Changing neighbourhoods, changing health? : residents’ experiences and expectations of urban renewal in their neighbourhood and influences on self-perceived health : the case of Geuzenveld

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Changing Neighbourhoods, Changing Health?

Residents’ experiences and expectations of urban renewal in their

neighbourhood and influences on self-perceived health:

The case of Geuzenveld

Photo: Geuzenveld Arial View sourced from buurzaamwonen.wordpress.com

Elizabeth Zeta Warnock (11122285)

MSc Human Geography (Urban) University of Amsterdam

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Sources 60

Appendix A - Participant Profile 64

Appendix B - Interview Guide Residents 65

Appendix C - Outline Analysis Phase 66

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List of Figures

Figure 1. Multi-Grounded Theory Approach. p.16 Figure 2. Conceptual model of how urban renewal may impact health p.17 Figure 3. Map of Geuzenveld’s location within city of Amsterdam p.21

Figure 4. AUP Extension Plan p.22

Figure 5. Timeline Government Policy Urban Renewal p.25

Figure 6. Urban Renewal Interventions Geuzenveld 2015-2020 p.27

Figure 7. Renovated Housing Block Geuzenveld p.29

Figure 8. Housing Block Undergoing Renovation p.29

Figure 9 Housing Block Yet To Be Renovated p.29

Figure 10. Mural Art on Renovated Block p.30

Figure 11. Rubbish in Neighbourhood p.30

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Chapter 1

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1.1 Introduction

In advanced capitalist countries health inequalities are increasing; research has pointed to an increasing trend in social inequalities in health, increasing variations in mortality, morbidity and health behaviours across deprived and non deprived areas (Jongeneel-Grimen , 2014) and a growing recognition that ever more sophisticated medical interventions and health promotion campaigns have been ineffective in tackling complex health problems (Kawachi et al. 2006). Within the public health field the rise of social epidemiology and health geography has increasingly focused attention of these policy failures on the limitations of a narrowly ‘individualist’ approach to population health (Szreter & Woolcock, 2004). Thus the focus of debates surrounding health inequalities and their unequal spatial distribution has shifted towards an ‘upstream’ approach of the determinants of health, that is the socio-structural effects and their association with individual health outcomes.

In policy and research circles the complex nature of health determinants and health inequalities has increasingly been described as a ‘wicked’ social problem (Blackman, 2006). Wicked social problems are not only characterised as being complicated but complex in that they are shaped by many interdependent factors, all constantly changing, and deeply rooted in the economic and social structures of neoliberal society (Kolko, 2012). As such, there is growing commitment in policy discourses that tackling health inequalities requires concentrated investment and cross-sectorial interventions that ‘cut across’ traditional silos of public service delivery to create capacity to intervene in causal complexity (Blackman 2006). In the European context this recognition has been enshrined in Article 152 of the Treaty of Amsterdam which commits the European Union to ensure that health impacts are considered in the ‘definition and implementation of all community policies and activities’ (Parry et al., 2004). Urban renewal and area-based interventions that target deprived neighbourhoods have been employed in multiple European context as one possible way to deliver the complex interventions needed to tackle unequal health and their distribution. (Lupton, 2003; Strattford et al., 2008; Jongeneel-Grimen , 2014; Mehdipanah et al., 2014 ). Jongeneel-Grimen , 2014; Mehdipanah et al, 2014 ).

Given that features of the residential neighbourhood environment have been shown to be important for the health of residents, including physical infrastructure (e.g. green spaces, housing conditions, provision of primary health care) and social functioning (e.g. social cohesion, social disorder, social networks) (Macintyre et.al 2002) and previous studies have shown that in the Netherlands, as in other countries, health problems tend to concentrate in deprived neighbourhoods (Jongeneel-Grimen , 2014), area-based interventions that address the social determinants of health make intuitive sense. However the causal pathways linking these determinants are typically long and

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complex and often involve multiple intervening factors along the way (Bharmal et al , 2015). This complexity makes it a challenge to study the impact of interventions and it has been suggested that this may be an explanation as to the lack of conclusive empirical evidence in Europe showing positive health impacts of area interventions in all contexts (Thomson et al., 2009; Jongeneel-Grimen , 2014).

In the Netherlands, the area of Geuzenveld-Slotermeer located in the Amsterdam City District New West is undergoing significant change to improve the housing and living environment of the

neighbourhood, and is considered one of the largest urban renewal projects in Europe (I Amsterdam, 2016). However as a consequence of the global financial crisis and the recession that followed there has been an unequal distribution of urban renewal interventions with the neighbourhood. As a result of the decline in the housing market post financial crisis, many major renewal projects in the Netherlands were suspended, including those in Geuzenveld (Savini et al., 2016). The suspension of the renewal plans had consequences for residents living in the areas. Many of the interventions were no longer committed to, which created an environment of uncertainty, some residents had been relocated due to the demolition and construction of housing that had already started whilst in other areas investment stopped completely (Gemeente Amsterdam, 2014a). The risk of tensions and conflicts within the neighbourhood and between neighbours that are close together and are in different stages of completion is significant, the trust in institutions is extremely low and a number of liveability indicators have declined during this period, all of which could detrimentally have an influence on residents' perceived health. In 2014 the largest housing association in the areas, Stadgenoot, and the City District of New West recommitted to renewing the neighbourhood albeit with a significant shift in focus (Gemeente Amsterdam, 2014b). This thesis will look at the case study of Geuzenveld with the aim of exploring how residents perceive their health in relation to the influence, or expected influence, of urban renewal and area-based interventions in their residential neighbourhood and the perceived pathways and mechanisms by which residents' health might be influenced by these changes.

