Problem definition

The system atic literature of the three topics: dem ographics, social m arketing and health inequalities identified a num ber of gaps in the research. There is a requirem ent for health outcomes, needs and inequality m easurem ent to m ove aw ay from a traditional "container" perspective of deprivation as defined by m any existing com posite deprivation m easures so th at it is considered as p art of a dynam ic process. The scale at w hich these traditional deprivation

m easures are created for do not provide sufficient specificity of local health disparities, and in an environm ent w here PCTs m ust dem onstrate best practice and value for money, social m arketing cam paigns derived from segm entation using deprivation indicators are unlikely to reach those w ith the greatest health needs. G eodem ographics are applied at the sm allest spatial u n it available to UK researchers, the postcode u n it (see table 6) w hich approxim ates 15 households, and because they are created by clustering together socially sim ilar population sub-groups it is fair to expect them to provide a m ore useful differentiation of the socially sim ilar characteristics.

As highlighted in the literature, health outcomes across all population groups and sub-groups in the UK have considerably im proved over the last 100

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years. But at the sam e time the nature of illness has changed. There has been a m ovem ent aw ay from large epidemics of communicable diseases tow ards disease prevalence associated w ith behaviour choices and lifestyle (Hicks and Allen, 1999). Despite these im provem ents, there still rem ain different levels of disease incidence, m orbidity and health outcom es across different sections of our society which is supported by a significant body of evidence (M arm ot and Brunner, 2005). Missing from m any of the indicators and m easures developed is consideration for describing in detail, at the local level,

m aterialist inequalities in health. By ascribing different neighbourhood Types w ith supplem entary health data, inform ation and know ledge of health

outcom es can be acquired. As a consequence the research will attem p t to identify variations across different social structures and the geographical scales at w hich they operate.

Despite the ever increasing num ber of qualitative and quantitative research projects, the contribution of social capital to understanding of health

inequalities has not yet been absolutely defined and there still rem ains a lack of consensus. The literature identified a developing discussion surro u n d in g the influence of neighbourhood differences in social capital and w h eth er the lack of, or differences in, social capital across neighbourhoods has an

influence on health outcom es (Subram anian et al., 2003; Lochner et al., 2003;

Wakefield and Poland, 2005; Veenstra et al., 2005).

The contributions that the theoretical concept of social capital will m ake to the thesis arise from the notion that health-threatening behaviour is a

response to m aterial deprivation and stress (Jarvis, W ardle et al., 1999). This suggests an apparent dichotom ous relationship betw een the m aterial and psychosocial explanations of health inequalities u p o n w hich m odels of social determ inants of health are built. Identification of likely health threatening behaviours for neighbourhoods will provide public health professionals w ith

tools w hich can be used to build and harness social capital th ro u g h social m arketing and participation interventions through w hich com m unities are encouraged to change their behaviours by taking p art in activities. Thus, if health threatening behaviours are m easured at the level of the

neighbourhood they m ay provide useful proxy m easures of social capital.

Existing m easures of social capital are ill-defined due to the lack of consensus about w h at it actually means, b u t certain health-harm ing behaviours which are reinforced by social cohesion and social netw orks m ay provide new insights for identifying neighbourhoods and the presence of social capital.

This is particularly relevant for the bonding social capital w hich relates to com m on identities and ties am ongst similar people, w here indicators of sm oking behaviours m ay act as a useful proxy for predicating this form of social capital.

It is evident from the literature that there is a clear requirem ent to m ove

tow ards developing m easures that encom pass com m unity attributes based on social similarity. Aggregation of population sub-groups according to

sim ilarity will highlight gradients of health inequalities at the neighbourhood level and provide an enriched evidence base for public health interventions and campaigns.

The requirem ent for these new m easures is further supported by the present lack of local neighbourhood m easures of health needs and behaviours. Data protection issues restrict access and use of individual level records and m andatory requirem ents for relevant data reporting are n o t in place. One of the paradoxes of local health care needs assessm ent is data collected by general practitioners are not m ade available to Prim ary Care Trusts (PCTs) for secondary analysis. General Practices collect individual level data, b u t because they are private businesses they are not legally obliged to share data w ith the prim ary care organisations responsible for com m issioning their

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services. The 1998 D ata Protection Act and laws relating to medical confidentiality further ensure specific inform ation is difficult to obtain.