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Area Deprivation and its Impact on Population Health: Conceptual Aspects, Measurement and Evidence from Germany

  • Alexander Karmann , Ines Weinhold EMAIL logo and Danny Wende
Published/Copyright: May 7, 2019

Abstract

Empirical evidence demonstrates associations between socioeconomic or environmental area deprivation and public health. To measure such structural effects, deprivation indices have been developed in the UK initially. Meanwhile their application is increasingly discussed in Germany, however with little attempts to adapt the concept to national conditions. In this paper, we develop a model of area deprivation differentiating between material, social and ecological deprivation effects. We apply structural equation modelling to endogenously estimate the latent deprivation dimensions as well as their relative impact on the health outcome, accounting for potential measurement errors and controlling for health care infrastructure. We use data at the level of German municipal associations (n=4,491) for the years 2013 and 2016, if available. We find that differences in material (βmaterial=−0.168, p<0.001) and social deprivation (βsocial=−0.249, p<0.001) as well as ecological damage (βecological=−0.077, p<0.001) explain part of the health differences in Germany. The social dimension is paramount in a health context. Moreover, deprivation dimensions cancel out each other and combining them in one overall index blurs the diverse picture of area deprivation in Germany. The small area analysis illustrates, that different strategies in environmental-, education- or health policy are necessary to reduce deprivation in different regions.

JEL Classification: I14; I18

Acknowledgements

The authors are grateful for valuable comments of two anonymous referees. Alexander Karmann wants to thank for helpful discussion of an earlier paper version at the Standing Fields Committee of Health Economics, Verein fuer Socialpolitik, University of Linz, October 6, 2017. Danny Wende did benefit from involvement in discussions on risk adjustment at the Bundesversicherungsamt (BVA) and - together with Ines Weinhold - in contributing to the report on capacity planning for the Federal Joint Committee (G-BA).

Conflict of Interest: The authors declare that they have no conflict of interest.

References

Bartlett, M. S. (1937): The Statistical Conception of Mental Factors, British Journal of Psychology. General Section 28(1), 97–104. https://doi.org/10.1111/j.2044-8295.1937.tb00863.x.Search in Google Scholar

Bauhoff, S. (2012): Do Health Plans Risk-Select? an Audit Study on Germany’s Social Health Insurance, Journal of Public Economics 96(9–10), 750–759. https://doi.org/10.1016/j.jpubeco.2012.05.011.Search in Google Scholar

Beelen, R., O. Raaschou-Nielsen, M. Stafoggia, Z. J. Andersen, G. Weinmayr, B. Hoffmann … G. Hoek (2014): Effects of Long-Term Exposure to Air Pollution on Natural-Cause Mortality: An Analysis of 22 European Cohorts within the Multicentre ESCAPE Project, The Lancet 383(9919), 785–795. https://doi.org/10.1016/S0140-6736(13)62158-3.Search in Google Scholar

Berschens,R.,S. Kerstings,D. Neuerer (2018): Luftqualität: EU reißt der Geduldsfaden – Klage gegen Deutschland wegen überhöhter Stickoxidwerte. Retrieved May 17, 2018 from: https://www.handelsblatt.com/politik/deutschland/luftqualitaet-eu-reisst-der-geduldsfa.den-klage-gegen-deutschland-wegen-ueberhoehter-stickoxidwerte/22578980.html?ticket=ST-1435557-Cj5MCr3o4LJlwzA9lHD6-ap2.Search in Google Scholar

Bollen, K. (1989): Structural Equations with Latent Variables. John Wiley & Sons, Inc, New York.10.1002/9781118619179Search in Google Scholar

Buchner, F., D. Goepffarth and J. Wasem (2013): The New Risk Adjustment Formula in Germany: Implementation and First Experiences, Health Policy 109(3), 253–262. https://doi.org/10.1016/j.healthpol.2012.12.001.Search in Google Scholar PubMed

Buehn, A. and M. R. Farzanegan (2013): Hold Your Breath: A New Index of Air Pollution, Energy Economics 37, 104–113. https://doi.org/10.1016/j.eneco.2013.01.011Search in Google Scholar

Buehn, A., A. Karmann and F. Schneider (2009): Shadow Economy and Do-it-Yourself Activities: The German Case, Journal of Institutional and Theoretical Economics JITE 165(4), 701–722. https://doi.org/10.1628/093245609789919658.Search in Google Scholar

