Neighbourhood effects on health: does it matter where you draw the boundaries?

There has been considerable discussion in health geography and related areas of neighbourhood effects on health: the idea that people's health in one geographical area may be influenced not only by the composition of that area's population, but also by the area's geographical context. Hence, the healthiness or otherwise of the neighbourhood may have an important effect on local people's health. Although neighbourhoods and their boundaries are sometimes obvious to local residents, it is more common to find considerable disagreement on the size and contents of a neighbourhood. In this paper, we use British census Enumeration Districts as building blocks to construct alternative zonal systems, and experiment to see if neighbourhoods defined in different ways have similar implications for health. The well known modifiable areal unit problem shows that analytical conclusions may differ substantially according to how data are aggregated. Boundaries can be drawn to maximize equality of size, compactness of shape, homogeneity in social composition, accordance with 'natural' boundaries, and probably many other factors; which of these criteria are more effective in defining zones relevant to health? One conclusion is that the effect of neighbourhood conditions should be looked at using several different ways to define neighbourhoods, and that the size and composition of these neighbourhoods may be different in different parts of a study area.