The residential environment in this thesis considers both the home and neighbourhood. The health effects of homes and neighbourhoods are often considered separately in research studies and policy documents (Barrow and Bachan, 1997; Thomson et al., 2002), however homes sit within a wider neighbourhood context of which they are part, and which exercise place influences on people’s health (Blackman, 2006). For example, hazards such as burglary and noise or psychosocial aspects such as social status are both features of a home and its neighbourhood. A related perspective is provided by Rapoport (1995) who observed that “home becomes a special kind of place”, in his words, the term ‘home’ is intended to “draw attention to certain psychological, temporal, economic, affective, behavioural and other links of people to certain settings”. This work suggests that the home has a dual significance, both internal and external, what has been called its psychosocial and

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sociospatial relevance (Kearns et al., 2000). As such, the focus of this paper is to explore the dual aspects of the residential living environment in Geuzenveld, the home and neighbourhood environment.

1.2 Research Objectives

The purpose of this study is to explore how residents perceive their health in relation to the influence, or expected influence, of urban renewal and area-based interventions in their residential neighbourhood.

In particular this study is interested in exploring what elements of renewal are perceived to affect residents' perception of their health and to get a deeper understanding of the pathways linking these effects. As such, the research objectives directing this study are as follows:

● What characteristics of their residential environment (including home and neighbourhood) do residents believe have important impacts on their perceived health?;

● Do residents believe that changes, or expected changes to their residential environment have important health consequences?;

● What are the perceived pathways and mechanisms by which residents' perceived health might be influenced by changes in their environment?

1.3 Outline of Thesis

The following chapter provides a review of relevant literature concerning urban renewal and health and the ways in which they intersect. The review of the literature is divided into three sections. The first section provides an introduction to urban renewal and health in the European context. The second section discusses theoretical tensions and complexity in framing neighbourhood renewal as a promising population health intervention. The third section provides a summary of relevant

empirical studies in relation to the purpose of this thesis. As the aims and objectives of this thesis are in essence interdisciplinary, the literature has been drawn from urban geography, sociology, psychology, public health, urban planning and other related disciplines.

A discussion on the methodological approach is presented in Chapter Three of this thesis. It includes a discussion on the rationale for employing qualitative research methods and outlines the methods used to select and recruit participants, collect and analyse data and a discussion on the limitations and strengths is also provided. Chapter Four introduces the case study and provides context to the history of Geuzenveld and urban renewal in the Netherlands. Chapter 5 present the findings of this thesis and discusses it in relation to relevant literature. Chapter 6 summarises the findings in relation

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to the objectives of this study and their wider significance. Chapter 7 concludes this thesis and provides an account of the key findings and recommendations.

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5 Chapter 2: Urban Renewal and Health

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2.1 Introduction

Urban renewal and area-based interventions have been rationalised in a number of ways, many of which relate to the perceived practical benefits of targeting interventions at lower spatial scales (Blackman, 2006). It has been described as the most efficient and effective way of targeting limited resources to benefit the greatest number of people; an opportunity to develop integrated and tailored solutions to complex problems by harnessing local knowledge; a response to the perceived failure of mainstream services at the local level; and a mechanism for enabling multi-agency cooperation and resident involvement (Tunstall & Lupton, 2003). Cutting across many of these rationales is a broader notion that spatial targeting makes sense as a way of addressing 'area effects'. These are the particular contextual features of place that are seen to compound disadvantages over and above the effects of individual characteristics. Although there is great variation in the kind of projects dictated by urban renewal policies, their general goal is to improve physical infrastructure, promote social integration and increase economic gain within the neighbourhood or area intervened (Elliott et al., 2001; McGregor, 2013). Historically urban renewal policies have tended to exclude health considerations and there continues to be few urban renewal projects that actively target health and promote health equity (Barton, 2005; MacGregor, 2010). As such, the size and type of health impacts following neighbourhood renewal largely remain unknown; studies have failed to come up with conclusive empirical evidence on the health impacts due to the mix of conflicting positive as well as negative and unclear effects that have been reported (Jongeneel-Grimen , 2014).

It has been theorised that because urban renewal initiatives are complex the variability in the outcomes can be contributed to, for example, variations in the implementation of the policy, the context in which the intervention is carried out and/or the actual projects undertaken (Dunn et al., 2013; Thomson et al., 2006). It has been suggested that such complexity has resulted in empirical studies showing a lack of health impact of area-based interventions and an inability to establish clear causal pathways (Jongeneel-Grimen , 2014; Mehdipanah et al.2013). In addition scholars have argued that empirical research has predominantly assessed the relationship between neighbourhood versus individual characteristics and health outcomes, thus resulting in a lack of research trying to understand the underlying processes causing these relationship (Jongeneel-Grimen, 2014; Elleway and colleagues, 2012).

Given the above context the purpose of this chapter is to frame urban renewal and health in relation to relevant literature and current theoretical debates, this framework has informed the

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methodological decisions discussed in the next chapter. Firstly however, urban renewal in the European context is brought to the fore. This is followed by a discussion on the theoretical tensions in explaining health disparity in place, and finally empirical research relevant to this study is examined.