Bundesinstitut für Bau-, Stadt- und Raumforschung (2009): Regionaler Preisindex. BBSR-Berichte 30. Selbstverlag des BBSR, Bonn.Search in Google Scholar

Bundesinstitut für Bau-, Stadt- und Raumforschung (2011): Bildung, Gesundheit, Pflege -Auswirkungen des demographischen Wandels auf die soziale Infrastruktur. BBSR-Berichte KOMPAKT 11. Selbstverlag des BBSR, Bonn. 1–16.Search in Google Scholar

Bundesinstitut für Bau-, Stadt- und Raumforschung (BBSR) (2013): INKAR: Indikatoren und Karten zur Raum- und Stadtentwicklung. Bundesinstitut für Bau-, Stadt- und Raumforschung (BBSR). http://www.inkar.de/.Search in Google Scholar

Bundeskriminalamt (2016): Polizeiliche Kriminalstatistik (PKS). Berichtsjahr 2016. Version 2.0. https://www.bka.de/DE/AktuelleInformationen/StatistikenLagebilder/PolizeilicheKriminalstatistik/pks_node.html.Search in Google Scholar

BusseR., M. Blümel (2014): Germany: health system review, Health Systems inTransition 16(2), 1–296.Search in Google Scholar

Butler, D. C., S. Petterson, R. L. Phillips and A. W. Bazemore (2013): Measures of Social Deprivation that Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery, Health Services Research 48(2,Part I), 539–559. https://doi.org/10.1111/j.1475-6773.2012.01449.x.Search in Google Scholar PubMed

Carstairs, V. (1995): Deprivation Indices: Their Interpretation and Use in Relation to Health, Journal of Epidemiology & Community Health 49(Suppl 2), 3–8. https://doi.org/10.1136/jech.49.Suppl_2.S3.Search in Google Scholar

Carstairs, V. and R. Morris (1989): Deprivation and Mortality: An Alternative to Social Class?, Journal of Public Health (United Kingdom) 11(3), 210–219. https://doi.org/10.1093/oxfordjournals.pubmed.a042469.Search in Google Scholar

Chateau, D., C. Metge, H. Prior and R. A. Soodeen (2012): Learning from the Census: The Socio-Economic Factor Index (SEFI) and Health Outcomes in Manitoba, Canadian Journal of Public Health 103(SUPPL.2), 23–27.10.1007/BF03403825Search in Google Scholar

Congdon, P. (2006): Estimating Diabetes Prevalence by Small Area in England, Journal of Public Health 28(1), 71–81. https://doi.org/10.1093/pubmed/fdi068.Search in Google Scholar

Curtis, S. and I. R. Jones (1998): Is There a Place for Geography in the Analysis of Health Inequality?, Socioloy of Health & Illness 20(5), 645–672. https://doi.org/10.1111/1467-9566.00123.Search in Google Scholar

Dale, M. R. T. and Fortin, M.-J. (2014): Spatial Analysis: A Guide for Ecologists. Cambridge University Press, Cambridge, 2nd ed.10.1017/CBO9780511978913Search in Google Scholar

Departmentfor Communitiesand Local Governement. (2015). The English Index of Multiple Deprivation (IMD) 2015: Guidance, (Imd), 1–7. https://doi.org/https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015.Search in Google Scholar

Destatis (2015): Allgemeine Sterbetafeln für Deutschland das frühere Bundesgebiet, die neuen Länder sowie die Bundesländer 2010/2012. Statistisches Bundesamt, Wiesbaden.Search in Google Scholar

Destatis (2017a): Regionaldatenbank Deutschland (GENESIS). Tabelle 21111-02-06-4-B. Allgemeinbildende Schulen: Absolventen/Abgänger nach dem Schulabschluss – Schuljahr-regionale Ebenen 2016. https://www.regionalstatistik.de/genesis/online/data;jsessionid=AAC03166C4868E3D00DAB469AE970465.reg3?operation=abruftabelleAbrufen&selectionname=21111-02-06-4-B&levelindex=1&levelid=1526288837276&index=4.Search in Google Scholar

