Ulster University

Academic Institute

Michael Rosato

E055

Social determinants of health are defined by the World Health Organization (WHO) as the conditions in which people are born, grow, live, work, and age (US Department of Health and Human Services, 2020). While persistent deprivation is a key factor for analysis, recent research suggests that, as area-level deprivation definitions may persist across time, the movement of people in and out of these areas (the churn) may show movement of these people in to or out of areas of higher deprivation (Jiang, Pacheco & Dasgupta, 2019). Within Northern Ireland (NI) we can use time-stamped small area-level deprivation measures to identify those areas classed as persistently deprived. This project is one part of a two-part project: this part focusing on the relationship between neighbourhood and localised personal distress (measured through hospital episodes and prescribing levels); with the focus of the other study (through NISRA) revolving around socioeconomic trajectories and related outcomes of those who live in these areas (especially over time) and those who leave. This HBS-based project utilizes: (a) linked administrative data from the GP registration system; (b) the patient administration system; (c) accident and emergency (A&E) presentations in all trust areas – the Emergency Department (eEMS) and Emergency Department (Symphony) systems; (d) the enhanced prescription database; (e) NI multiple deprivation measures (at SOA level); (f) the self-harm register; (g) and mortality data. One feature of current research is that it typically focuses on urban areas. Figures released by NISRA suggest that in NI, while deprivation is more visible in urban areas, it is also a rural (and specifically border-area) phenomenon (Northern Ireland Assembly, 2018). This research will allow equal weight to be given to both urban and rural areas.

The proposed research will help in understanding the landscape of areas of stagnation in terms of deprivation in NI. Understanding of the geography of poverty and its implications is an ongoing area of concern and this study has the potential to inform NI policy and strategy in this area. This study aims to provide a richer picture of those living in these areas and also those that leave. There are clear health as well as social and economic issues related to this research. This study has the potential to help us understand the health implications of living in these areas, e.g. in the context of indicators of social distress such as presentations which are non-accidental at A&E departments, which may involve alcohol, and which may result in self-harm. Other studies which have addressed these health implications include a study from the NI Longitudinal Study (NILS) which reported that those who live in urban areas of deprivation have elevated rates of prescriptions for anxiety medication (74%) and depression medication (65%) compared to rural areas of deprivation. A further study by O’Reilly and colleagues (2008) addressed area factors in relation to suicide by using linked NI administrative data. This study used a cohort which experienced 566 suicides and looked at the influence of area, family and individual characteristics. This research can be used to identify areas which will benefit from additional resources through health policy interventions.

07/07/2021

TRE