|
Chapter 5: Health and Wellbeing
Karen Galway and Dermot O’Reilly
Executive Summary
Key Findings and Recommendations
Chapter 1: Introduction and Background to the Study
Chapter 2: Population Statistics: Belfast and Donegall Pass, 1971-2001
Chapter 3: Internal Migration and Community Dynamics
Chapter 4: Housing and the Environment
Chapter 6: Children and Young People
Chapter 7: Education in Context
Chapter 8: Education and Training Issues in Donegall Pass
Chapter 9: The Role of Community in Regeneration
Appendix 1 Donegall Pass Profile
Appendix 2 Focus Group Topics/Questions
Appendix 3 Recruitment Form
CHAPTER FIVE - HEALTH AND WELLBEING
Key Points
- International research has long since established a gradient between health and socio-economic status and it is now clear that the social and physical context in which people live can have a negative influence on health.
- Recent research has established an adverse effect on the health of people who remained in an area that had become more deprived over time
- The mechanisms thought to influence health in declining communities include stress, loss of self-esteem, stigma, powerlessness, a lack of hope and fatalism.
- These mechanisms are related to the concept of social capital, a resource produced when people co-operate for mutual benefit
- Residents’ key concerns relating to the decline in the community are housing shortages which are perceived to be contributing to the breakdown of the family-based community, along with traffic; pollution; non-resident parking problems; a lack of youth facilities; and the influx of ethnic minorities who are less inclined to become involved with the community
- In the Donegall Pass a dual process of outward migration and business development has resulted in a decline in social capital within the community which was particularly evident amongst the younger generations
- People living in deprived areas, such as the Donegall Pass, that are adjacent to affluent areas, such as the new apartment developments surrounding the area, can often feel relatively more deprived due to such direct comparisons. Although relative deprivation was evident, peer comparisons with the Donegal Road/Sandy Row community were more commonly expressed
- The area can be described as a ‘food desert’ as no affordable fresh grocery supplies are available within walking distance
- Residents expressed mixed opinions about the future of the Donegall Pass including a common sense of resignation towards the decline in the core community
- Many residents recognise the need for people to work together and gain empowerment in order to work with the authorities (i.e., the Housing Executive and the Council) towards progressive re-development that is in keeping with the aims of the community members, however, equally many were impervious towards these suggestions feeling that previous efforts had gone unrewarded.
Introduction and background
International research has established a gradient between health and socio-economic status or SES, (measured according to income, occupation, education and housing conditions). The reasons for this gradient are not entirely clear. One of the ongoing debates in social epidemiology is the extent to which the worse health of people in poorer areas is due to content (people factors such as SES) or context (area factors such as the physical and social environment). Many studies have examined the relative importance of content and context in explaining the variations in health and mortality and it is now clear that the social and physical context in which people live can influence health. As a result, there has been a raft of recent policy initiatives spearheaded at local and national level aimed at regenerating the physical fabric and the social relationships that hold communities together.
A study by Boyle (2004) demonstrated that a change in relative deprivation exerts an influence on health, that is, the research established an adverse effect on the health of people who remained in an area that had become more deprived over time. The reason for a decline in health under these circumstances is unclear. However, the mechanisms by which contextual factors are believed to act upon health include stress, loss of self-esteem, stigma, powerlessness lack of hope and fatalism.
Social capital protects health
Underpinning these mechanisms is the concept of social capital (a resource produced when people co-operate for mutual benefit) which is beneficial for understanding the relationship between poverty, place of residence and health and well being (Cattell, 2001). The existence of social life networks, trust and participation provides mutual benefits for the effectiveness of the community as a whole. These social networks and a sense of social capital have been demonstrated to have a protective influence on health, and to mediate the effects of poverty and deprivation on health and wellbeing. It is not necessarily the case that deprived areas suffer from a lack of social cohesion or depleted stores of social capital. Neither is it the case that in neighbourhoods with a strong sense of social cohesion that every member will benefit equally. Rather, there is a societal level of social capital which works alongside an individual level of embeddedness within a community (Poortinga, 2006). Hence, if there are measurable health effects resulting from changes occurring within a community, they are likely to affect different sections of the community in different ways and to differing degrees.
