The relationship between health and place is traditionally explained by geographers in terms of both compositional (who lives here) and contextual (what is this place like) factors. The compositional explanation asserts that the health of a given area, such as a town, region or country, is a result of the characteristics of the people who live there (individual-level demographic, behavioural and socioeconomic factors), whereas the contextual explanation argues that area-level health is also in part determined by the nature of the place itself in terms of its economic, social and physical environment. These two approaches are not mutually exclusive, and indeed places are about both people and the wider environment. The complexity of how place shapes health is explored further in this chapter through a series of examples. These approaches are then applied to the case study health divides of the US health disadvantage, the ‘Scottish health effect’, the North–South divide and local health inequalities via a case study of Stockton-on-Tees in the North East of England. The chapter concludes that health divides are a matter of both poor people and poor places, with economic factors being the key at this scale of analysis.

Who lives here?

The compositional view argues that ‘who lives here’ – the demographic (age, sex and ethnicity), health behaviour (smoking, alcohol, physical activity, diet, drugs) and socioeconomic (income, education, occupation) profile of the people within a community determines its health outcomes: that poor people result in poor places.

Demographic and health behaviours

Generally speaking, health deteriorates with age. For example, in the 2011 Census, those aged 45 to 64 were almost twice as likely (42%) to report a long-standing illness than those aged 16 to 44 (22%). Most analysis of health data takes into account age differences between populations to account for these important effects on health – so-called age-standardisation. In wealthy countries, women live longer than men – for example, life expectancy for women in the UK is four years higher than for men (English men, 78.7 years, women, 82.7 years; Scottish men, 76.2 years, women, 80.6 years; Welsh men, 77.8 years, women, 82.0 years; Northern Irish men, 77.7 years, women, 81.8 years). Similarly, on average, American women live five years longer than American men (81 compared to 76 years). However, women (particularly older women) also generally experience worse health: women get sick, men die.