1. HEALTH INEQUALITIES AND AGEING IN THE COMMUNITY: EXPERIENCES, CAUSES AND CONSEQUENCES Health Systems Research & Development Centre, Dept. of Sociology UL with: Department of Medicine for the Elderly, Mid-Western Regional Hospital, Limerick For information contact: Stiofan.Deburca@ul.ie or Eileen.Humphreys@ul.ie 1. INTRODUCTION / BACKGROUND Demographic projections anticipate an increase in the population aged 65 years and over and a trend towards an ageing population structure in Ireland: By 2036, it is expected that 20 per cent of the population will be aged 65 years+; There is expected to be a large increase in “oldest old”, (80 years and over). Demographic trends towards on ageing population will result in changes in requirements for services and community, family and informal support to respond to needs of this group. There is an international body of research evidence on the link between socio- economic status and health status – i.e. evidence of the social gradient in health. Current research focuses on the causal factors and “pathways”. “Neighbourhood” as the contextual context and a social capital dimension – as an explanatory factor - have been the focus of some recent studies. Local factors influencing the study include the formation of Thomond Parish Cluster – a grouping of four parishes on the northside of Limerick City. The research is responding to the need for information / insights related to the needs of older people in the four parishes. A local stakeholder group including community / parish organisations, the local partnership companies, local authority and various services of the HSE has been set up in a supportive capacity to the research. 4. METHODOLOGY Multi-strategy research combining quantitative and qualitative methods Social research (survey & interviews) and clinical research (health screening / objective health assessment) Cross-sectional design Research methods: Socio-economic - Resident survey (people 65 years and over) in 4 parishes (450 face-to-face in total, structured questionnaire); Clinical tests (same population, target 400 cases) at site of day hospital; Sample: from Electoral Register & other sources; 4 independent samples In-depth interviews with sub-sample (40, 10 by 4 parishes) Stakeholder interviews (10) Secondary data – mapping local areas (CSO and HSE sources) Data analysis: single / integrated dataset for quantitative data; comparative analysis / profiling by parish. Parishes / Neighbourhoods Christ the King, Caherdavin (middle class suburb (1970 ’ s), small elderly population); Corpus Christi, Moyross (very disadvantaged suburb, very small older population & exodus in recent years); St. Munchin ’ s, Thomandgate, Killeely, Farranshone, part of Mayorstone (mixed with strong working class base, inner city, large elderly population); Our Lady of the Rosary, Ennis Road, North Circular Road (most affluent part of the city, large elderly population). 3. AIMS AND OBJECTIVES Aim: to inform the policy debate on health inequalities as this affects older people in the population living in urban communities, to use this evidence to suggest lines of policy and practice to address causal factors (long-term), alleviate consequences (short-to medium-term) and create healthier communities (medium-to long-term). Objectives are: To examine the association between socio-economic status & health status with reference to an older population cohort living in different types of urban community; To identify the main demographic and socio-economic factors associated with variations in health status; To explore the relative importance of intervening factors (moderators and mediators) including social capital, health and other services ’ utlilisation in the local area, health history and life style factors, and contextual conditions of neighbourhood; To develop comparative profiles of experiences of ageing in the different types of urban community with a view to developing a deeper understanding of the causal processes and consequences. See Conceptual Framework below. 5. PROGRESS & INDICATIVE TIMESCALE 2. KEY LITERATURE The key hypotheses informing this research are: Health inequalities in advanced societies are linked to psycho-social stress arising from relative income disparities (Wilkinson 1996) and social hierarchies (Marmot 2004); Levels of social capital in spatial communities affect health outcomes (Kawachi & Kennedy, Wilkinson 1996), but this is contested. Contextual conditions of neighbourhood are important to outcomes including health status, particularly conditions of concentrations of affluence or poverty (Wilson 1987). The link between income inequality and health status is more in evidence at large spatial levels of aggregation (nations) while it is mixed as the focus moves to smaller spatial levels such as neighbourhoods (see Wilkinson and Pickett 2006 for a review of the evidence). Wilson (1987) argues that the less affluent benefit from sharing neighbourhoods with more affluent individuals deriving positive externalities from richer institutional resources in more affluent neighbourhoods and social learning effects. There is some support for this in recent empirical research on health outcomes (Hou and Myles 2005). In terms of ageing populations, a body of research evidence suggests a pattern of cumulative disadvantage over the lifecourse (Breeze et al 2001). A further body of work suggests a more optimistic perspective linked to “ theory of the third age ” and compression of morbidity into later life allowing for “ successful ageing ” (Laslett 1989; Bury 2000). These perspectives have tended to operate with little reference to each other. Key research questions concern identification of moderators and mediators of, and their relative importance in, the relationship between socio-economic status (structural factors) and health status drawing on a developing body of empirical research within health and related fields. Research Team: Professor Stiofan deBurca, Director, Health Systems Research & Development Centre, Dept. of Sociology UL; Dr. Eileen Humphreys and Nuala Kitson, Health Systems Research & Development Centre, Dept. Sociology, UL Prof. Declan Lyons, Dr. Thomas Walsh and Caroline O’Connor, Department of Medicine for the Elderly, Regional Hospital Limerick Social status Individuals Health & quality of life outcomes Structural neighbourhood Social class Education Social capital Quality of services (health & other) Preve n-tive health Physical environ- ment