Destatis (2017b): Regionaldatenbank Deutschland (GENESIS). Tabelle 14111-01-03-5. Bundestagswahl: Wahlberechtigte und -beteiligung 2013. https://www.regionalstatistik.de/genesis/online/data;jsessionid=AAC03166C4868E3D00DAB469AE970465.reg3?operation=abruftabelleAbrufen&selectionname=14111-01-03-5&levelindex=0&levelid=1526289067036&index=2.Search in Google Scholar

Dibben, C., I. Atherton, M. Cox, V. Watson, M. Ryan and M. Sutton (2007): Investigating the Impact of Changing the Weights that Underpin the Index of Multiple Deprivation 2004. Department for Communities and Local Government, London. Retrieved from Www.Communities.Gov.Uk/Documents/Communities/Pdf/323211.Pdf.Search in Google Scholar

Dressler, W. W., M. C. Balieiro, R. P. Ribeiro and J. E. Dos Santos (2014): Culture as a Mediator of Health Disparities: Cultural Consonance, Social Class, and Health, Annals of Anthropological Practice 38(2), 214–231. https://doi.org/10.1111/napa.12053.Search in Google Scholar

Drösler et al. (2018): Gutachten zu den regionalen Verteilungswirkungen des morbiditätsorientierten Risikostrukturausgleichs, Bonn.Search in Google Scholar

Eikemo, T. A., C. Bambra, K. Judge and K. Ringdal (2008): Welfare State Regimes and Differences in Self-Perceived Health in Europe: A Multilevel Analysis, Social Science & Medicine 66(11), 2281–2295. https://doi.org/10.1016/j.socscimed.2008.01.022.Search in Google Scholar

European Environment agency (2016): Premature deaths attributable to air pollution. Retrieved May 13, 2018 from: https://www.eea.europa.eu/media/newsreleases/many-europeansstill-exposed-to-air-pollution-2015/premature-deaths-attributable-to-air-pollution.Search in Google Scholar

Goddard, M. and P. Smith (2001): Equity of Access to Health Care Services: Theory and Evidence from the UK, Social Science and Medicine 53(9), 1149–1162. https://doi.org/10.1016/S0277-9536(00)00415-9.Search in Google Scholar

Göpffarth, D., T. Kopetsch and H. Schmitz (2016): Determinants of Regional Variation in Health Expenditures in Germany, Health Economics 25(7), 801–815. https://doi.org/10.1002/hec.3183.Search in Google Scholar PubMed

Gordon, D. (1995): Deprivation Weighting, Journal of Epidemiology and Community Health 49(Suppl 2), 39–44.10.1136/jech.49.Suppl_2.S39Search in Google Scholar

Gulliford, M., J. Figueroa-Munoz, M. Morgan, D. Hughes, B. Gibson, R. Beech and M. Hudson (2002): What Does “Access To Health Care” Mean?, Journal of Health Services Research and Policy 7(3), 186–188. https://doi.org/10.1258/135581902760082517.Search in Google Scholar

Halonen, J. I., J. Vahtera, T. Oksanen, J. Pentti, M. Virtanen, M. Jokela … M. Kivimäki (2013): Socioeconomic Characteristics of Residential Areas and Risk of Death: Is Variation in Spatial Units for Analysis a Source of Heterogeneity in Observed Associations?, BMJ Open 3(4), e002474. https://doi.org/10.1136/bmjopen-2012-002474.Search in Google Scholar PubMed

Harrison, S. and J. B. Grace (2007): Biogeographic Affinity Helps Explain Productivity-Richness Relationships at Regional and Local Scales, The American Naturalist 170(Suppl 2(S2)), S5–15. https://doi.org/10.1086/519010.Search in Google Scholar PubMed

Hofmeister, C., W. Maier, A. Mielck, L. Stahl, J. Breckenkamp and O. Razum (2015): Regionale Deprivation in Deutschland: Bundesweite Analyse Des Zusammenhangs Mit Mortalität Unter Verwendung Des ‚German Index of Multiple Deprivation (GIMD) ‘, Das Gesundheitswesen 78(01), 42–48.10.1055/s-0034-1390421Search in Google Scholar

Hu, L. T. and P. M. Bentler (1999): Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives, Structural Equation Modeling 6(1), 1–55. https://doi.org/10.1080/10705519909540118.Search in Google Scholar

Jacobson, M. Z. (2008): On the Causal Link between Carbon Dioxide and Air Pollution Mortality, Geophysical Research Letters 35(3), 1–5. https://doi.org/10.1029/2007GL031101.Search in Google Scholar

