Place effects on health: how can we conceptualise, operationalise and measure them?

In this paper we highlight what we consider to be a lack of adequate conceptualisation, operationalisation and measurement of "place effects". We briefly review recent historical trends in the study of the effects of place on health in industrial countries, and argue that "place effects" often appear to have the status of a residual category, an unspecified black box of somewhat mystical influences on health which remain after investigators have controlled for a range of individual and place characteristics. We note that the distinction between "composition" and "context" may be more apparent than real, and that features of both material infrastructure and collective social functioning may influence health. We suggest using a framework of universal human needs as a basis for thinking about how places may influence health, and recommend the testing of hypotheses about specific chains of causation that might link place of residence with health outcomes. (C) 2002 Elsevier Science Ltd. All rights reserved.