Declining community
It is hypothesised that the patterns of outward migration from the Donegall Pass, along with associated changes to the physical and social environment, may be having an impact on the social networks and social capital in the area. The closure of local facilities, such as schools and shops, may increase feelings of isolation amongst local residents by removing natural opportunities for networks and co-operative friendships to exist. The health aspect of this project has focused on exploring the effects of these changes, on the health and wellbeing of residents who have remained in the area.
Relative Deprivation
A further theory posits that perceptions of inequality are detrimental to health. Wilkinson (1992) has found that where greater disparities of income exist between the poorest and the wealthiest in an area, there will be a greater socio-economic health gradient. It appears that constantly being made aware of the level of poverty within which you live, (or having your nose rubbed in it) can make the situation seem even worse. This may be relevant to the residents of the Donegal Pass, who are surrounded by ongoing modern urban developments in the form of hotel and apartment buildings, from which they are generally excluded (as they are designed for tourists or wealthy young professionals). Perceptions of inequality have been included in order to explore these phenomena in the Donegall pass area.
To sum up, the residents of the Donegal Pass are likely to be facing an element of decline in social capital due to the evident outward migration patterns. This may be having a knock-on effect on the health and wellbeing of residents through mechanisms such as the removal of natural opportunities for co-operation, diminishing of community spirit and trust, and a sense of hopelessness or anomie, amplified by relative deprivation due to the encroaching prosperous developments on their doorstep. These changes are likely to affect different members of the community in different ways.
The research aims were to:
- explore the relationship between the impact of the physical, geographical and population changes in the area on the social networks, and social capital within the community
- assess the impact (if any) of relative deprivation on the perception of health and wellbeing of residents, and;
- evaluate the impact of community decline (if any) on the health and wellbeing of residents
Research Methods and Participants
Seven focus groups were carried out with a cross section of residents of the Donegall Pass area. Community sources, such as the Youth Club, SureStart (a mother and baby group) and the South Belfast Somme Society (a local heritage group), provided lists of community members to facilitate recruitment. The use of these pre-existing groups allowed for observation of fragments of naturally occurring interactions, granting authenticity to the accounts shared by residents. Participants were approached either by telephone or in person by trusted community activists, known to residents.
Decline in Social Capital and health:
Sense of community
A manifest sense of community spirit was expressed by adult residents and was strongest amongst those in the older age range. Older residents exhibit evidence of community interaction by maintaining a wide variety of opportunities for participation in social activities within the area, such as bingo, senior citizen’s groups, health promotion clubs and holiday outings.
|
Female, 60+ “it’s a very close knit wee community”
Male, 26-59; “it’s like a small village.. it’s a kinda close knit wee community”
Female, 26-59; “You couldn’t get nicer people in a crisis”
|
|
This contrasts with the younger residents who expressed a sense of ‘dampened’ community spirit and apathy towards community-based activities. For those in the middle age range, the levels of community spirit fell somewhere in between the youngest and oldest members of the community.
Where older residents were proud to describe themselves as being from the Donegall Pass or The Pass, younger groups admitted to tailoring the description of where they were from (such as city centre, Botanic or Dublin Road) according to both the social class and religion of the person(s) they were speaking to. Most residents acknowledged that the Donegall Pass has a bad reputation, particularly during the marching season and, as such, a certain stigma is associated with living in the area. This lack of pride in the community was particularly emphasised in those aged under 25. However, it cannot be assumed that such age differences are purely attributable to a decline in the community, rather it could represent rose-tinted recall by older people hankering for a return to ‘yester-year’, compared to the grumblings of generally disenchanted and disaffected youths.
|
Female, 18-25; “years ago people would have been close and they would have had street parties and all”
Female, 18-25; “When I tell people in work where I live they kinda just look at me twice”
|
|
Most participants have family members living in the area, although there were frequent reports of extended family and friends having to move away in order to acquire suitably sized social housing for both larger families (three and four bedroom houses) and single adults (one bedroom flats). Residents expressed resentment and bitterness towards the NIHE concerning the perceived lack of provision for those who were born and bred in the area. The necessity for people to move out of the area in order to find appropriate social housing is collectively seen as a threat to the cohesion of the community. It was reported that the general level of trust had dropped in recent years, due to the influx of ethnic minorities, students and generally unfamiliar faces living in the neighbourhood. Residents also acknowledged some negative aspects of living in a close knit community, with even the older participants reporting inter-family conflicts and prolonged grudges. Nevertheless, they stated that, in times of need, emotional support would be available from neighbours and friends within the community.
