How Goes the Neighbourhood? Rethinking Neighbourhoods and Health Research in Social Epidemiology

In this chapter, we describe how social epidemiology has been proficient at describing patterns in neighbourhood health inequalities and even in modelling them in a sophisticated fashion, but has been less capable at fostering an understanding of how these effects relate to the social mechanisms of causation that underlie such inequalities at multiple levels – including with respect to neighbourhoods and more macrosocial contexts. We argue that this paradigm has to be shifted to improve the translation of research about neighbourhoods and health into ­effective health equity interventions, and we outline some specific ways for social epide­miologists to supplement their approach to research. We thereby problematize the social epidemiologic treatment of neighbourhoods as simple containers as a way of clarifying how neighbourhood effects may reflect complex fundamental and ­proximate causes of health disparities. We also describe four assumptions of ­commonly used, ­multilevel models that ought to be closely considered when using this approach to study social mechanisms of causation. Finally, we argue that more diverse use of theory in the study of neighbourhood effects can help social epide­miologists embrace complexity in their research, and we review key recent (and not so recent) geographic perspectives on neighbourhoods and health that can be ­utilized to put “space in its place” and to better understand why some neighbourhoods are less healthy than others.