Defying the odds: a mixed-methods study of health resilience in deprived areas of England.

Previous studies have identified an area-level association between socio-economic deprivation and poorer population health. However, some recent studies have suggested that some areas exhibit better health outcomes than would be expected given their level of deprivation. This has been conceptualised in terms of 'health resilience'. This study is the first to explore area-level 'health resilience' at different geographical scales and by using mixed-methods. Regression Tree Classification was used to identify local areas (Local Authority Districts and Census Area Statistical Wards) in England that performed relatively well in terms of mortality (premature mortality 1998-2003) or morbidity (2001 Census measures of self-reported general and limiting long-term illness) despite experiencing long term deprivation (Townsend scores 1971-2001). Five Local Authority Districts (LADs) and 90 Census Area Statistical Wards (CASWARDS) exhibited 'health resilience' in terms of self-reported health, three LADs and 88 CASWARDS for limiting long-term illness, and three LADs and 62 CASWARDS for premature mortality. Potential mechanisms underpinning this resilience were explored using focus groups and in-depth interviews in one case study area in the North East of England. This suggested that for this case study area, place attachment, the natural environment and social capital may have played a role in mediating the detrimental health effects of long term deprivation. The study concludes by exploring the implications of these findings within the context of the study limitations and by outlining future avenues for research and policy.