Nationwide equity assessment of the 20-min neighbourhood in the scottish context: A socio-spatial proximity analysis of residential locations

Socio-spatial inequalities in alcohol outlet availability: Evidence from register data in 15 urban areas in Québec, Canada

BACKGROUND

Alcohol spatial availability is linked with public health issues, with disadvantaged populations experiencing disproportionate harm. This study examined the association between alcohol spatial availability and area-level measures of disadvantage and sociodemographic characteristics in Québec, Canada.

METHODS

We conducted a cross-sectional analysis using 2021 liquor register and census data across 15 Québec urban areas. Measures included outlet counts within 800 m buffers and a spatial access index. Multilevel regression models assessed associations with composite measures of area-level disadvantage and single-item measures of area-level sociodemographic characteristics.

FINDINGS

On average, Québec areas exhibited higher offsite than onsite alcohol outlet availability. We found a J-shaped relationship between offsite alcohol availability and material disadvantage, with the most disadvantaged areas having 25 % more offsite outlets (95 % CI: 1.14-1.37) than the least disadvantaged. Conversely, onsite availability was 24 % lower (95 % CI: 0.67-0.87) in the most materially disadvantaged areas. Social disadvantage was associated with higher availability of both offsite and onsite outlets, with the highest socially disadvantaged areas having nearly 15 times as many onsite outlets (IRR 14.77, 95 % CI: 13.05-16.72) compared to the least disadvantaged. Higher population density and higher percentages of young adults, new immigrants, and recent movers were also associated with higher availability.

CONCLUSION

Alcohol availability differed by outlet type and disadvantage dimension. Offsite outlets were more common in both highly and minimally materially disadvantaged areas, while onsite outlets were more common in minimally disadvantaged areas. Socially disadvantaged areas had higher availability of both types of outlets. These findings suggest the need for targeted policies to reduce alcohol outlet availability, particularly in socially disadvantaged areas.

How could 20-minute neighbourhoods impact health and health inequalities? A policy scoping review

BACKGROUND

'Twenty-minute neighbourhoods' (or variations, such as 15-minute cities) are receiving increasing policy attention with anticipated impacts on population health (inequalities) outcomes alongside sustainability improvements. Yet, factors contributing to possible health impacts are not well understood. This scoping review aimed to identify proposed and evidenced pathways to health (inequality) outcomes from international policy plans.

METHODS

We first identified relevant academic literature, searching Scopus, (Ovid) Medline and Embase databases. A second search aimed to identify local or national planning or policy documents on government websites and related organisations. We followed a snowball search strategy to retrieve examples identified from the academic literature search and from the C40 cities network. These policy documents were our primary target for extraction, and we extracted and analysed by individual place. Pathways to health and health inequality outcomes identified in these documents were inductively coded thematically. We used Sankey diagrams to visually aggregate the thematic codes for each place relating to pathways to health outcomes and social determinants (mechanisms).

RESULTS

In total, 36 places across 17 countries were included, described across 96 academic articles, policy plans and reports. While different health improvement outcomes were included as a goal in nearly all policy plans, most frequently references were to health in general rather than specific health outcomes. Pathways to health were discussed in numerous policy plans across three overarching themes: proximity, place redesign, and environmental action. Proximity pathways were most frequently outlined as the means to achieve health outcomes, with active travel acting through increased physical activity/reduced obesity as the most frequent individual pathway. However, few plans specified what would actually be implemented in practice to achieve the increased proximity to services. Health inequalities were only mentioned by six places specifically, although nearly half of all places mentioned broader inequality aims (e.g., poverty reduction). Possible unintended consequences to health inequalities also received some attention, for example through displacement of residents.

DISCUSSION

Pathways to assumed health (inequality) outcomes require better specification and evidence. Health inequalities are particularly under-explored, and scenario modelling might provide a means to explore the dynamic aspects necessary to examine these important outcomes pre-implementation.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

Exploring young people's views of their local area related to the 20-minute neighbourhood policy: a national cross-sectional study

This study aimed to examine how young people subjectively perceive their local neighbourhoods and compare these perceptions with objective data regarding access to amenities aligned with features of the 20-minute neighbourhood (20MN) policy. Objective data (n:287 aged 12-18 years) were gathered through an online adaptation of the Place Standard Tool for Young People in Scotland. Subjective data concerning access to ten amenities in line with the 20MN concept, along with crime statistics, area-level deprivation and urbanicity were spatially linked. The association between perceptions of localities and factors such as gender, as well as both subjective and objective neighbourhood assessments were examined. Young people were most satisfied with nature and active travel in their local area. Conversely, their satisfaction was lowest for active travel to school. Rural young people were more dissatisfied with their localities. Agreement was observed between satisfaction with their 20 neighbourhoods and objective data indicating the presence of frequent public transportation, recreational spaces, and access to services. In conclusion, our study highlights the importance of amenities in healthy urban planning, showing a positive impact on young people's perceptions. Additionally, we uncover a connection between crime perceptions and area-level crime variables, potentially influencing health outcomes.