2.2. Defining Urban Renewal in the European Context

Urban renewal is the process of regeneration or redevelopment of the environment (in its widest sense: social, economic, cultural, physical and compositional) through policies and programmes aimed at urban areas which experience multiple disadvantage (MacGregor, 2010). An urban renewal project is typically a partnership undertaken by local and / or central government, the local

community and sometimes private developers (Johnson et al., 2000) and use a variety of measures to improve economic, physical and social conditions in an area through integrated action (Curtis & Cave, 2001). The historical and theoretical underpinnings of urban renewal have their genesis in the spirit of modernity at the turn of the late nineteenth century. Over the course of this time urban renewal has been known under many different names in different countries, such as: Slum

Clearance, Reconstruction, Revitalisation, Urban Regeneration and increasingly Urban Renaissance. The redevelopment of “depressed” urban areas has often been justified and executed as a means of improving housing and physical environmental conditions (MacGregor, 2010). In recent decades however, Western cities have been involved in urban renewal targeting deprived areas that goes beyond the repair of physical and aesthetic components of the built environment to also address economic objectives, such as stimulating investment and employment, as well as social objectives, such  as alleviating the problems caused by poverty and disadvantage, targeting both people and place (Curtis & Cave, 2001). Most conceptions of urban renewal hold that physical, economic, social and health problems are entwined and that renewal will not be sustainable unless all aspects are tackled. Such projects have taken place in various European countries including England and Scotland, France, Spain and the Netherlands.

Many similarities can be found across Europe in the approaches on how urban renewal is driven in deprived neighbourhoods. Although neighbourhoods can differ in the type of problems they face deprived neighbourhoods, at least in the European context, commonly do not lack important basic conditions for living but do show social-economic and physical problems (Musterd & Ostendorf, 2009). Area-based interventions are the primary tools used to tackle these problems and are mostly strategic national policy interventions undertaken at specific micro level locations within

neighbourhoods identified as requiring renewal (Droomers et al., 2014). Although the area-based interventions can range from physical renovation to education and community empowerment through participation, research, at least in the Netherlands, has found that interventions have

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seldom been chosen with a clear strategy and therefore interventions seem to be similar in different areas (Jongeneel-Grimen , 2014). The following is a list of the most common area-based

interventions in Europe to tackle problems in deprived neighbourhoods (Andersen, 2002):

. Physical renovation and embellishment;  

. Improving management and housing service for residents;  

. Active marketing and attempts to counteract bad press and bad reputation;   . Change of tenure or extended disposal of dwellings;  

. Support for private service facilities;  

. Special efforts against crime—cooperation with police and other local institutions;   . Mobilisation and empowerment of residents and communities;  

. Direct social support for socially weak groups—integration measures for immigrants;   . Attempts to attract new private firms and workplaces to the neighbourhood;   . Education, job training and other attempts to get employment to residents.  

The different types of interventions in this list can be categorized in multiple ways however it is useful to view these interventions in relation to what has been hypothesised to enable a ‘healthy neighbourhood’. According to MacIntyre and colleagues (2002) there are five types of features of a local (contextual) environment that might influence health: physical features of the shared

environment; availability of healthy environments at home, work and play; public or private services that support people in their daily lives; socio-cultural features of the neighbourhood; the reputation of the area. The first three of these categories can best be seen as material or infrastructural

resources which may promote or damage health either directly or indirectly through the possibilities they provide for people to live healthy lives. An example of a direct effect would be if polluted air compromises the health of residents; an example of an indirect effect would be the local availability of affordable and nutritious food (since not all individuals are totally dependent on local food supplies, some being able to range further afield and thereby manage to achieve a healthy diet). The last two categories relate to collective social and cultural functioning and practices, for example perceived social cohesion, social participation and symbolic and actual representations of the areas via newspaper and other accounts of the area. (MacIntyre & Ellaway, 2003)

The above features of a health enabling neighbourhood features the role of place and contextual aspects of specific local physical and social environments which might influence health or health-related behaviours however not all area-based interventions focus on the living environment and rather focus on the position of individuals, such as education and training. There are a number of theoretical tensions on the significance of both place and context in explaining health inequalities, and whether explanations of neighbourhood health inequity operate through psychosocial or

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material pathways, these tensions will be discussed in the following section.

2.3. Theoretical tensions: ‘Area effects’ and the spatial dimensions of health

inequality.

Despite broad agreement that variance in health outcomes within urban environments is likely to be explained, at least to a degree, by contextual factors, within the public health sciences, in particular epidemiology and medical geography, there has been a tendency to contribute much within country spatial variation to compositional differences (MacIntyre et al. 2002). Contextual explanations  of health are frequently rejected due to the fear of falling prey to the ecological fallacy, inferring that relationships observed at an aggregate level might be used to generate inaccurate assumptions about individuals in the population (Curtis & Rees Jones, 1998). However others have argued that an overemphasis on individuals as the most useful unit of analysis may result in problems associated with the atomistic fallacy, whereby one may overlook or misinterpret effects which can be better understood at the level of households, neighbourhoods or regions (Schwartz, 1994). For example research on ethnic group density effects have shown that individual ethnicity may relate to health differently when it constitutes a minority state from when it denotes membership of a majority group in the local population (Pickett et al 2008). The extent to which compositional and contextual effects are clearly distinguishable has recently been the source of much debate (Curtis & Rees Jones,1998). Despite this, the focus on ‘area-effects’ in examining health inequality has generally remained on partitioning predictors of health into compositional and contextual boxes, there has been little empirical research directly examining the influence of local contexts on health and even less research systematically evaluating the effects on health through urban renewal interventions at an area level (Macintyre et al., 2002).  

