: the dynamic influence of socioeconomic status." Health Sociology Review 28, no. 2: 177-193.
El análisis de la desigualdad en las ciudades cuenta con una amplia tradición, desde los análisis de áreas urbanas mediante ecología factorial de la Escuela de Chicago a los estudios contemporáneos sobre ‘vulnerabilidad urbana’. Desde un punto de vista operativo su objetivo principal ha consistido en elaborar un índice sintético que permita situar a las áreas urbanas en un continuum respecto a los recursos que poseen sus residentes y/o los riegos que enfrentan. En este trabajo se presenta una propuesta y validación de un indicador para medir el nivel socio-económico de áreas urbanas. En primer lugar, se revisan algunos aspectos básicos de esta tradición en el análisis de la sociología urbana. En segundo lugar, se presenta la propuesta para, en tercer lugar, proceder a su validación, finalizando con unas breves conclusiones sobre el indicador propuestos y sus posibles limitaciones.The analysis of inequality in cities has a wide tradition, from the analysis of urban areas through factorial ecology of the Chicago School to contemporary studies on 'urban vulnerability'. From an operative point of view, its main objective has been to elaborate a synthetic index that allows to place to the urban areas in a continuum with respect to the resources that own its residents and / or the risks that they face. This paper presents a proposal to measure the socio-economic level of urban areas and its validation. First, some basic aspect in the analysis of urban inequalities are reviewed. Then, the proposal is presented and validated, and finally, some few conclusions about the proposal and its limitations are included.
Manuel Fernández-García; Clemente J. Navarro Yáñez; Ángel R. Zapata Moya; Cristina Mateos Mora. El análisis de la desigualdad urbana. Propuesta y validación de un índice de nivel socio-económico en áreas urbanas españolas (1991-2001). Empiria. Revista de metodología de ciencias sociales 2018, 1 .
AMA StyleManuel Fernández-García, Clemente J. Navarro Yáñez, Ángel R. Zapata Moya, Cristina Mateos Mora. El análisis de la desigualdad urbana. Propuesta y validación de un índice de nivel socio-económico en áreas urbanas españolas (1991-2001). Empiria. Revista de metodología de ciencias sociales. 2018; (39):1.
Chicago/Turabian StyleManuel Fernández-García; Clemente J. Navarro Yáñez; Ángel R. Zapata Moya; Cristina Mateos Mora. 2018. "El análisis de la desigualdad urbana. Propuesta y validación de un índice de nivel socio-económico en áreas urbanas españolas (1991-2001)." Empiria. Revista de metodología de ciencias sociales , no. 39: 1.
Background Urban regeneration policies are area-based interventions addressing multidimensional problems. In this study, we analyse the impact of urban regeneration processes on the evolution of inequalities in mortality from certain causes. On the basis of Fundamental Cause Theory (FCT), our main hypothesis is that the impact of urban regeneration programmes will be more clearly observed on the causes of preventable deaths, as these programmes imply a direct or indirect improvement to a whole range of ‘flexible resources’ that residents in relevant areas have access to, and which ultimately may influence the inverse relationship between socioeconomic status and health. Methods Using a quasi-experimental design and data from Longitudinal Statistics on Survival and Longevity of Andalusia (Spain), we analyse differences in the evolution of standard mortality ratios for preventable and less-preventable causes of premature death. This encompasses 59 neighbourhoods in 37 municipalities where urban regeneration projects were implemented in the last decade within the framework of three different programmes and in 59 counterparts where these policies were not implemented. Results As expected in line with FCT, there are no significant patterns in the evolution of internal differences in terms of less-preventable mortality. However, excessive preventable mortality strongly decreases in the neighbourhoods with intervention programmes, specifically in those where two or more projects were in force. This is even more apparent for women. Conclusions The urban regeneration policies studied seem to contribute to reducing health inequity when the interventions are more integral in nature.
Ángel R. Zapata Moya; Clemente J Navarro Yáñez. Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities. Journal of Epidemiology and Community Health 2016, 71, 239 -247.
AMA StyleÁngel R. Zapata Moya, Clemente J Navarro Yáñez. Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities. Journal of Epidemiology and Community Health. 2016; 71 (3):239-247.
Chicago/Turabian StyleÁngel R. Zapata Moya; Clemente J Navarro Yáñez. 2016. "Impact of area regeneration policies: performing integral interventions, changing opportunity structures and reducing health inequalities." Journal of Epidemiology and Community Health 71, no. 3: 239-247.
Inspired by the 'Fundamental Cause Theory (FCT)' we explore social inequalities in preventable versus relatively less-preventable illnesses in Spain. The focus is on the education-health gradient, as education is one of the most important components of an individual's socioeconomic status (SES). Framed in the context of the recent economic crisis, we investigate the education gradient in depression, diabetes, and myocardial infarction (relatively highly preventable illnesses) and malignant tumors (less preventable), and whether this educational gradient varies across the regional-economic context and changes therein. We use data from three waves of the Spanish National Health Survey (2003-2004, 2006-2007, and 2011-2012), and from the 2009-2010 wave of the European Health Survey in Spain, which results in a repeated cross-sectional design. Logistic multilevel regressions are performed with depression, diabetes, myocardial infarction, and malignant tumors as dependent variables. The multilevel design has three levels (the individual, period-regional, and regional level), which allows us to estimate both longitudinal and cross-sectional macro effects. The regional-economic context and changes therein are assessed using the real GDP growth rate and the low work intensity indicator. Education gradients in more-preventable illness are observed, while this is far less the case in our less-preventable disease group. Regional economic conditions seem to have a direct impact on depression among Spanish men (y-stand. OR = 1.04 [95 % CI: 1.01-1.07]). Diabetes is associated with cross-regional differences in low work intensity among men (y-stand. OR = 1.02 [95 % CI: 1.00-1.05]) and women (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]). Economic contraction increases the likelihood of having diabetes among men (y-stand. OR = 1.04 [95 % CI: 1.01-1.06]), and smaller decreases in the real GDP growth rate are associated with lower likelihood of myocardial infarction among women (y-stand. OR = 0.83 [95 % CI: 0.69-1.00]). Finally, there are interesting associations between the macroeconomic changes across the crisis period and the likelihood of suffering from myocardial infarction among lower educated groups, and the likelihood of having depression and diabetes among less-educated women. Our findings partially support the predictions of the FCT for Spain. The crisis effects on health emerge especially in the case of our more-preventable illnesses and among lower educated groups. Health inequalities in Spain could increase rapidly in the coming years due to the differential effects of recession on socioeconomic groups.
A.R. Zapata Moya; V. Buffel; C.J. Navarro Yáñez; P. Bracke. Social inequality in morbidity, framed within the current economic crisis in Spain. International Journal for Equity in Health 2015, 14, 131 .
AMA StyleA.R. Zapata Moya, V. Buffel, C.J. Navarro Yáñez, P. Bracke. Social inequality in morbidity, framed within the current economic crisis in Spain. International Journal for Equity in Health. 2015; 14 (1):131.
Chicago/Turabian StyleA.R. Zapata Moya; V. Buffel; C.J. Navarro Yáñez; P. Bracke. 2015. "Social inequality in morbidity, framed within the current economic crisis in Spain." International Journal for Equity in Health 14, no. 1: 131.