Jarman, B. (1983): Identification of Underprivileged Areas, British Medical Journal 286(6385), 1705–1708. https://doi.org/10.1136/bmj.286.6379.1705.Search in Google Scholar

Jen, M. H., K. Jones and R. Johnston (2009): Compositional and Contextual Approaches to the Study of Health Behaviour and Outcomes: Using Multi-Level Modelling to Evaluate Wilkinson’s Income Inequality Hypothesis, Health and Place 15(1), 198–203. https://doi.org/10.1016/j.healthplace.2008.04.005.Search in Google Scholar

Kawachi, I. (1999): Social Capital and Community Effects on Population and Individual Health, Annals of the New York Academy of Sciences 896(1), 120–130. https://doi.org/10.1111/j.1749-6632.1999.tb08110.x.Search in Google Scholar PubMed

Kawachi, I. and B. P. Kennedy (1999): Income Inequality and Health: Pathways and Mechanisms, Health Services Research 34(1 Pt 2), 215–227.Search in Google Scholar PubMed

Krieger, N., J. T. Chen, P. D. Waterman, D. H. Rehkopf and S. V. Subramanian (2003): Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health: A Comparison of Area-Based Socioeconomic Measures–The Public Health Disparities Geocoding Project, American Journal of Public Health 93(10), 1655–1671.10.2105/AJPH.93.10.1655Search in Google Scholar

Kroll, L. E., M. Schumann, J. Hoebel and T. Lampert (2017): Regionale Unterschiede in der Gesundheit – Entwicklung eines sozioökonomischen Deprivationsindex für Deutschland, Journal of Health Monitoring 2(2), 103–120. https://doi.org/10.17886/RKI-GBE-2017-035.Search in Google Scholar

Lawlor, D. A., G. Davey Smith, R. Patel and S. Ebrahim (2005): Life-Course Socioeconomic Position, Area Deprivation, and Coronary Heart Disease: Findings from the British Women’s Heart and Health Study, American Journal of Public Health 95(1), 91–97. https://doi.org/10.2105/AJPH.2003.035592.Search in Google Scholar PubMed

Lupton, R., A. Fitzgerald and A. Fenton (2013). The Distribution of Local Government Finance by Local Authority-Level Deprivation, (April 2013), 1–6. Retrieved from https://www.research.manchester.ac.uk/portal/en/publications/the-distribution-of-local-government-finance-by-local-authority-level-deprivation(02589c27-e583-467c-acfd-8a8b406b7879).html.Search in Google Scholar

Lynch, J. W., G. A. Kaplan and J. T. Salonen (1997): Why Do Poor People Behave Poorly? Variation in Adult Health Behaviours and Psychosocial Characteristics by Stages of the Socioeconomic Lifecourse, Social Science and Medicine 44(6), 809–819. https://doi.org/10.1016/S0277-9536(96)00191-8.Search in Google Scholar

Macintyre, S., A. Ellaway and S. Cummins (2002): Place Effects on Health: How Can We Conseptualise. Operationalise and Measure Them?, Social Science and Medicine 55, 125–139.10.1016/S0277-9536(01)00214-3Search in Google Scholar

Macintyre, S., S. Maciver and A. Sooman (1993): Area, Class and Health: Should We Be Focusing on Places or People?, Journal of Social Policy 22(02), 213. https://doi.org/10.1017/S0047279400019310.Search in Google Scholar

Macintyre, S., L. McKay, S. Cummins and C. Burns (2005): Out-Of-Home Food Outlets and Area Deprivation: Case Study in Glasgow, UK, The International Journal of Behavioral Nutrition and Physical Activity 2(1), 16. https://doi.org/10.1186/1479-5868-2-16.Search in Google Scholar PubMed

Mackenbach, J. P., I. Stirbu, A.-J. R. Roskam, M. M. Schaap, G. Menvielle, M. Leinsalu and A. E. Kunst (2008): Socioeconomic Inequalities in Health in 22 European Countries, New England Journal of Medicine 358(23), 2468–2481. https://doi.org/10.1056/NEJMsa0707519.Search in Google Scholar

Maier, W., J. Fairburn and A. Mielck (2012): Regionale Deprivation und Mortalität in Bayern. Entwicklung eines “Index Multipler Deprivation” auf Gemeindeebene, Gesundheitswesen 74(7), 416–425. https://doi.org/10.1055/s-0031-1280846.Search in Google Scholar