As such, the explanation of potential area effects in health inequalities remains a subject of intense debate (Kawachi & Berkman, 2003) further to this debate has been a tendency to polarise contextual explanations as to whether they relate to the physical or social environment (MacIntyre et al., 2002). A key issue in urban renewal has therefore been whether to focus on material features of the place (for example building new houses or sports facilities) or on the collective socio-cultural features (for example enhancing social cohesion and collective efficacy). Most of the evidence, however, suggests that an exclusive focus on either is counter-productive; there is no point investing in new sports facilities if the local population cannot afford to use or to travel to them, or sports participation is not a valued activity, but there is equally no point investing in encouraging collective action among the local population if no tangible advantages (such as jobs or facilities) are being offered (MacIntyre & Ellaway, 2003).

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In addition to theoretical debates concerning contextual and compositional explanations of area effects and whether urban renewal interventions should focus on physical or social interventions, it has also been argued that an emphasis on area-based interventions to tackle health is at best marginal to, and at worst a distraction from the real issues of income and wealth inequality that are the underlying causes of health disparities, therefore emphasising the need to tackle broader structural inequalities. (Pantazis and Gordon, 2000). There is, however, increasing acceptance of the evidence that where you live can shape your health in many important ways, in addition to the characteristics of individuals (Blackman, 2006), therefore it has been argued that in order to

effectively address spatial health inequalities, interventions at a neighbourhood level are essential in tackling the local factors that combine with wider determinants of health to create preventable geographic inequalities (Blackman, 2006).

Another theoretical tension in the explanation of neighbourhood effects on health is whether they operate through psychosocial or material pathways (Kawachi & Berkman, 2003). As stated previously research examining area-based interventions on health have tended to focus on the relationship between contextual versus compositional characteristics and health outcomes rather than to try to understand the mechanisms whereby such improvements may deliver health impacts (Acevedo-Garcia et al., 2004). According to the proponents of the psychosocial theory psychosocial

mechanisms mediate the influence of social determinants of health. As explained by Martikainen and colleagues:

‘‘. . . psychosocial factors, at least in the context of health research, can be seen as: (1) mediating the effects of social structural factors on individual health outcomes, or (2) conditioned and modified by the social structures and contexts in which they exist. The definition thus raises the question of what the relevant broader social structural forces are, and how such forces might influence health through their effects on individual characteristics’’ (2002).

If it is correct that psychosocial factors are ‘‘conditioned and modified by the social structures and contexts in which they exist’’, then it is key to understand these structures and contexts in order to to understand how urban renewal interventions may impact upon health. In this sense the central constituent of a psychosocial explanation of health is that macro and meso level social structural processes lead to perceptions and processes at the micro individual level which can influence health through modified behaviours and lifestyles or direct psychobiological processes (Rugulies, 2011). The psychosocial approach suggests that health can be promoted by improving the neighbourhood psychosocial environment (Agyemang et al., 2007). According to the proponents of the material theory the health outcomes of residents results from the accumulation of exposure and experiences that have their root in the material world (Agyemang et al., 2007). Therefore the health effects of

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being deprived of material goods are a consequence of a combination of exposure to material deprivation and a lack of individual economic resources associated with a systematic low investment in a range of human, physical, health and social infrastructures (Wilkinson, 2007). According to the material perspective, health can be promoted through the restructuring of the structural

determinants that condition inequality of income, such as residential segregation and unemployment (Wilkinson, 2007).

Both psychosocial and material mechanisms can occur and material circumstances can have psychosocial consequences and vice versa. For example unemployment (‘stressful’ life event) leads to loss of income and which in turn can lead to an inability to buy material necessities, this does not constitute a psychosocial explanation of health but rather a material explanation, however a

psychosocial process is operating when unemployment leads to feelings of worthlessness and loss of control that can affect health via direct psychobiologic processes, such as depression, or through modified behaviour, such as increased alcohol consumption. Rather than taking a polarized stance on either material or psychosocial mechanisms, researches have called for a more nuanced

understanding of identifying specific mechanisms by which neighbourhood characteristics and urban renewal interventions influence specific health outcomes (MacIntyre & Ellaway, 2003).

2.4. Empirical Accounts of Health Variation

There is a general presumption that urban renewal is beneficial for health because area-based interventions target living conditions, which are, in turn, determinants of health. It may appear self-evident that improvements in health determinants for disadvantaged groups will lead to health improvement and so reduce spatial health inequalities in society. However, this assumption must be considered in the light of the evidence from research on health inequalities. As stated previously very few urban renewal measures are properly evaluated with regard to their impact on health or health inequalities (Jongeneel-Grimen , 2014). Recent studies have indicated however that

evidence points to relatively greater positive change for urban renewal interventions targeting place, rather than people, in relation to general health outcomes (Crisp et al. 2014; Droomers et al., 2014). In England the national evaluation of the New Deal for Communities Program carried out between 2001-2010, the largest and most intense area-based urban renewal initiative ever introduced in England, found that place-based interventions in housing, crime and the physical environment contribute to improving health and wellbeing of residents more than people-based interventions (health, education and community participation) (Batty et al., 2010). The study found that

improvements in health and wellbeing through place-based interventions contrasted markedly with less favourable outcomes from interventions directly targeting health. The study suggest that indirect mechanisms that improve living conditions may be more effective than ‘pure’ health

