Presentación de resultados por ítem variable independiente: Energías

A conceptual framework for this thesis is provided below in Figure 3-1. This framework broadly summarises the causal pathways thought to be operating between health outcomes and the wider determinants of health in the context of area regeneration interventions. The narrative description in this section will explain how the framework is conceived to summarise the process of how area regeneration can achieve improvements in health and well-being outcomes for residents.

As stated earlier in this chapter, area regeneration programmes in the UK have attempted to bring about health and well-being improvement in disadvantaged areas by adopting wide-ranging holistic strategies that target determinants of health and well-being (Stafford et al. 2006). The implementation strategies of an area regeneration programme often involve the development of initiatives that can be separated into three domains; economic, social and physical. How these strategies are implemented is crucial to the success of the intervention as poor implementation will likely have a negative impact on other stages (or the outcome). Implementation is therefore included in the framework as a crucial intermediate stage of the process of regeneration impacting on health and well-being.

2.7.1 How do economic, social and physical strategies impact on determinants of health and well- being?

Firstly, the economic focus of regeneration programmes places emphasis on regenerating the local economies of disadvantaged areas. As we have seen above, this work in the main focuses on provision of education training programmes for residents to improve employment prospects (Thomson 2006). However, debate has also been had regarding the role of regeneration in job creation. For example, Turok (2004) has stated that it is also the responsibility of regeneration

48 programmes to play a leading role in job creation. Nevertheless in reality, contemporary forms of regeneration have focused more on ‘supply’ side approaches with emphasis on education and training rather than job creation. This will be discussed more fully in Chapter 4. The idea that economic regeneration work will impact on positively on health and well-being relates to the well- established finding that those in employment will experience better health than those who are not in employment. For example, Kearns et al. (2009) stated that unemployment has routinely been found to be a determinant of ill health, often accompanied by financial problems thus resulting in psychological vulnerabilities, whilst job insecurity is also harmful to health and well-being. Thus in relation to the conceptual framework presented below, economic regeneration can improve individual determinants of health such as education and employment status. However, in addition, economic regeneration can also have a key impact at the community level in terms of population retention. We have seen in this chapter (e.g. Cotterill et al. 2008, Huxley et al. 2004, Kearns et al. 2008 and Stafford et al. 2008) that migration can potentially play a key role in the relationship between area regeneration and health improvement as those who benefit most from the regeneration programmes may move out. Thus if residents who have their job prospects boosted by economic regeneration and then move out to an area perceived as better then the regeneration programme will not have succeeded in improving the area that it has been implemented as the residents who move out will likely be replaced by more disadvantaged individuals. Thus, economic regeneration can be seen as potentially having a positive impact on individual determinants of health, whilst also potentially having a negative on community-level determinants of health if other efforts are not made to retain residents who have ‘got on’ through experiencing economic initiatives.

In terms of social regeneration initiatives, a key aspect of this domain of the regeneration effort is to concentrate on issues such as health promotion and tackling crime and anti-social behaviour. In relation to the conceptual framework presented below, it is clear that components of health promoting initiatives have the ability to positively impact on individual determinants of health such as physical activity levels and the quality of residents’ diets at the individual level. At the community level social regeneration initiatives that tackle anti-social behaviour and crime may, if successful, impact positively by reducing negative perceptions of disadvantaged areas which may work to offset the potential of residents leaving if their economic prospects have improved by reducing negative perceptions of disadvantaged areas.

The physical focus of regeneration programmes also aim to impact on the determinants of health shown in the conceptual framework below. Physical regeneration includes crucial infrastructure

49 renewal projects in disadvantaged areas such as new housing, new public services and the provision of green space. In terms of individual sense, a key aspect of physical regeneration to impact on determinants of health can be observed in relation to housing. By improving the quality of rental properties, health and well-being can be improved by making housing more energy efficient and thus warmer, which can reduce respiratory problems (Kearns et al. 2008). Moreover, housing renewal that improves the appearance of housing can improve mental health and self-confidence in residents. The aspects of physical regeneration that focus on improved public services can also impact positively on community determinants of health and well-being. For example, projects that increase access to health services by using regeneration funding to establish new health centres in disadvantaged areas can improve health and well-being outcomes for residents. Similarly physical regeneration projects that establish leisure facilities in disadvantaged areas such as a swimming pool or new park will have health benefits for residents that use these facilities. In addition, physical regeneration projects will also improve the aesthetic appeal of an area and thus enhance the likelihood that the population will be retained and also perhaps encourage in-migration of wealthier and healthier residents through gentrification processes.

However, we have also seen in this chapter that community engagement is crucial for this three- pronged (economic, social and physical) effort to be successful. Community engagement is important as the regeneration efforts can only succeed through community buy-in. Thus in the framework below community engagement is included (like implementation outlined earlier) as an intermediate stage through which other stages or the outcome can be impacted. Previous research outlined above has suggested (e.g. Mathers et al. 2008, Gosling 2008) that, without community engagement, residents feel disempowered and alienated. It is therefore key that the community ‘being regenerated’ have an active involvement in regeneration programmes so that regeneration professionals can be aware of the main economic, social and physical needs in each community in order to secure health and well-being improvement.

In summary, Figure 3-1 summarises the process by which area regeneration can impact on determinants of health to induce improvements in health and well-being outcomes for residents. This process begins with the implementation of the programme which focuses on delivering projects across economic, social and physical domains. The success of these projects relies on the buy-in of the community that is being served by the programme. If this is achieved then the economic, social and physical projects will address (in the ways outlined above) various individual and community level determinants of health and well-being which can then produce improved health and well-being outcomes for residents over time.

50 Figure 3-1 Thesis Conceptual Framework