Deprived yet healthy: neighbourhood-level resilience in New Zealand.

Geographical inequalities in health are omnipresent with health and related behaviours typically worse in socioeconomically deprived places. However, this is not always true. Deprived places with unexpectedly good health outcomes, or what might be considered 'resilient' places, have been noted. Few studies have quantitatively examined resilience in neighbourhoods or investigated potential explanations for this resilience. This paper examines the paradox of low mortality despite high social deprivation in New Zealand neighbourhoods and considers possible neighbourhood characteristics that contribute to unanticipated positive health outcomes. Using area-level mortality (2005-2007) and socioeconomic data, we developed the Resilience Index New Zealand to quantify neighbourhood levels of resilience across the country. We then examined relationships between this measure and a suite of built, physical and social characteristics. We found that resilient places tended to be densely populated, urban areas. We observed gradients and increases/decreases in the most resilient groups in access to or levels of physical environment factors (environmental deprivation, safe drinking water, air quality) and unhealthy living infrastructure (alcohol and gambling outlets). Since these factors are amenable to change, these findings are the strongest evidence that such improvements may lower mortality in similarly deprived places. The social environment of resilient areas was characterised by high levels of incoming residents. We also found some surprising associations and observed U-shaped relationships for a number of the neighbourhood factors. Such findings suggest the need to develop a better proxy of community cohesion and a better understanding of the interactions between people and their neighbourhoods, rather than simply the presence of certain factors. We argue that this study has identified amenable neighbourhood characteristics and highlighted the importance of 'place-specific' resilience factors that may be effective in reducing mortality in some neighbourhoods, but be less effective in others.