Similarly, environmental design and layout can influence social interactions and the level of social capital and cohesion in a community.[13-15] Neglected urban environments have been linked to social isolation and depression.[6,16] The provision of decent housing, safe playing areas, transport, green spaces and street lighting makes the community feel good about a place and leads to greater levels of interaction and community participation.[17]

Urban renewal or regeneration programs aim to target both the physical and social environments including improvements to housing, landscaping of the immediate neighbourhood, increasing safety and improving employment opportunities.[18] These measures are thought to improve the social capital, social connectedness, sense of community and economic conditions of residents of the neighbourhoods. There are only a few studies that have sought to evaluate health outcomes and general well-being of residents as a result of urban renewal[19-23] and there has been only one study from Australia.[18] A synthesis of evaluations of the United Kingdom national renewal program found little evidence of the impact of the national renewal program on socioeconomic or health outcomes.[24]

There were no significant differences in any of the demographic characteristics between the group who participated in both the pre- and post-intervention surveys (n=28) and the group who participated only in the pre-intervention survey (n=14) (Table ​(Table11).

Of the 28 householders who completed both pre and post-intervention surveys, 71% were women, 86% were aged 18–54years, 89% spoke English at home, 82% had not completed year 12, 57% were the heads of single parent families, 86% were not working for income and 46% did not own a motor vehicle.

Perceptions of safety and aesthetics of the immediate neighbourhood are presented in Table ​Table2.2. Following the urban renewal program, a greater percentage of householders reported that they felt safe walking from the bus or train at night and a smaller proportion reported that that the level of crime made it unsafe to walk in the immediate neighbourhood in the daytime. There were no significant statistical differences in any of the reported perceptions about neighbourhood safety. Many more of the householders responded positively to questions around the aesthetics of the immediate neighbourhood (Table ​(Table2).2). This was particularly for questions around pleasant natural features, attractive buildings and homes, and the immediate neighbourhood being free of graffiti, rubbish and litter. However, none of these were statistically significant

After the urban renewal program, more householders reported being satisfied with their neighbourhood as a place to live and felt that they belonged to the neighbourhood (Table ​(Table3).3). More householders also reported that their area had a reputation for being a safe place and they felt safe walking down their street after dark in the post-intervention survey.

Following the urban renewal program, a greater proportion of householders reported that people who come to live in the neighbourhood would be more likely to stay on for a number of years rather than move elsewhere (Table ​(Table3).3). More householders also reported that they would be sad to leave the neighbourhood.

There were no significant differences in the proportion of daily smoking, hazardous alcohol intake, adequate physical activity, and overweight/obesity before and after the urban renewal program (Table ​(Table44).

Results from the few published studies are mixed. In a pre-and-post study of 98 households in a deprived area with sub-standard housing in Newcastle, United Kingdom, where the neighbourhood intervention was similar to ours (environmental improvements, external fabric repairs, refurbishment, some demolition of empty dwellings, renovation grants for individual dwellings and security and road safety improvements),[23] a post-intervention survey showed significantly fewer mental health problems but also a significantly greater proportion reporting ‘not good’ health. There were also significantly larger proportions of participants who reported that their area was a very/quite nice place to live and very/quite safe.

It is suggested by Blackman et al.[23] that improvements in mental health in their study may be due to the perceptions of increased neighbourhood safety although the authors acknowledge that improvements in mental health could also influence perceptions of safety. The link between urban renewal, perceptions of neighbourhood safety and mental health is not clear. Petticrew et al.[22] investigated the health and well-being of people provided with new social housing in the United Kingdom and found there was no change in the mean mental health score despite improved perceptions of neighbourhood problems such as vandalism and graffiti, general appearance of the area and adequate street lighting. On the other hand, in a prospective controlled study of the health impacts of urban renewal, Thomson et al.[20] compared 50 households who moved to newly built housing in the same locality with 50 control households from a matched nearby locality and found no difference in the mean scores of both the mental health component of the SF-36 and perceptions of neighbourhood problems such as vandalism, litter and rubbish, crime, adequate street lighting.

The mixed results for mental health are especially of interest. Both people and places can impact on mental health. There are links between the social environment and mental health[26-28] and also between social capital and mental health.[29] Although, like us, Blackman et al.[23] showed improvement in mental health after the urban renewal program, others have not been able to demonstrate this.[20-22] The most likely explanation is that compositional factors, which also have important influences on health,[30] are not, or are inadequately, addressed by urban renewal programs. Residents of neighbourhoods targeted for urban renewal often suffer from multiple deprivations, including poor housing conditions, and any interventions to improve health and well-being should also target other social determinants of health, for example, education and unemployment.

We did not find any changes in health behaviours (daily smoking, hazardous alcohol consumption, adequate physical activity), health status (BMI, self-rated health) or use of health services (visits to a general practitioner) following the urban renewal program. This is not surprising as the urban renewal program was not specifically targeting health behaviours and health status and the follow-up period was very short (eight months). Only one other study has reported the effects of an urban renewal program on health behaviours and health service utilisation. In a much larger study than ours (n=166 adults with paired data five years apart), Blackman et al.[23] reported mixed results post-housing renewal with some deterioration of general health status, increase in chronic respiratory symptoms, but improvements in mental health problems and no overall change in health service utilisation. However, they reported a marked decline in smoking rates (72% to 28%) and suggest that this could be partly attributable to improvements in mental health.

There has only been one published study from Australia on the impact of urban renewal. Kelaher et al.[18] evaluated a place-based whole of government intervention to narrow the gap between disadvantaged neighbourhoods and the rest of the state of Victoria, Australia. In this ‘pre-and-post’ study design, there was increased reporting of ‘good/very good/excellent’ self-rated health and satisfaction with life following the intervention. In contrast we found we found that fewer residents rated their self-rated health as ‘good/very good/excellent’ (decrease from 64% to 50%). Internationally, the effects of urban renewal on self-rated health have also been mixed. Petticrew et al.[22] reported significantly better self-rated health following an urban renewal program whereas Thomson et al.[20] reported no difference and Huxley et al.[21] reported a decrease in self-reported ‘satisfaction with health’. The reasons for such mixed results are likely due to the fact that the relationships between housing, deprivation and health are complex.

Our study has a number of limitations. The major limitation is our small sample size which limited our ability to detect small, yet meaningful, differences pre- and post-intervention. Despite this, our results were consistent with other published studies that have evaluated urban renewal or regeneration programs. The other major limitation was that we did not have a comparison group to take into account any changes that would have occurred due to factors other than the urban renewal program. Further, longer follow-up is required to determine whether changes are sustained over the longer term, and to be able to detect changes in health-related behaviours. We conducted a large number of statistical tests, and although we corrected for multiple testing, we must exercise caution when interpreting the results. Finally, our study was conducted in a social housing neighbourhood and therefore our results may not be generalisable to similar urban renewal interventions in non-social housing neighbourhoods.

The urban renewal intervention in this study consisted of a number of initiatives and included physical improvements to the homes (both internally and externally), improvements to the immediate physical neighbourhood environment (for example graffiti removal and landscaping) and social interventions such as community activities, learning and employment initiatives and establishing a community meeting place. All of these initiatives would have been likely to contribute to the householders’ perception of their immediate environment and their health status. It is not possible to ascribe changes in perception of the immediate neighbourhood to any one component of the urban renewal program.