|
Male 26-59; “ We all know there’s personalities on the Donegall Pass, there’s groups, they’re working against each other, and that’s a detrimental effect on the community”
Male 18-25; “Sometimes people know too much [about each other], a lot of rumours and all going, about a whole lot of s**t sometimes”
|
|
Effect of community decline on health
One of three key concerns expressed by local residents is the lack of appropriate social housing, which residents suggested was leading to the breakdown of the family based community. The second is excessive traffic and associated pollution coupled with extensive non-resident parking. This is seen as an invasion of space and territory. The third main concern is fragmented schooling and a lack of facilities for socialising, particularly for young people, which is perceived to be reducing the opportunities for members of the community to form relationships.
The NIHE was universally identified as the chief source of complaint and dissatisfaction for those living in the Donegall Pass. The vast majority of residents had personal experience of the NIHE but no one had any positive reports of these interactions. Many residents felt that the NIHE could do more to maintain the quality of the housing and surrounding areas. Their negativity was usually expressed as a deep-rooted lack of respect and trust towards the organisation, with many residents outraged that housing allocation policies did not take sufficient account of having been born and bred in the Donegall Pass area. To add insult to injury, residents also felt that the Donegall Pass was used as a ‘dumping ground’ for the destitute and homeless, and that these individuals and immigrants receive a disproportionate level of support from the organisation.
The people of the Donegall Pass expressed animosity towards the Chinese community in the area. Many residents see the Chinese community as the main protagonists of the housing crisis, by usurping the available housing in the area therefore depriving the long-standing residents. It was also felt that some of the private apartment developments in the area would be perfect for single adults who are currently in need of housing, but that they are priced out of that market.
Over the past two years, due to the development of the Gas Works business park adjacent to the Donegall Pass, the level of non-resident parking was reported to have worsened dramatically. Residents suggested that the traffic wardens are overwhelmed by the current state of affairs. Many residents complained that their driveways are often blocked and that pavements are frequently inaccessible. Residents felt that the threat of being issued a parking ticket no longer functions as a deterrent for those who park in Donegall Pass vicinity. Rather the cost of an occasional parking ticket is more economical than paying for legitimate weekly parking in the city. Residents do not believe that enough is being done to tackle the problem.
|
Female, 18-25; “The Housing Executive are trying to dwindle the Donegall Pass community .. by just pushing it in and pushing it in”
Male, 26-59; “The business community coming into Donegall Pass at the minute and buying all round them and taking up where there used to be housing .. eventually probably squeeze us all out of the area.”
Male, 26-59; “I think we can be very introspective in this area…. we feel very defensive”
|
|
The local primary school closure in the mid-eighties was regarded by residents as a contentious turning point for the community, leading to fragmented schooling arrangements. This has resulted in local children attending two or three different schools outside the area. Apart from the detrimental effect these arrangements have had on the opportunities for children in the area to develop friendships, they have also reduced opportunities for parents to co-operate and derive benefit from friendships made through such interactions. Another common complaint was the depletion of extra mural activities for children and youths growing up in the area over recent years.
These housing, parking and schooling problems coupled with the encroaching private developments, have left the local community feeling threatened. In addition, there is a sense that the increasing number of Asian businesses that now operate on the main road could build up to become Belfast’s ‘China Town’. This appears to be nurturing a defensive, almost siege mentality amongst many residents.
Health and wellbeing
Health concerns did not naturally emerge during the focus group discussions, but were teased out by specifically asking questions about aspects of lifestyle such as availability of fresh food and leisure facilities. Participants did not consider it a priority to be concerned about the effect of community decline on their ability to live a healthy lifestyle. Medical and dental facilities were reported as adequate, with most people able to access services nearby. However, when prompted, concerns were expressed about provision of fresh food and the lack of open/green spaces, fresh air and facilities for recreation and leisure.
