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Place effects on health: how can we conceptualise, operationalise and measure them?


  • Macintyre, Sally
  • Ellaway, Anne
  • Cummins, Steven


In this paper we highlight what we consider to be a lack of adequate conceptualisation, operationalisation and measurement of "place effects". We briefly review recent historical trends in the study of the effects of place on health in industrial countries, and argue that "place effects" often appear to have the status of a residual category, an unspecified black box of somewhat mystical influences on health which remain after investigators have controlled for a range of individual and place characteristics. We note that the distinction between "composition" and "context" may be more apparent than real, and that features of both material infrastructure and collective social functioning may influence health. We suggest using a framework of universal human needs as a basis for thinking about how places may influence health, and recommend the testing of hypotheses about specific chains of causation that might link place of residence with health outcomes.

Suggested Citation

  • Macintyre, Sally & Ellaway, Anne & Cummins, Steven, 2002. "Place effects on health: how can we conceptualise, operationalise and measure them?," Social Science & Medicine, Elsevier, vol. 55(1), pages 125-139, July.
  • Handle: RePEc:eee:socmed:v:55:y:2002:i:1:p:125-139

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    References listed on IDEAS

    1. Miller, Douglas L. & Paxson, Christina, 2006. "Relative income, race, and mortality," Journal of Health Economics, Elsevier, vol. 25(5), pages 979-1003, September.
    2. Angus Deaton, 2001. "Relative Deprivation, Inequality, and Mortality," NBER Working Papers 8099, National Bureau of Economic Research, Inc.
    3. Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among U.S. Elderly," NBER Chapters,in: Perspectives on the Economics of Aging, pages 367-414 National Bureau of Economic Research, Inc.
    4. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, Oxford University Press, vol. 115(2), pages 617-650.
    5. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, Oxford University Press, vol. 114(4), pages 1243-1284.
    6. Michael Grossman, 1976. "The Correlation between Health and Schooling," NBER Chapters,in: Household Production and Consumption, pages 147-224 National Bureau of Economic Research, Inc.
    7. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    8. repec:aph:ajpbhl:1998:88:7:1074-1080_3 is not listed on IDEAS
    9. repec:aph:ajpbhl:2001:91:3:385-391_5 is not listed on IDEAS
    10. David A. Jaeger & Susanna Loeb & Sarah E. Turner & John Bound, 1998. "Coding Geographic Areas Across Census Years: Creating Consistent Definitions of Metropolitan Areas," NBER Working Papers 6772, National Bureau of Economic Research, Inc.
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