Maier, W., R. Holle, M. Hunger, A. Peters, C. Meisinger, K. H. Greiser … A. Mielck (2013): The Impact of Regional Deprivation and Individual Socio-Economic Status on the Prevalence of Type 2 Diabetes in Germany. A Pooled Analysis of Five Population-Based Studies, Diabetic Medicine 30(3), 78–86. https://doi.org/10.1111/dme.12062.Search in Google Scholar

McLennan, D., H. Barnes, M. Noble, J. Davies, E. Garratt and C. Dibben (2011): The English Indices of Deprivation 2010. Department for Communities and Local Government, London. (April), 1–20.Search in Google Scholar

Metge, C., D. Chateau, H. Prior, R.-A. Soodeen, C. De Coster and L. Barré (2009): Composite Measures/Indices of Health and Health System Performance. Winnipeg, MB: Manitoba Centre for Health Policy.Search in Google Scholar

Moran, P. A. P. (1950): A Test for the Serial Dependence of Residuals, Biometrika 37(1/2), 178–181.10.1093/biomet/37.1-2.178Search in Google Scholar

Morgan, O. and A. Baker (2006): Measuring Deprivation in England and Wales Using 2001 Carstairs Scores, Health Statistics Quarterly/Office for National Statistics 31, 28–33.Search in Google Scholar

Noble, M., G. Wright, G. Smith and C. Dibben (2006): Measuring Multiple Deprivation at the Small-Area Level, Environment and Planning A 38(1), 169–185. https://doi.org/10.1068/a37168.Search in Google Scholar

Ozegowski, S. and L. Sundmacher (2012): Wie “bedarfsgerecht” ist die Bedarfsplanung? Eine Analyse der regionalen Verteilung der vertragsärztlichen Versorgung. Is the Needs-Based Planning Mechanism Effectively Needs-Based? An Analysis of the Regional Distribution of Outpatient Care Providers, Gesundheitswesen 74(10), 618–626. https://doi.org/10.1055/s-0032-1321748.Search in Google Scholar

Pampalon, R., D. Hamel, P. Gamache and G. Raymond (2009): A Deprivation Index for Healthy Planning, Chronic Diseases in Canada 29(4), 178–191. Retrieved from http://www.kflaphi.ca/wp-content/uploads/DeprivationIndex.pdf10.24095/hpcdp.29.4.05Search in Google Scholar

Pasetto, R., L. Sampaolo and R. Pirastu (2010): Measures of Material and Social Circumstances to Adjust for Deprivation in Small-Area Studies of Environment and Health: Review and Perspectives, Annali Dell’Istituto Superiore Di Sanita 46(2), 185–197. https://doi.org/10.4415/ANN_10_02_13.Search in Google Scholar PubMed

Pickett, K. E. and M. Pearl (2001): Multilevel Analyses of Neighbourhood Socioeconomic Context and Health Outcomes: A Critical Review, EmJournal of Epidemiology and Community Healthmmunity Health 55(2), 111–122. https://doi.org/10.1136/jech.55.2.111.Search in Google Scholar

Popay,J.,M. Whitehead,R. Carr-Hill,C. Dibben,P. Dixon,E. Halliday,P. Walthery (2015): The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative: a mixed-methods evaluation, Public Health Research 3(12), 1–146. https://doi.org/10.3310/phr03120.Search in Google Scholar

Reich, O., C. Weins, C. Schusterschitz and M. Thöni (2012): Exploring the Disparities of Regional Health Care Expenditures in Switzerland: Some Empirical Evidence, European Journal of Health Economics 13(2), 193–202. https://doi.org/10.1007/s10198-011-0299-x.Search in Google Scholar

Richardson, E. A., R. J. Mitchell, N. K. Shortt, J. Pearce and T. P. Dawson (2009): Evidence-Based Selection of Environmental Factors and Datasets for Measuring Multiple Environmental Deprivation in Epidemiological Research, Environmental Health : A Global Access Science Source 8 Suppl 1(Suppl 1), S18. https://doi.org/10.1186/1476-069X-8-S1-S18.Search in Google Scholar