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initiatives. In the Netherlands a study reporting on the general health effects of area-based

initiatives in Dutch deprived neighbourhoods found that areas that focused their investments on the district environment showed more beneficial developments in general health than areas that

targeted their investment in the individual socio-economic position of residents (Jongeneel-Grimen , 2014, Droomers et al., 2014). These findings are in line with suggestions that area-based

interventions in themselves are a more effective means to improve the neighbourhood environment than to focus purely on the inhabitants (Batty et al., 2010). Given that there is stronger and more consistent evidence of place-based interventions resulting in changes to population health, and the focus of this study is on changes to the contextual characteristics of the residential environment, the following section will look at empirical evidence related to interventions in the residential

environments, home and neighbourhood.

Housing Environment

A long-standing body of empirical evidence has demonstrated a significant association between the physical aspects of housing, like poor quality and design with morbidity, physical and mental health (Krieger & Higgins, 2002, Dunn & Hayes, 2000). For example, many studies have shown poorly built houses are prone to water intrusion, mould, poor ventilation, pest infestations and, in turn, increase the prevalence of infectious and chronic diseases (Krieger & Higgins, 2002). However the evidence concerning the links between health and renewal changes in housing are not as conclusive, the available evidence suggests that outcomes may not be strongly or universally positive (Curtis et al., 2012). While there is potential for health gain for the people moving into improved housing, the health effects for the wider population of rehousing or housing refurbishment may be mixed. In the short term housing refurbishment can be disruptive and intrusive. The evidence suggests that housing renewal programs do not always improve housing equally for all local populations. Those with the most severe housing needs and some marginalized groups may be further excluded or displaced by housing schemes (Curtis et al., 2012). Neighbourhood 'improvements' may displace social problems rather than solve them, and this will not help to reduce inequalities in housing or in health. For example Atkinson (1999) describes how urban renewal may ‘gentrify’ an area evacuating rather than solving social problems and is thereby used as evidence that gentrification has positive social impacts. The displacement can in turn lead to increased social costs, for example,

overcrowding in ‘hidden households’. In addition displacement also has neighbourhood effects such as impaired social networks, which in turn may adversely affect vulnerable groups that are less able to cope with the psychological and financial costs (Atkinson, 1999).

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significant health implications (Dunn et al., 2004; Dunn & Hayes, 2000). The significance of home as a marker of social status and identity has been well established and used as an explanation for some of the pathological effects of homelessness, housing precariousness and substandard housing (Dunn & Hayes, 2000). For example, a study by Dunn & Hayes demonstrated that survey respondents, who indicated that they were proud of their home or believed their home to be a positive reflection of themselves, also reported better health status, satisfaction and mental health (2000). The amount of control individuals feel they can exert at home is also a major factor through which housing operates as a social determinant of health (Dunn & Hayes, 2000). In the same study, Dunn and Hayes found that respondents who reported greater frustration with the condition of their home or concern over being forced to leave, were more likely to also report poorer physical and mental health and express higher levels of stress. They found that social support was mediator of a wide range of stressors in participants home and neighbourhood environment (2000). These findings parallel an earlier study by Evans et al. (2003), which identified personal control of ones' living environment as a key mediating factor between the effects of the physical environment on mental health outcomes. Investigators found that when individuals experience a lack of control over the maintenance of their home, noise level or overcrowding, the risk of psychological distress is increased (Evans et al., 2003).

Given the above empirical evidence it may be assumed that housing renewal interventions may not influence health equally dependant on a number of intermediary factors, such as financial stress, short term housing disruption and psychosocial factors such as perceived control over one's

environment. However social support and positive associations with one’s home may be factors that ameliorate these influences.

Neighbourhood Environment

The local, physical and social environment surrounding a home plays a significant role in producing health outcomes. Local services and amenities such as schools, public recreation facilities, health centres, banks, retailers, grocery stores, public transportation and employers are important resources for everyday life. Macintyre, Ellaway & Cummins call such resources “opportunity structures,” that can work directly or indirectly to promote or negatively impact health through the chances they provide for people to lead healthy lives (2002). Low socioeconomic status

neighbourhoods tend to have fewer local services and amenities, thus reducing the quality of life for residents (Macintyre et al., 2002). Research from Scotland found that experiences of prolonged, chronic stress have both psychological and biological consequences and that neighbourhoods provide an important context in providing a stressful, or stress-free residential context, the findings suggest that urban renewal initiatives will be more effective where they ameliorate stressful living

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environments (Egan et al., 2013). Reducing stress through urban renewal is purported to  provide wide-ranging benefits to residents in  terms of psychosocial health through addressing issues such as better neighbourhood reputation, more support  for facilities and services, increased social  cohesion and community participation (Gibson et al., 2011).