A lack of fresh, affordable food in inner city estates is often referred to as a ‘food desert’ and recent research tentatively suggests that there is an association between the existence of food deserts and poor health (Cummins, 2005). Despite the close proximity to Belfast’s city centre, residents reported a notable lack of grocery outlets in the vicinity. They have no supermarkets within walking distance, and the convenience stores that do exist within the area have limited opening hours, above average prices and a poor selection of fresh fruit and vegetables. In order to acquire the supplies to facilitate a fresh and healthy diet, residents stated that their weekly shopping requirements have to be sourced beyond the immediate locality. Although most residents are able to travel for this purpose, those with lower levels of mobility are disadvantaged by the poor quality of what is available, particularly within a moderate budget. Older residents reminisced about the extensive choice of grocery shops and local businesses that operated in the Pass in years gone by. When these shops closed members of the community organised a bus service to take elderly people to the supermarket, but it had to be cancelled because excessive non-resident parking prevented the bus from accessing some of the streets in the estate.
It should be noted that perhaps resident reports on availability of fresh supplies indicate a lack of adaptability to their changing circumstances. For example, even though there is a lack of adequate grocery outlets on the Donegall Pass, no one reported using St George’s Market (which takes place close by, once a week) to replenish fresh fruit and vegetable supplies.
|
Female, 60+; “Oh, you don’t get fresh food in that shop, but you pay over the nail for anything you do get
”
Female, 60+; “You make a pot of soup that’s off the same day, the vegetables are rotten”
|
|
When prompted, the absence of opportunities for keeping fit within the area was frequently pointed out. Donegall Pass is lacking an open/green space in which to congregate, socialise or exercise with only a small infant play park provided. The nearest leisure centre is located across the perceived sectarian divide, Botanic Park. The shortage of an open area was expressed most strongly by the young people, who also recognise that the opportunities for organised youth activities are dwindling as people move out of the area. In addition, the parking problems and traffic pollution were often cited in relation to accessing footpaths, particularly with prams, making the prospect of walking for exercise less attractive and less feasible.
|
Male, 14-17; “There used to be something on every night of the week… like swimming, go-karting, mini-golfing, banana boating and all [but] people leave the estate and then there is no one to take it”
Male 14-17; “you just run about… getting into trouble and stuff ‘cause there’s nothing to do”
Male 26-59; “There is nothing here for men… so we would actually socialise round the bar”
|
|
Residents made consistent, unprompted comparisons between their own area and the Donegall Road/Sandy Row area, an adjacent inner-city residential estate. An extensive range of facilities are perceived to be available to residents of the neighbouring area, along with generous redevelopment plans. Although the common understanding of relative deprivation is built upon differences in socio-economic status, here the expression of relative deprivation more frequently cited a peer-group of other protestant loyalists, whose socio-economic status is similar to that of the residents of the Donegal Pass. This suggests that a greater community value may be assigned to developing opportunities for resident participation, rather than to purely affluence alone. It is difficult to ascertain whether the facilities and opportunities for community development reported in relation to this neighbouring area represent rivalry between the two areas, or a latent ‘grass is greener’ mentality.
|
Female 18-25; “Every time you’re opening the post it’s Sandy Row, Sandy Row, Sandy Row… they are all being regenerated and we get nothing”
|
|
Perceptions of a social and economic chasm between long standing residents and the recent influx of young professionals and students living locally in private housing did exist, giving a sense of class-based relative deprivation. However, surprisingly fewer direct comparisons were made with these ‘outsiders’/’blow-ins’, and they were not perceived as a direct threat to the community.
|
Male, 26-59; “In reality I think we are pushing against the tide because of the prime land of where we are actually sitting, close to the city centre”
Female 26-59; “people I think, have lost heart… why go out and support and why go out and fight for things if nothing happens at the end of the day, they made all these promises and nothing ever really materialises out of it.”