Sánchez-Santos, M. T., M. Mesa-Frias, M. Choi, E. Nüesch, A. Asunsolo-del Barco, A. Amuzu … J. P. Casas (2013): Area-Level Deprivation and Overall and Cause-Specific Mortality: 12 Years’ Observation on British Women and Systematic Review of Prospective Studies, PLoS ONE 8(9), 1–11. https://doi.org/10.1371/journal.pone.0072656.Search in Google Scholar

Schuurman, N., N. Bell, J. R. Dunn and L. Oliver (2007): Deprivation Indices, Population Health and Geography: An Evaluation of the Spatial Effectiveness of Indices at Multiple Scales, Journal of Urban Health 84(4), 591–603. https://doi.org/10.1007/s11524-007-9193-3.Search in Google Scholar

Sheiner, L. (2014). Why the Geographic Variation in Health Care Spending Cannot Tell Us Much about the Efficiency or Quality of Our Health Care System. Brookings Papers on Economic Activity, Fall 2014, 1–67.10.1353/eca.2014.0012Search in Google Scholar

Shohaimi, S., R. Luben, N. Wareham, N. Day, S. Bingham, A. Welch … K.-T. Khaw (2003): Residential Area Deprivation Predicts Smoking Habit Independently of Individual Educational Level and Occupational Social Class. A Cross Sectional Study in the Norfolk Cohort of the European Investigation into Cancer (Epic-Norfolk), Journal of Epidemiology and Community Health 57, 270–276. https://doi.org/10.1136/jech.57.4.270Search in Google Scholar PubMed

Shohaimi, S., A. Welch, S. Bingham, R. Luben, N. Day, N. Wareham and K. T. Khaw (2004a): Area Deprivation Predicts Lung Function Independently of Education and Social Class, European Respiratory Journal 24(1), 157–161. https://doi.org/10.1183/09031936.04.00088303.Search in Google Scholar

Shohaimi, S., A. Welch, S. Bingham, R. Luben, N. Day, N. Wareham and K.-T. Khaw (2004b): Residential Area Deprivation Predicts Fruit and Vegetable Consumption Independently of Individual Educational Level and Occupational Social Class: A Cross Sectional Population Study in the Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk), Journal of Epidemiology and Community Health 58(8), 686–691. https://doi.org/10.1136/jech.2003.008490.Search in Google Scholar

Shortt, N. K., E. A. Richardson, R. Mitchell and J. Pearce (2011): Re-Engaging with the Physical Environment: A Health-Related Environmental Classification of the UK, Area 43(1), 76–87. https://doi.org/10.1111/j.1475-4762.2010.00960.x.Search in Google Scholar

Siegel, M., V. Vogt and L. Sundmacher (2014): From a Conservative to a Liberal Welfare State : Decomposing Changes in Income-Related Health Inequalities in Germany, 1994–2011, Social Science & Medicine 108, 10–19.10.1016/j.socscimed.2014.02.022Search in Google Scholar

Singh, G. K. (2003): Area Deprivation and Widening Inequalities in US Mortality, 1969–1998, American Journal of Public Health 93(7), 1137–1143. https://doi.org/10.2105/AJPH.93.7.1137.Search in Google Scholar PubMed

Singh, G. K. and M. D. Kogan (2007): Widening Socioeconomic Disparities in US Childhood Mortality, 1969–2000, American Journal of Public Health 97(9), 1658–1665. https://doi.org/10.2105/AJPH.2006.087320.Search in Google Scholar

Sloggett, A. and H. Joshi (1994): Higher Mortality in Deprived Areas: Community or Personal Disadvantage?, BMJ (Clinical Research Ed.) 309(6967), 1470–1474. https://doi.org/10.1136/bmj.309.6967.1470.Search in Google Scholar PubMed

Smith, D. M., S. Cummins, M. Taylor, J. Dawson, D. Marshall, L. Sparks and A. S. Anderson (2010): Neighbourhood Food Environment and Area Deprivation: Spatial Accessibility to Grocery Stores Selling Fresh Fruit and Vegetables in Urban and Rural Settings, International Journal of Epidemiology 39(1), 277–284. https://doi.org/10.1093/ije/dyp221.Search in Google Scholar

Smith, J. P. (1999): Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status, Journal of Economic Perspectives 13(2), 145–166. https://doi.org/10.1257/jep.13.2.145.Search in Google Scholar

