20 minute neighbourhoods and allostatic load: How unequal access to public space ‘gets under the skin’

Living in areas with high levels of poverty and deprivation is associated with poorer health outcomes across the life-course, even after wide-ranging individual characteristics have been accounted for. However, understanding the processes through which neighbourhood conditions ‘get under the skin’ and which aspects of the built environment are most salient for health remains an important area of research. A promising avenue of study to understand this process points to the stress pathway, measured by the concept of Allostatic Load (AL), as a biologically plausible mechanism explaining how where we live impacts longer term health outcomes. The stress pathway represents the body’s biological response to environmental and psychological stressors and is impacted by the interplay between multiple physiological systems including the nervous, neuroendocrine, and immune systems. Tools from Geographic Information Systems also make it possible to assess detailed aspects of the built environment that may have shared effects across space. Moreover, evolutionary and neurobiological evidence points to feelings of safety being the primary driver of the stress response, indicating the potential importance of subjective experiences of neighbourhoods and objective aspects of the built environment. Chapter 2 introduces the literature surrounding neighbourhood effects and 20-minute neighbourhoods, allostatic load, and the importance of feelings of safety for the stress response. Chapter 3 uses cross-sectional data from Understanding Society to assess whether positive and negative subjective measures of neighbourhood environments predict AL. Chapter 4 links measures of proximal access to 20-minute Neighbourhood domains using OS Maps Points of Interest data to Understanding Society data to assess whether access to domains considered key to daily living predict AL, with consideration given to spatial aggregation effects. The final empirical chapter uses 4 waves from the English Longitudinal Study of Aging to assess the effects of proximal access at the area level on AL.