Factors which nurture geographical resilience in Britain: a mixed methods study

Objectives: To identify plausible mechanisms by whichresilience (low mortality rates despite persistent economicadversity) was achieved in some areas in Britainbetween 1971 and 2001.Methods: Mixed method observational study, combiningquantitative analyses of cause- and age group-specificmortality rates, and area sociodemographic and environmentalcharacteristics, with case studies of resilient areaswhich included in-depth interviews.Results: The causes of death, and age groups,contributing most to resilience varied markedly betweenthe 18 resilient areas; as disease aetiology varies, a rangeof protective processes must be in operation. Four areacharacteristics, which plausibly contributed to resilience,emerged from the in-depth interviews: populationcomposition; retaining or attracting population; environmentand housing; and social cohesion. Quantitativeanalyses demonstrated significant difference betweenresilient and non-resilient areas in retaining or attractingpopulation only. Conclusions: While we identified plausible area characteristics through which resilience was achieved, theredoes not appear to be a definitive set that reliablyproduces resilience, and resilient and non-resilient areasdid not differ significantly in their possession of most ofthese characteristics. If such characteristics do have arole in creating resilience, but are present in both resilient and non-resilient areas, further work is needed to explore what makes them ''successful'' in some areas, but not in others.