What do we know about the health impacts of urban regeneration programmes? A systematic review of UK regeneration programmes (1980-2004) Hilary Thomson,

What do we know about the health impacts of urban regeneration programmes? 

A systematic review of UK regeneration programmes (1980-2004)

Hilary Thomson, 1 Rowland Atkinson, 2

Mark Petticrew, 1 Ade Kearns 2

1 MRC Social & Public Health Sciences Unit, Glasgow, 2 Department of Urban Studies,

University of Glasgow

Background

• Area Based Initiatives (ABI) are major means of urban regeneration to alleviate socio-economic deprivation

• Massive public investment tackling deprivation: » over £11bn (€16bn) 20 years

• Intuitive links between positive investment to tackle deprivation and improved health and reduction in health inequalities

A strategy to tackle health inequalities

‘Local neighbourhood renewal and other regeneration initiatives are in a

particularly good position to address health inequalities because they

have responsibility for dealing with the wider determinants that have

impact on people’s physical and mental health.’Tackling health inequalities: summary of the 2002 cross cutting spending review. London: HM Treasury & Department of Health, 2002.

Programme vision: New Deal for Communities, 2000

‘to have lower worklessness; less crime; better health; better skills and better

housing’A new commitment to neighbourhood renewal: national strategy action plan. London: HMSO: Social Exclusion Unit, The Cabinet Office, 2001.

Developing evidence base to support healthy public policy

‘every opportunity to generate evidence from current

policy and practice needs to be realised’

Wanless D. Securing good health for the whole population. London: HM Treasury & Department of Health. HMSO, 2004.

‘every opportunity to generate evidence from current policy and practice needs to be realised’…

• Little or no research evidence of the health impacts of regeneration

• Evaluations of previous national regeneration programmes of central policy relevance previously untapped resource in grey literature

• Systematic review of health impacts AND impacts on socio-economic determinants of health

Systematic review of national regeneration programmes (UK)

Review questions

What is the available evidence that national programmes of urban regeneration have an impact on:

– population health?

– socio-economic determinants of health? » employment, education, income, housing

– health inequalities?

Methods: search strategy

• Nine UK programmes included 1980 to 2004:

– Urban Programme

– Urban Development Corporations

– Estate Action

– City Challenge

– Small Urban Renewal Initiatives

– Single Regeneration Budget

– New Deal for Communities

– Social Inclusion Partnerships

– New Life for Urban Scotland

• Seven electronic bibliographic databases searched (1980 to 2004)

• Experts contacted

Methods: review inclusion/exclusion criteria

• Included: evaluations which reported on achievements or impacts of regeneration programme-

qualitative or quantitative

• Excluded: evaluations of strategy or process issues

evaluations of only one target area

evaluations of single projects within local ABI areas

• Two reviewers screened identified documents independently to ensure agreement about included evaluations

Search results

896 references identified

86 evaluations identified: examined independently by 2

researchers

10 evaluations reporting impacts on health or socio-economic outcomes

All data from 1988-2000

not relevant n=810

Process evaluation n=51 Inadequate assessment of health or socio-economic impacts n=25

Evaluation quality & methods

• Inadequate assessment of impacts n=25

– Gross outputs and activity reported as impact e.g. how many miles

of new road built n=17

– Impacts reported but with no supporting data n=2

– Retrospective assessment by stakeholders n=6

Evaluation quality & methods

• Inadequate assessment of impacts n=25

– Gross outputs and activity reported as impact e.g. how many miles

of new road built n=17

– Impacts reported but with no supporting data n=2

– Retrospective assessment by stakeholders n=6

• Impact evaluations n=10

– Poor reporting of methods, sample sizes, response rates, data

sources

Impacts: self-reported health and mortality

Self-reported health @ 3 years

1 SRB evaluation (panel survey of same residents before and after)

– 3 measures deteriorated (+/- 3.8%, ranges included zero)

– 1 measure improved (range +2% to +4%)

Impacts: self-reported health and mortality

Self-reported health @ 3 years

1 SRB evaluation (panel survey of same residents before and after)

– 3 measures deteriorated (+/- 3.8%, ranges included zero)

– 1 measure improved (range +2% to +4%)

Mortality rates @ 4-6 years

crude mortality: 1 evaluation

– decreased (-0.6%, range -1% to -0.2%)

standardised mortality: 2 evaluations

– decreased (-4, range -7 to -1)

– decreased (-17, range -29 to +12)

Impacts: self-reported health and mortality

Self-reported health @ 3 years- unclear effect1 SRB evaluation (panel survey of same residents before and after)

– 3 measures deteriorated (+/- 3.8%, ranges included zero)– 1 measure improved (range +2% to +4%)

Mortality rates @ 4-6 years- improvement but no comparison with national trend

crude mortality: 1 evaluation– decreased (-0.6%, range -1% to -0.2%)

standardised mortality: 2 evaluations– decreased (-4, range -7 to -1)– decreased (-17, range -29 to +12)

What about impacts on determinants of health?

• Employment

• Education

• Income

• Housing

Impacts: employment

Overall improvement

Effect size Range of effects in same direction

Improvement compared to wider trend?

New Life (after 10 years)

+6%

(41% v 47%)

(-9% to +20%)

SRB (after 3 years)

+4%

(56% v 60%)

(+3% to +5%)

Employment rate

Wider trend: compared to changes in regional or national figures over same time period

Impacts: unemployment @ 2-10 years

Nine evaluations Overall 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%

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’

Impacts: household income

Overall improvement

Effect size Range of effects in same direction

Improvement compared to wider trend?

New Life -16.5% SRB -4%

Households with incomes of <£100/week

Impacts: housing quality & rent

Overall improvement

Effect size

Range of effects in same direction

Improvement compared to wider trend?

UDC (residents from target area now living in improved housing)

+42.5%

Estate Action

(average weekly rent local authority tenants)

+99.3%

Available evidence from existing policy

• population health?» self reported health: unclear

» mortality: small improvement but no comparison with national trends

• socio-economic determinants of health?

• health inequalities?

Available evidence from existing policy

• population health?» self reported health: unclear

» mortality: small improvement but no comparison with national trends

• socio-economic determinants of health? » housing, education, employment, income: small

improvements but rarely in addition to wider trends

» adverse impacts a possibility

• health inequalities?

Available evidence from existing policy

• population health?» self reported health: unclear

» mortality: small improvement but no comparison with national trends

• socio-economic determinants of health? » housing, education, employment, income: small

improvements but rarely in addition to wider trends

» adverse impacts a possibility

• health inequalities?» remains unknown

Available evidence from existing policy

• Very little available

• Poor quality

What does it all mean?

• Positive health and social impacts of regeneration investment cannot be assumed

• Methods to evaluate outcomes need further development

– accountability for massive public investment

– improve effectiveness of future regeneration investment

– identify and prevent unintended negative health and social impacts

Generating usable evidence through evaluation

Evaluations designed with possible evidence use in mind

» Usefulness of cheap routine data v costly panel surveys looking at

impacts for target groups

» Improve reporting- methods, samples, response rates, range of

effects across case study areas

» Outcomes: impacts on determinants of health may be more feasible

than health impacts

In the meantime…

» Lack of impact data is not grounds for inaction

» No evidence does not mean that regeneration has not had an impact-

more that we don’t know- can’t assume

» Be aware that actual impacts may be counter intuitive and may include

adverse impacts