The concept of neighborhood in health and mortality research

The focus of health and mortality research is changing from individual-level frameworks and analyses of disease causation to multilevel frameworks and analyses that incorporate both individual and environmental or contextual explanations. This research explores the meaning of neighborhood-the contextual-level variable used most often in health and mortality research-and discusses how neighborhood effects are related to health and mortality outcomes. A conceptual model that proposes the pathways through which neighborhood effects operate to influence health and mortality differentials is developed. Neighborhoods have a social as well as a spatial dimension, and geographically smaller neighborhoods often provide a more accurate measurement of neighborhood effects. Neighborhoods affect health and mortality outcomes primarily in an indirect fashion through proximate determinants such as smoking, diet, exercise, stress, and access to health insurance and medical providers.