Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach

Roshanak Mehdipanah, Ana Manzano, Carme Borrell, Davide Malmusi, Maica Rodriguez-Sanz, Joanne Greenhalgh, Carles Muntaner, Ray Pawson

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)


Introduction: Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. Methods: We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. Discussion: In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. Conclusion: This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation.

Original languageEnglish
Pages (from-to)266-274
Number of pages9
JournalSocial Science and Medicine
Publication statusPublished - 2015 Jan 1

Bibliographical note

Funding Information:
The authors would like to thank Dr. Sanjeev Sridharan for his guidance and advice. The research leading to these results forms part of the SOPHIE project (Evaluating the impact of structural policies on health inequalities and their social determinants and fostering change) which has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 278173 . We would also like to thank the researchers within the SOPHIE project and ASPB for their suggestions. Contracts for the intensification of researcher activity in the SNS for 2014. Strategic Actions in Health 2013–2016, from the Programa Estatal de Investigación Orientada a los Retos de la Sociedad , in the Plan Estatal de Investigación Científica y Técnica y de Innovación 2013–2016 framework (granted to Carme Borrell, grant number INT13/00252 ).

Publisher Copyright:
© 2014 Elsevier Ltd.


  • Evaluation
  • Health inequality
  • Public space
  • Theory-driven
  • Urban renewal

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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