Male, 60+; “..people is going to have to accept that no matter what… it’s happening all over, it’s going to be an international community of people.”
|
|
Adult residents expressed mixed opinions about the future of the Donegall Pass which commonly featured a sense of resignation and anomie or a lack of hope towards sustaining the core Protestant loyalist community living in the area. In addition, a lack of facilities coupled with a lack of drive and ambition has inevitably contributed to the anti-social and deviant behaviour of youths living in the area. As a result, young people do not look towards a long term future in the Donegall Pass.
|
Female, 13-17; “The only thing I don’t really want to do is, if I end up having kids, is bring them up around here because there is nothing for them to do and they will get into an awful lot of trouble”
Female, 13-17; “there’s nothing and alls you do is sit about the park and most people of our age, now all they do is smoke blow”
|
|
Paramilitary activity within the community
For many of the residents who participated in this research, the paramilitary presence in the Donegall Pass is an accepted part of daily life. It was clear that living in a paramilitary-run area is seen as a double-edged sword. On the one hand, when petty crime occurs such as theft or damage to property, residents do not always call the Police, rather they contact ‘the boys’ to deal with it and they report that such problems are always resolved one way or another. These actions are endorsed, albeit reluctantly, by the residents of the Pass. Many of the residents, who participated in this research, expressed appreciation for the law and order imposed, and look upon these organisations as a necessary evil to prevent local youths from causing trouble, but they commonly remain reluctant to become involved themselves.
On the other hand, these activities are clearly illegal and, as such, go unchecked. Members of paramilitary groups exercise a disciplinary role over the youths in the area who reported having been ‘grounded’ by the paramilitaries on a regular basis, for anything from harassing people in the street, to meeting up with friends of the ‘wrong’ religion. Being involved was also expressed as ‘getting into trouble’. Furthermore, when discussing paramilitary activity in relation to the political developments in Northern Ireland over recent years, it emerged that the paramilitaries in the Donegall Pass currently find their role under question, and there was recognition of their need for empowerment beyond the original sectarian aims and objectives.
|
Male 26-59; “..you don’t go to the police station, you go to the local bars and see the local boys because they can sort it out properly and they are the ones that has kept the area very safe and, like, fair play to them”
Male 26-59; “You’ll get ones that’ll take plenty out [of the paramilitaries] but they will put nothing into it.”
Male 26-59; “We have had a problem, see, since the so called cease fire I feel that Protestants, Loyalists they have been at a bit of a loss, there is no military enemy now and we are all standing by, where the hell do we go now and nobody seems to know”
|
|
Summary
The residents of the Donegall Pass are facing constant and growing pressures of space, combined with a perceived lack of support from the authorities, and worse from the NIHE. The future of their community is uncertain, and, as a result, the underlying premise of the focus groups encompassed feelings of apprehension, resignation, resentment and concern for the future. Social capital is declining with the community, as those in the younger generations fail to develop close relationships and opportunities for community participation. It is difficult to ascertain whether it is the activists in the community who are moving out, therefore leaving a fragmented or less involved group behind, or whether it is the physical changes in the area that are affecting residents in a negative way. Either way, the sense of anomie, lack of hope and the tried and failed attitude that commonly emerged illustrates that this a community with a dismal sense of their prospects for the future. Motivation was highlighted as a problem for many, and the youths in the area are clearly disaffected. However, particularly, but not exclusively, in this younger group, the reluctance to get involved in community activities, could be entwined with a fear of becoming involved with the paramilitaries.
It is encouraging to note that there was recognition amongst residents that they need to develop a sense of empowerment in order to protect and strengthen their community. When asked about ideas for improving the area, residents often suggested a drop-in/advice centre to provide help with entitlement to housing and benefits, to act as a link between the community and the authorities, and to provide a second point of social focus for residents (the first being the Community Centre). However, for each positive statement about the possibilities for the future, there was a negative experience of having tried and failed to create changes in the past, as the residents of the Donegall Pass continue to experience the effects of community decline.
References
Boyle, P., Norman, P., Rees, R. (2002) Does migration exaggerate the relationship between deprivation and limiting long term illness? A Scottish Analysis. Social Science and Medicine, 55; 21-31.
Cattell, V. (2001) Poor People, Poor places and poor health: the mediating role of social networks and social capital. Social Science and Medicine, 52; 1501-1516
Cummins, S., MacIntyre, S. (2005) Food environments and obesity – neighbourhood or nation? International Journal of Epidemiology, Feb; 35(1):100-4.
Poortinga, W. (2006) Social capital: An individual or collective resource for health? Social Science and Medicine, 62; 292-302.
Wilkinson, R. (1992) National mortality rates: the impact of inequality? American Journal of Public Health. 1992 Aug;82(8):1082-4.
|
