International Journal of Integrated Care, 4 June 2007 - ISSN 1568-4156
Book review
Placing health: neighbourhood renewal, health improvement and complexity
Tim Blackman
Bristol: The Policy Press, University of Bristol, 2006, pp 230,
ISBN 1861346107
Pim de Graaf, MD, MPH, Health policy consultant

Where people live matters to their health. Health improvement strategies often target where people live, but do these strategies work? ‘Placing Health’ tackles this question by exploring new theoretical, empirical and practice perspectives on this issue, anchored by studies of England's Neighbourhood Renewal Strategy and the Programme for Action on health inequalities.

‘Placing Health’ is the first major publication to use complexity theory to understand the relationships between neighbourhood change, the emergence of states of health, and policy interventions managed using performance indicators. This is complemented by reviews of the international evidence base on area effects and neighbourhood change and is supplemented by new insights from the author's own research and experience.

‘Placing Health’ is a wide-ranging study with many new examples of the impact of neighbourhood conditions, from smoking to dementia. It is aimed at researchers, teachers and students in the social health and policy sciences with an interest in area-based health improvement. It is also written for those who seek a conceptually based and evidence-informed underpinning to neighbourhood renewal and health improvement work.

While this book may be of less interest to the individual practitioner of integrated care, it certainly does offer experiences and views to those whose task is to provide context to patients and practitioners in integrated care.

This is underlined by the opening chapter, which raises the question if the NHS contributes to health inequalities by unequal spatial distribution of resources and services, and also by practitioners whose attention has shown to be biased, away from the socially less favoured. Chapters 2, 3 and 4 describe how the environment and intervention programmes exert influence on people's health, with an emphasis on neighbourhoods. The complexity of relationships is shown by some examples, including smoking cessation and how the functioning of people with dementia interacts with the immediate environment.

Chapter 5 describes England's National Strategy for Neighbourhood Renewal which was launched in 2001 and the subsequent planning of programmes. Thereby, a shift takes place from government to governance and the notion of floor targeting is introduced. Floor target action plans—for example, for teenage conceptions and premature deaths from circulatory diseases—are concepts used to address the six key outcome areas: health, unemployment, crime, education, housing and liveability.

Chapter 6 describes how tackling health equalities actually became a policy priority from 1997 onwards and has led to the 2003 Tackling Health Inequalities, a Programme for Action. The role of performance management, local authorities and impact assessment are all scrutinized.

The concluding chapter returns to the role and importance of neighbourhoods. It emphasises that the English Neighbourhood Renewal Strategy will only make a small contribution to tackling health inequality, given that the wider determinants of health lie beyond the neighbourhood system. But still, it makes a difference. In these times of globalisation and the development of virtual and other communities, neighbourhoods remain an important factor in shaping our lives and health.

One of the key challenges is mentioned at the end of the book: how to marry the bottom-up agenda of neighbourhood participation and governance with national targets. The former does receive less attention in the book—and in British policies: people in neighbourhoods and their health are mostly portrayed as targets, not as actors. This may partially be explained by the inactivity of previous governments, which essentially paid no attention to health inequalities. In compensation, current central government is in a hurry and rains down policies on the country, with an emphasis on results. Also, throughout the book, some references are made to the relationship between neighbourhoods and communities, but this could have been elaborated more in order to help us understand what and how additional health benefits may result from neighbourhoods that are also communities.

The author, Tim Blackman, is Professor of Sociology and Social Policy and Head of the school of Applied Social Sciences at Durham University. He advises the Labour government in the UK on its policies with regard to health inequalities. This book draws on many years of experience. One main lesson he teaches us is that it is possible and worthwhile to address the complex relationships that determine our health, taking neighbourhood as the basic organising principle. His book also shows the need for sustained policy and pays much attention to approaches and tools of strategy implementation.

Internationally, there is increasing consensus on two public health objectives: adding healthy years to life and reducing health inequalities. This book is a valuable contribution to the second one. In many countries, spatially distributed health inequalities are larger than in the UK. This book may help their public health professionals and policy makers to set out directions, making use of the unique UK experiences.