A study in the Netherlands investigating the association between neighbourhood level psychosocial stressors (experience of crime, nuisance from neighbours, drug misuse, antisocial behaviour, rubbish on the streets, feeling unsafe and dissatisfaction with the quality of green space) and self-rated health in Amsterdam found that fair to poor self-rated health was significantly associated with neighbourhood-level psychosocial stressors. In addition, when all the neighbourhood-level psychosocial stressors were combined, individuals from neighbourhoods with a high score of psychosocial stressors were more likely than those from neighbourhoods with a low score to report fair to poor health. These associations remained after adjustments for individual-level factors (i.e. age, sex, educational level, income and ethnicity). The neighbourhood-level variance showed significant differences in self-rated health between neighbourhoods independent of individual-level demographic and socioeconomic factors (Agyemang, 2007). These results were consistent with a number of earlier studies on neighbourhood deprivation and self rated health in the Netherlands (Reijneveld, 2002; Drukker & Van Os, 2003). Although the study did not directly examine the mechanisms by which neighbourhood psychosocial stressors may be linked to poor health the authors hypothesised that, for example, neighbourhoods that score high on perceived fear of victimisation (such as frequently feeling unsafe as a result of youngsters hanging around) may discourage residents from engaging in healthy lifestyle measures such as physical activity, which, in turn, may lead to poor health. In addition, a poor quality of the neighbourhood built environment, such as unsatisfactory green space, may also discourage residents from engaging in outdoor recreation, which in turn may lead to unhealthy lifestyles (Agyemang, 2007).

In contrast, recent individual studies in the Netherlands as well as in other places have found conflicting or inclusive results in regards to improving green space and improved health outcomes. Greener neighbourhoods have been associated with less cardiovascular disease in New Zealand (Richardson et al., 2013) but not in Australia (Pereira et al. 2012). Better mental health has been reported in greener neighbourhoods in some studies (De Vries et al., 2011; Richardson et al., 2013) but refuted in others (Van den Burg et al., 2010). A recent study in the Netherlands assessing the impact of area-based interventions in green space in Dutch deprived neighbourhoods on physical health and general health found that the interventions in green space did not show more favourable changes in the trend of physical activity or general health compared to the control areas (Droomers et al., 2016). The authors of this study offered a number of hypotheses as to why the study did not yield positive health outcomes. As with all studies evaluating area-based interventions the study of

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one intervention, in this case the effects of green space on health, is carried out simultaneously with many other interventions targeting other problems such as housing, employment, social cohesion etc., therefore it is possible that the health impacts of improvements in green space may be outweighed by other interventions that discourage physical activity or have an impact on

psychosocial outcomes. The authors therefore made the recommendation to consider a wider range of interventions and their possible impact to distinguish between different pathways by which health outcomes are affected (Droomers et al., 2016).

In addition it has been hypothesised that perceived safety may be a barrier to the use of green space, explaining the lack of occurrence of potential health benefits resulting from green spaces (Lee & Maheswaran, 2010; Gladwell, 2013 ). Actual crime and perceived safety has also found to have a strong association with health outcomes (Agyemang, 2007). For example, a recent study from Sweden showed a positive association between neighbourhood crime and coronary heart disease even after controlling for the individual-level factors (Sundquist, 2006). In the Netherlands a recent study found a positive association between neighbourhood crime and blood pressure in Amsterdam (Agyemang, 2007b).

The neighbourhood social environment has also been found to have significant impacts on health outcomes. For example, an Australian study examining various aspects of neighbourhood, including social characteristics, demonstrated that reciprocity between neighbours and a sense of community played key roles in generating positive or negative health outcomes (Ziersch et al., 2005). In addition, participants who reported stronger neighbourhood connections and better perceived safety also reported better mental health (Ziersch et al., 2005). Another study in Scotland found that the social environment was perceived by residents to influence a greater range of health issues than the physical environments of homes and neighbourhoods (Egan & Lawson, 2012). However, a study by Veenstra et al. (2005) found that the relationship between neighbourhood involvement and self-rated health, chronic conditions and emotional distress was mediated by a variety of other independent factors like neighbourhood context, age, income, education and coping skills.

Therefore, the authors concluded that the effects of social neighbourhood characteristics on health are highly complex and may work through a number of other social determinants of health.

Overall evidence suggests that the neighbourhood environment influences health in complex ways and there is need to distinguish between different pathways by which health outcomes are affected in order to understand the potential impact of urban renewal on residents health.

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15 Chapter 3: Research Design

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3.1 Introduction

The objectives of this study in Geuzenveld were threefold. The first objective was to understand what characteristics of the residential environment were perceived by residents to influence their health. The second objective was to explore whether changes to their residential living environment was perceived to influence, or expected to influence their health. The third objective was to explore the perceived pathways and mechanisms by which residents' health might be influenced by changes to their environment. The common purpose of these objectives was to explore what elements of urban renewal interventions in residents' living environment are perceive to influence their self-perceived health and to get a deeper understanding of the pathways linking these effects. In order to achieve this purpose, qualitative research methods using a multi-grounded theory methodology were employed. The first section of this chapter will discuss the methodological considerations and the conceptual model, the second half will outline the methods used in conducting this research and the rationale for their use.

