Article

Recommendations to promote healthy social environments☆

Emerging evidence demonstrates that neighborhood characteristics are associated with sleep health. This chapter will (1) introduce the theoretical rationale for why contextual and/or environmental factors may affect sleep health, (2) review recent literature on the neighborhood determinants of sleep among children and adolescents, followed by (3) a similar review of the adult literature, and (4) conclude with the opportunities and challenges for advancing research and interventions on neighborhoods and sleep. Epidemiologic research has shown that both social and physical features of neighborhoods, including social cohesion, safety, neighborhood disorder, light, noise, traffic, pollution, and walkability, are related to sleep health among children and adults. More research is necessary to evaluate which contextual and/or environmental factors are most important for sleep health as well as to elucidate the underlying mechanisms that drive such relationships. Neighborhood-level interventions to promote healthy sleep should be developed, tested, and evaluated as possible pathways for ameliorating sleep health disparities and consequent health disparities.

High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes.

Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations.

Review and dialectical synthesis of evidence.

Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside—for hypotheses deemed causally linked to mortality—comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines.

In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective effects on comparator cities. Further resulting protective factors were identified (e.g. greater ‘social capital’ in Liverpool) which placed Glasgow at a further relative disadvantage. Other contributory factors were highlighted, including the inadequate measurement of deprivation.

A similar ‘explanatory model’ resulted for Scotland as a whole. This included: the components of the Glasgow model, given their impact on nationally measured outcomes; inadequate measurement of deprivation; the lagged effects of deprivation (in particular higher levels of overcrowding historically); and additional key vulnerabilities.

The work has helped to further understanding of the underlying causes of Glasgow's and Scotland's high levels of excess mortality. The implications for policy include the need to address three issues simultaneously: to protect against key exposures (e.g. poverty) which impact detrimentally across all parts of the UK; to address the existing consequences of Glasgow's and Scotland's vulnerability; and to mitigate against the effects of future vulnerabilities which are likely to emerge from policy responses to contemporary problems which fail sufficiently to consider and to prevent long-term, unintended social consequences.

The social and physical surroundings in which people live affect their health. Knowing what basic conditions and opportunities in communities advance or impede improvement of community health can inform public health practice and policy. This article describes the methods for conducting systematic literature reviews of three community interventions to promote healthy social environments: early childhood development programs, programs to promote affordable family housing in safe neighborhoods, and interventions to increase the cultural and linguistic competence of healthcare systems. Existing methods, established for conducting systematic reviews for the Guide to Community Preventive Services, were applied to these interventions to promote healthy social environments.