Declan French

Residential segregation and health in Northern Ireland

Patterns of residential segregation in Northern Ireland reflect historic sectarian conflict as well as current animosities. A number of indices of segregation are examined in this paper and their relative merits in capturing localised societal divisions are discussed. The implications of such divisions on health as mediated through conflict-related stress are then considered. Costed datasets of hospital, community and anxiety/depression prescribing data have been assembled and attributed to local geographies. The association between geographical variations in these costs and levels of segregation was modelled using regression analysis. It was found that the level of segregation does not help to explain variations in costed utilisation of acute and elderly services but does explain variations in the costs of prescribing for anxiety and depression with controls for socio-economic deprivation included. Results in this paper would indicate that strategies to promote good relations in Northern Ireland have positive implications for mental health.

Residential segregation, dividing walls and mental health: a population-based record linkage study

Background Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. While most previous research has relied on conceptualised measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or ‘peacelines’) which can be used to accurately identify residential segregation. Methods We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health. Results Using multilevel logistic regression models, we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a ‘peaceline’ increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI 1.14 to 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI 1.32 to 1.48), even after adjustment for gender, age, conurbation, deprivation and crime. Conclusions Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.

Did the Millennium Development Goals Change Trends in Child Mortality

There has been little assessment of the role the Millennium Development Goals (MDGs) have had in progressing international development. There has been a 41% reduction in the under-five mortality rate worldwide from 1990 to 2011 and an acceleration in the rate of reduction since 2000. This paper explores why this has occurred, and results for all developing countries indicate that it is not due to more healthcare or public health interventions but is driven by a coincidental burst of economic growth. Although the MDGs are considered to have played an important part in securing progress against poverty, hunger and disease, there is very little evidence to back this viewpoint up. A thorough analysis of the successes and failures of the MDGs is therefore necessary before embarking on a new round of global goals. Copyright

How financial strain affects health: evidence from the Dutch National Bank Household Survey

The mechanisms by which financial strain affects health are not well understood. In this paper, we conduct a longitudinal mediation analysis of the Dutch National Bank Household Survey. To quantify the relative importance of biological and nonbiological pathways from financial strain to health, we consider smoking, heavy drinking and being overweight as plausible behavioural responses to financial strain but find that only 4.9% of the response of self-reported health to financial strain is mediated by these behaviours. Further analysis indicates that although financial strain increases impulsivity this has little effect on unhealthy behaviours. Economic stresses therefore appear to be distinct from other forms of stress in the relatively minor influence of nonbiological pathways to ill-health.

The impact of debt and financial stress on health in Northern Irish households

We analyse data collected from a survey of Northern Irish low-income households experiencing varying degrees of financial hardship and examine how debt affects health and health-related behaviours. Our results indicate that the subjective experience of feeling financially stressed has a robust relationship with most aspects of health, including ability to self-care, problems performing usual activities, pain problems and psychological health. In contrast, the size of the debt, the type of debt or the number of different lenders does not add any extra explanatory power. Additionally, our results indicate that the pathway from financial difficulties to worse health runs through worse diets and increased consumption of cigarettes and drugs. This research is timely as household debt burdens will soon surpass the high levels seen at the time of the financial crisis and the introduction of welfare reform in Northern Ireland will put additional strain on low-income households.

Non-parametric estimation of data dimensionality prior to data compression: the case of the human development index

In many applications in applied statistics, researchers reduce the complexity of a data set by combining a group of variables into a single measure using a factor analysis or an index number. We argue that such compression loses information if the data actually have high dimensionality. We advocate the use of a non-parametric estimator, commonly used in physics (the Takens estimator), to estimate the correlation dimension of the data prior to compression. The advantage of this approach over traditional linear data compression approaches is that the data do not have to be linearised. Applying our ideas to the United Nations Human Development Index, we find that the four variables that are used in its construction have dimension 3 and the index loses information.

Pensions, Housing and Mortgage Markets in the UK

Recent reforms to pensions in the UK have been driven by low levels of retirement savings, increased life expectancy and public expectations of standards of living in later life. The government has introduced auto-enrolment of employees into occupational schemes for the purposes of increasing the numbers of those saving for retirement. To lessen budget deficits, they are also seeking to introduce measures, which will make non-pension savings more attractive. The government’s desire to reduce budget deficits has made the future of State Pensions uncertain, and the onus of retirement provision is increasingly moving towards individuals. Consequently, more people are looking to use their house as a retirement asset. There has been a significant rise in the demand for mortgage products in the 65+ population, and an increasing number of consumers are taking out mortgages that will extend into their retirement. However, the existing mortgage market in the UK is not equipped to support the changing pattern in consumer needs. In addition, the changing political and social environment in the UK has created uncertainties in housing and mortgage markets. In this chapter, we report and explain current developments in pensions, housing and mortgage markets in the UK. Our analysis indicates that each of these sectors has reached a turning point necessitating significant responses from stakeholders and policymakers.

Early HIV treatment and labour outcomes: A case study of mining workers in South Africa: Early HIV treatment and labour outcomes

This study examines whether labour outcomes of HIV-infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africas largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4+ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time. Also, we find that workers initiating antiretroviral therapy at CD4  ≥  350 have an 8% lower risk of absence prior to treatment. Although many companies and the South African government have adopted universal test-and-treat policies aiming to initiate all HIV-infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.

P2-523 Residential segregation and mental health in a post conflict society

Introduction Research shows conflict and racial/ethnic segregation leads to poor health. Northern Irelands emerging from over 30 years of civil disturbance but remains a society markedly segregated along religious lines with >70% population living in areas comprising >70% one religion. This study aims to determine if segregation is an independent predictor of psychological morbidity. Methods A geographical information system was used to produce a dissimilarity index for the 890 super-output areas (SOA) in Northern Ireland (average pop. 1900), modelling residential segregation by measuring dissimilarity within a SOA compared to its surrounding SOAs. Population was divided into equally proportioned segregation deciles. Psychological morbidity was assessed using uptake of antidepressant and anxiolytic medication data from a population-wide electronic prescribing system over 14 months (2009/10). Multiple logistic regression of ∼1.2 million non-institutionalised patients aged 18–74 was executed, with adjustment for demographic factors, residential social fragmentation, deprivation, and multi-level modelling to adjust for variations in prescribing at general practice level. Results Almost 20% patients were prescribed antidepressant and/or anxiolytic medication. Likelihood of antidepressant and anxiolytic use was higher in segregated than non-segregated areas (OR=1.45 95% CI 1.35 to 1.56 and OR=1.49 95% CI 1.32 to 1.68 respectively) after adjusting for age and gender. Further adjustment for fragmentation and income deprivation eliminated the relationship (OR=1.02 95% CI 0.96 to 1.08 and OR=1.00 95% CI 0.90 to 1.10 respectively). Conclusion Segregation is related to poor mental health but only because the people living in the more segregated areas are economically disadvantaged. Further analysis is being undertaken to determine if this holds true for other measures of residential polarisation.