3.2 Methodological Approach

The theoretical and empirical literature that has informed this proposal led me to decide to conduct a qualitative rather than quantitative study. Qualitative research has often been advocated as the best strategy for exploring a new area and developing hypotheses (Miles & Huberman, 1994). Given that little is known about the specific features of neighbourhood interventions and health outcomes and particularly the mechanisms whereby such improvements deliver these impacts, a qualitative research design is therefore a highly appropriate choice for investigating this issue. Because qualitative research focuses on peoples' lived experiences or events in their lives, including the repetitive or mundane, it is "fundamentally well-suited for locating the meanings people place on the events, processes and structures of their lives" (Miles & Huberman, 1994). I will be employing a qualitative Multi-Grounded Theory (MGT) design as the overall research approach as it applies a pragmatic approach in exploring empirical observations with internal and external congruence with theory (Goldkuhl & Cronholm. 2010).

Unlike a pure Grounded Theory (GT) inductive approach or a strict theory driven deductive approach, MGT is a dialectical synthesis between inductivism and deductivism (see Figure 1 below) (Goldkuhl  & Cronholm, 2010).

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Figure 1: Multi-Grounded Theory Approach.

Source: Goldkuhl  & Cronholm, 2010

A MGT approach claims that theory development should aim at knowledge integration and synthesis, which means that theories can be used actively, aiming at knowledge synthesis of such theories and new abstractions arrived from the coding of new data. As such MGT utilizes a more systematic approach to the use of pre-existing theory than a pure GT approach. According to MGT, it is important to be open-minded and continuously reflective during the research processes and let empirical observations and theoretical insights influence the research interest, as such it was expected that the research questions may evolve through this process. Initially the research question was focused purely on residents' experiences of urban renewal however during the interview process and reflection during analysis residents' expectations of renewal emerged as significant in relation to how they perceived area-based interventions to influence their health.

3.3 Conceptual Model

The key concepts relevant to this study that form the conceptual model have been discussed in Chapter 2 and have been visualised (see figure 1 below) to show how urban renewal may impact health outcomes, however it is important to be clear that the specific mechanisms by which urban renewal interventions effect which neighbourhood characteristics and influence perceived health outcomes may be more complex than this model suggests. Furthermore, more than one mechanism may be involved for any given health outcome (MacIntyre & Ellaway, 2003). A summary of the conceptual model will follow.

The starting point in this conceptual model is the macro-level economic, social, and political structures of society. These structures determine macro urban renewal policy and select areas for intervention. The area-based interventions interact with the meso-level residential living

environment: home, physical and social. From this context the psychosocial factors originate, such as control over core aspects of life, social cohesion, social reciprocity, interpersonal conflicts, or

availability of socio-emotional support, to name just a few. The psychosocial factors are experienced and cognitively and emotionally processed by the individual. It is important to note that it is

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presumed that individual differences in their substance are shaped by societal structures and social contexts (Rugulies , 2012), which as a result may impact health through reactions on the behavioural and the psychophysiological levels. The framework also includes a material pathway connecting the urban renewal interventions at the residential living environment directly with health behaviours and health. To ensure successful translation of knowledge into action the full range of mechanisms by which neighbourhood environment-both physical and psychosocial-can influence health must be considered.

Figure 2: Conceptual model of how urban renewal may impact health Adapted from Rugulies, 2011

3.4 Participant Recruitment and Profile

An extensive description of the demographic and housing characteristics of the respondents can be found in Appendix A. In short a total 23 interviews were conducted, 20 with Geuzenveld residents and 3 with relevant stakeholders. All 23 interviews were recorded, transcribed and coded, in addition one document that was also coded “Gekwalificeerd advies Bewonerscommissie Bart van Hovestraat e.o aan Woningcorporatie Stadgenoot: Complex 8035” (Qualified Advice Residents Commission Bart van Hove Street - Complex 8035 for the Housing Corporation Stadgenoot). Participants were asked whether they preferred the interviews to be conducted in English or Dutch, in total 12 interviews were conducted in English and 11 interviews were conducted in Dutch. The Dutch interviews were first transcribed in Dutch and translated to English.

The main three actor groups relevant to this study are residents, housing corporations and the City District New West. The largest housing corporation active in Geuzenveld, Stadgenoot, was

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interview was also conducted with the Area Coordinator of Geuzenveld-Slotermeer, City District New West and the President of the Residents Commission for Complex 8035 Bart van Hove Street which is currently undergoing renovations. It should also be noted that a number of other key stakeholders, including local neighbourhood houses, health workers and tenancy advocacy groups were

approached to participate however due to a number of other commitments declined. Although this was initially a constraining factor as the original recruitment design was to identify participants through local key stakeholders, the recruitment strategy was altered to accommodate for the time constraints.

A maximum variation purposive sampling technique was used to capture a wide range of

perspective. To maximise variation, traits that will guide this selection are: length of residence, age, ethnicity and household composition. Exploring similarities and difference through maximum

variation will provide greater insights by exploring health outcomes from all angles to help to identify common themes across the sample, whilst additionally allowing for properties, dimensions and conditions of categories and subcategories to materialise (Freeman, 2009). The key inclusion criterion in this study was that the participants were residents of Geuzenveld and had lived in the neighbourhood for more than 3 years. Although there have been several rounds of urban renewal in Geuzenveld over the previous decades the most recent urban renewal plans were re-instigated after the financial crisis in 2014, this would thus provide a timeframe for residents to have experienced changes in their neighbourhood as a result of the current area-based interventions.

