Background There is substantial evidence from multilevel studies in high income countries that neighbourhood socioeconomic status (SES) influences health independent of individual SES characteristics. In comparison, few qualitative studies have explored lay knowledge of neighbourhood influence on health. We explored and compared views on how neighbourhoods influenced health in married women, from different socioeconomic positions and living in neighbourhoods of contrasting SES in Aleppo.
Methods A qualitative study was undertaken in April-May 2011 as part of a mixed-method study investigating the relationship between neighbourhood socioeconomic status and self-reported health (prior to the armed conflict in Aleppo). In-depth interviews were conducted with 27 married women. Respondents were asked how living in the neighbourhood influenced their health and whether anything disturbed them in their life in the neighbourhood. Thematic analysis was used.
Results Only a few high-income women living in high SES neighbourhoods perceived a direct link between neighbourhood characteristics and physical health. However, all respondents pointed to multiple physical and social neighbourhood characteristics that they perceived as stressors. Many respondents, irrespective of their neighbourhood SES, perceived the poor quality of the physical neighbourhood environment, especially from traffic congestion and waste, to influence their wellbeing. We found similarities in women’s views on perceived neighbourhood stressors based on household and neighbourhood socioeconomic status as well as ethnicity and religion. Irrespective of socioeconomic position, respondents from certain religious or ethnic minorities emphasised the importance to their wellbeing of living in neighbourhoods with a large population of a similar religious or ethnic composition. The majority of women living in poor neighbourhoods viewed poor quality housing and overcrowding as sources of stress.
Conclusion Our findings support previous results from western nations. Overall this suggests that the influence of neighbourhood on wellbeing maybe a universal phenomenon. Religion represented an important ‘normative guideline’ in the way women perceived their neighbourhoods and their effect on wellbeing. This study offers a unique insight into mechanisms by which neighbourhoods influenced health and wellbeing of women before the armed conflict in Syria. Understanding the nature and causes of neighbourhood influences on health and health inequalities will be particularly important for urban and social renewal policies as Syria emerges from its present crisis. It will also have wider application for urban renewal in other nations.
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