What do we know about the health and socio-economic impacts of neighbourhood renewal? Hilary Thomson MRC Social & Public Health Sciences Unit, Glasgow

Socio-economic impacts urban regeneration & neighourhood renewal National (UK) ABI programmes 1980 to 2004: Start date »Urban Programme1969 »Urban Development Corporations1981 »New Life for Urban Scotland1988 »Estate Action1991 »City Challenge1992 »Small Urban Renewal Initiatives1993 »Single Regeneration Budget1995 »Social Inclusion Partnerships1996 »New Deal for Communities2001 (not included)

Impacts: 2-10 years Nine evaluationsOverall improvement Effect size Range of effects in same direction Improvement compared to wider trend? SRB  -1.3%  SRB  -10.8%n/a  SRB  -4%  Estate Action  -29.5%  SIP  -3.8%  SIP  -32%  New Life  -5.3%  Urban Programme  +3.25%  City Challenge  +0.3%  Improvement- but rarely in addition to national trend Possibility of deteriorating effect

Impacts: educational achievement at school Overall improvement Effect size Range of effects in same direction Improvement compared to wider trend? Five evaluations (New Life, City Challenge, SRB x3)  mean +6.25%  Pupils gaining ‘>4 GCSEs’ or ‘>2 Standard Grades’ Improvement- but not in addition to national trend

Other impacts: housing & income Housing quality: 1 evaluation Improved Rent: 1 evaluation Rent increased in majority of case study areas Household income <£100/week: 2 evaluations Small improvement Other impacts rarely assessed- both negative and positive impacts reported

Health impacts urban regeneration National (UK) ABI programmes 1980 to date: Start date »Urban Programme1969 »Urban Development Corporations1981 »New Life for Urban Scotland1988 »Estate Action1991 »City Challenge1992 »Small Urban Renewal Initiatives1993 »Single Regeneration Budget1995 »Social Inclusion Partnerships1996 »New Deal for Communities most recent programmes included ‘health’ in at least one evaluation of impacts

Impacts: self-reported health Programme (Panel data) MeasureOverall improvement Effect size Range of effects in same direction SRB ‘good’ health  -4%  SRB ‘not good’ health  +2%  SRB ‘worse’ health  +6%  SRB ‘improved’ health  +3%  New Deal ‘not good’ health ** 0%? New Deal ‘worse’ health ** +2%? New Deal ‘long standing illness’ ** +2%? New Deal SF-36 ** 0%? SIP (one area) ‘limiting long term illness’  +14%? * No change or deterioration in comparison to control area Little or no health impact- possibility of deteriorating health

Impacts: 3-6 years Programme (routine data) MeasureOverall improvement Effect size Range of effects in same direction SRB ‘crude mortality’  -0.6%  SRB ‘standardised mortality’  -4  New Life ‘standardised mortality’  -17  SIP ‘suicide’ (absolute numbers)  ? SIP ‘deaths from coronary heart disease’ (absolute numbers)  -3? Possible improvement but: Genuine improvement would have to be over and above national trend of ongoing improvements in mortality rates

Health impacts of neighbourhood renewal National (UK) ABI programmes 1980 to date Other evidence from smaller studies of housing-led neighbourhood renewal »Systematic review of available research (anywhere in the world)

Health impacts of housing-led neighbourhood renewal 11 studies since 1995 »(9 from UK) Little or no change in mental or physical health outcomes (mean follow-up time 1-2 years) Little evidence of adverse health impacts

Summary of available evidence on impacts National urban regeneration programmes socio-economic determinants of health? »Employment & education: small improvements but rarely in addition to wider trends »Adverse impacts a possibility health? »Unclear: rarely assessed Housing-led renewal improvements socio-economic circumstances determinants of health? »Unknown: rarely assessed health? »Little or no change

Why are the reported health (and other) impacts of housing-led regeneration so small? Intervention issues Not targeted according to individual need Housing-led renewal likely to be diffuse across an area »Wide range of intervention type »Additional neighbourhood change/relocation »Potential for disruption related to improvement Evaluation issues »Difficult to detect Diffuse intervention, mobile population….. Timescale for health effect –Look at proximal effects »Difficult to attribute Multiple confounding factors- wider economic influences etc

Room for improvement? Need to generate better evidence on the actual impacts of regeneration investment Improved evaluation »Reporting »Methods »Assessing direct impacts on socio-economic outcomes »Map out pathways for expected impacts

Room for improvement? Health impacts may take many years to emerge Small impacts difficult to detect Assess change for people rather than place Need »Long term follow-up »Large samples »Need individual level data

Is new improved evaluation the answer? Long term follow-up evaluation »Very costly »Response rates very low Even with ideal long term evaluation »Introduces multiple confounders over time Need to agree realistic expectations of evaluations

Room for improvement? Criticisms of area based renewal programmes Relatively modest investment Not tackling societal causes of inequality May only address one determinant of health e.g. housing quality Need for realistic expectations of investment

Neighbourhood renewal and health Not grounds to abandon as a healthy investment »established links between poverty and health provide strong support ‘impacts uncertain’ not ‘certainly no impact’ At population level small impacts are important Little evidence of harm »Need to remain open to the possibility of adverse effects

Economic and neighbourhood regeneration as a healthy investment: a solid foundation? Strong evidence to support investment to improve socio-economic determinants of health Keep open mind about possible impacts (+/-) Scope to improve what is known about impacts on health and socio- economic determinants of health Agree realistic expectations of what both investment and evaluation can achieve