Stafford, M. and M. Marmot (2003): Neighbourhood Deprivation and Health: Does It Affect Us All Equally?, International Journal of Epidemiology 32(3), 357–366. https://doi.org/10.1093/IJE/DYG084.Search in Google Scholar PubMed

Stamatakis, E., M. Hillsdon, G. Mishra, M. Hamer and M. Marmot (2009): Television Viewing and Other Screen-Based Entertainment in Relation to Multiple Socioeconomic Status Indicators and Area Deprivation: The Scottish Health Survey 2003, Journal of Epidemiology and Community Health 63(9), 734–740. https://doi.org/10.1136/jech.2008.085902.Search in Google Scholar PubMed

Sundmacher, L., L. Schang, W. Schüttig, R. Flemming, J. Frank-Teewag, I. Geiger, S. Franke, I. Weinhold, D. Wende, T. Kistemann, C. Höser, J. Kemen, W. Hoffmann, N. Van den Berg, F. Kleinke, U. Becker, and T. Brechtel (2018): Gutachten zur Weiterentwicklung der Bedarfsplanung i.S.d. §§ 99 ff. SGB V zur Sicherung der vertragsärztlichen Versorgung. Im Auftrag des Gemeinsamen Bundesausschusses. München, Köln.Search in Google Scholar

Talbot, R. J. (1991): Underprivileged Areas and Health Care Planning: Implications of Use of Jarman Indicators of Urban Deprivation, BMJ (Clinical Research Ed.) 302(6773), 383–386. https://doi.org/10.1136/bmj.302.6773.383.Search in Google Scholar PubMed

Townsend, P. (1979): Poverty in the United Kingdom. A Survey of Household Resources and Standards of Living. Penguin Books Ltd, Harmondsworth. Retrieved from http://www.poverty.ac.uk/system/files/townsend-book-pdfs/PIUK/piuk-whole.pdf10.1525/9780520325760Search in Google Scholar

Townsend, P. (1987): Deprivation, Journal of Social Policy 16(2), 125–146.10.1017/S0047279400020341Search in Google Scholar

Trebicka, B. (2014): Mimic Model: A Tool to Estimate the Shadow Economy, Academic Journal of Interdisciplinary Studies 3(6), 295–300. https://doi.org/10.5901/ajis.2014.v3n6p295.Search in Google Scholar

Umweltbundesamt (2016): Fachgebiet II 4.2. Beurteilung der Luftqualität Aktuelle Luftdaten, Jahresmittel 2016. https://www.umweltbundesamt.de/daten/luft.Search in Google Scholar

Van Doorslaer, E. and X. Koolman (2004): Explaining the Differences in Income-Related Health Inequalities across European Countries, Health Economics 13(7), 609–628. https://doi.org/10.1002/hec.918.Search in Google Scholar PubMed

Van Jaarsveld, C. H. M., A. Miles and J. Wardle (2007): Pathways from Deprivation to Health Differed between Individual and Neighborhood-Based Indices, Journal of Clinical Epidemiology 60(7), 712–719. https://doi.org/10.1016/j.jclinepi.2006.10.005.Search in Google Scholar PubMed

Van Kleef, R. C., R. C. Van Vliet and W. P. Van De Ven (2013): Risk Equalization in the Netherlands: An Empirical Evaluation, Expert Review of Pharmacoeconomics & Outcomes Research 13(6), 829–839. https://doi.org/10.1586/14737167.2013.842127.Search in Google Scholar PubMed

Wen, M., C. R. Browning and K. A. Cagney (2003): Poverty, Affluence, and Income Inequality: Neighborhood Economic Structure and Its Implications for Health, Social Science and Medicine 57(5), 843–860. https://doi.org/10.1016/S0277-9536(02)00457-4.Search in Google Scholar

Wende, D. (2017): Anreize für regionale Risikoselektion unter dem Morbiditätsorientierten Risikostrukturausgleich, Das Gesundheitswesen 79(10), 816–820. https://doi.org/10.1055/s-0042-123851.Search in Google Scholar

Wilkinson, R. G. and M. Marmot (2003): Social Determinants of Health: The Solid Facts. World HealthOrganization. World Health Organization, Kopenhagen, 2nd ed.Search in Google Scholar

Published Online: 2019-05-07
Published in Print: 2019-05-27

© 2019 Oldenbourg Wissenschaftsverlag GmbH, Published by De Gruyter Oldenbourg, Berlin/Boston

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