Defying the odds?
Identifying and understanding the relationship between health and resilience

Abstract

Research on ‘health resilience’ at the area-level is still in its infancy. Only a few studies to date have identified areas in England that have exceeded, or overachieved, in health outcomes despite significant long-term economic deprivation (otherwise known as ‘defying the odds’). Such findings have previously been conceptualised in terms of ‘health resilience’. This research is the first to explore area-level ‘health resilience’ (captured by morbidity and mortality) at different geographic scales using a mixed-methods approach. Regression Tree Classification (RTC) was used to identify local areas (Local Authority Districts, Census Area Statistical Wards and Lower Super Output Areas) that performed relatively well in terms of mortality (premature mortality 1998-2003) and/or morbidity (self-reported not good general health and limiting long-term illness from the 2001 Census) despite experiencing long-term economic deprivation (Townsend scores 1971-2001).
The RTC statistical analysis results show that there is considerable variability in the identification of ‘health resilience’ in terms of both scale and health outcome considered. Potential mechanisms underpinning this ‘health resilience’ were explored using focus groups and in-depth interviews in one ‘health resilient’ case study area in North East England. Case study findings suggested that place attachment, social capital, and the natural environment may have played a role in militating against the detrimental health effects of long-term economic deprivation. Factor Analysis, Multiple Correspondence Analysis and Logistic Regression examined these factors further in order to see if they had wider transferability; however, the results indicated mixed findings. The study concludes by exploring the implications of these findings within the context of both public health policy and by outlining future avenues for research.