The participants were approached at the Lambertus Zijlplein between the hours of 10am -4pm of the course of 7 days (Tuesday x2, Wednesday, Friday, Saturday and Sunday x2). Interviews were carried out either with individuals or in groups of two people sitting in the public square. The individual interviews lasted between 20-30min and the group interviews between 30-45min. In total 35 people were approached to participate, 6 people did not fit the selection criteria and 9 people declined. The interviews with key stakeholders were conducted in their respective offices and a neighbourhood house, the three interviews were conducted for approximately 1 hour each.

The participants included a range of self-identified ethnicities, 80% identified as non-Western/mixed ethnicity, 60% were female, the length of residence ranged from 4 years to 55 years, age ranged from 18 to 84, and there was a mixture of single and family households, social housing, private renting and home owners. This sample broadly reflects the socio-demographic characteristics of this neighbourhood, however this study does not claim to have samples that are statistically

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19 3.5 Semi-Structured Interviews

The general aim of this study is to better understand how residents perceive changes in their health in regards to the influence of changes in their residential environment. Therefore interviews were considered the most appropriate method for collecting data because it allows participants to explain their experiences, perceptions, beliefs and feelings in “their own words” (Longhurst, 2010).

Specifically, semi-structured interviews were selected as the main source of data collection as it allows “the discussion to unfold in a conversational manner,” whereby both interviewer and respondent can shape questions (Longhurst, 2010). This kind of two-way, conversational dialogue was important for this project to fully investigate the rich narratives of respondents . In terms of health, adopting a qualitative approach that uses residents’ own accounts also helps to explore a range of perceived pathways by which residential environments might affect health outcomes, which also addresses a key objective of this study.

Interview guides were developed separately for the three key stakeholder and can be found in Appendix B

3.6 Data Analysis

The analysis of the data was undertaken incorporating Braun and Clarke’s (2006) thematic analysis guide and elements of the working structure of the Multi-Grounded Theory approach. An outline of the full analysis phase and techniques undertaken can be found in Appendix C. In summary the analysis was undertaken in six phases, however this was not a linear processes and involved moving back and forward between the data set and theory. The six phases were: familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and the final production. The full code list inclusive of themes, categories and codes are listed in Appendix D.

3.7 Limitations and Strengths

Qualitative studies seek to obtain detailed and complex data from relatively small samples of participants.  They provide insights into participants’ range of experiences and help us understand processes and mechanisms (Egan & Lawson, 2012). This study, which focuses on individuals’ perceptions and situations, does not provide generalizable evidence of prevalence or causation. It should be recognised that complex factors influence outcomes for the individuals, households and communities that this study focuses on. In terms of generalizability, it should be noted that the participants’ accounts are based on experiences of living in an area of multiple deprivation in Amsterdam currently undergoing urban renewal. The extent to which the findings are applicable to other neighbourhoods depends on the extent to which those other neighbourhoods resemble the places that provide the setting for this study. This has been recognised as an issue for all studies of

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health and place that need to contend with – and suggests limits in generalisability beyond the most immediate local context (Egan & Lawson, 2012). However a strength of utilising a qualitative

approach is that it moves beyond discussions of prevalence and statistical associations, which have been found to be inconsistent in urban renewal and health outcomes, and allows a deeper

understanding of how residents view their own experiences illuminating a range of potential pathways and mechanisms by which residents perceive their changes in their residential environment to influence health.

Different ways of recruiting participants have varying strengths and limitations, so there are

advantages to using more than one method of recruiting participants. In this study it was the original intention to utilise a mixture of recruitment methods including approaching local key stakeholders who have built relationships with residents however this was unable to be undertaken. It should be noted that a limitation in this original approach was that it risks selection bias, for example those approached through this sampling method could potentially lead to the sampling of particular kind of participants characterised by high levels of involvement in local housing committees and community initiatives ie. the ‘usual suspects’: connected, motivated and articulate local activists. The strength of recruiting in public spaces is that it has the potential to sample of wider range of participants with a broader range of experiences.

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21 Chapter 4: Geuzenveld- A Neighbourhood in Transition

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4.1 Introduction

The case in which this study is undertaken is Geuzenveld located in the New West of Amsterdam (see figure 3). The area of Geuzenveld is primarily residential and is in the process of undergoing

significant urban renewal to improve the housing and living environment. Inclusive of Slotermeer it is considered one of the largest urban renewal projects in Europe (I Amsterdam, 2016). The area scores poorly on a number health and socioeconomic indicators compared to Amsterdam and has a high proportion of multi-disadvantaged households (Gemeente Amsterdam, 2014a). As such Geuzenveld has been the target for, and has undergone multiple waves of urban renewal starting in the 1990’s with the demolition and construction of new buildings, however as a consequence of the global financial crisis the urban renewal plans for Geuzenveld came to a standstill (Gemeente Amsterdam, 2015). Currently the process of renewal has resumed albeit in an altered form, the focus of renewal has shifted to an integrated neighbourhood approach focusing on the housing and the neighbourhood environment and an emphasis on refurbishment rather than demolition

(Gemeente Amsterdam, 2014b). Given these circumstances Geuzenveld is an appropriate case study to investigate how residents' expectations of living in an environment undergoing significant

renewal, to both housing and the neighbourhood, may affect their perceived health.

Figure 3: Map of Geuzenveld’s location within city of Amsterdam Adapted from: Stadsmonitor Amsterdam, Department of Geography and Planning & O+S, 2003

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This chapter will discuss first the history and development of Geuzenveld and how it became an area of socioeconomic disadvantage. The next section will discuss the context and urban renewal policies in the Netherlands and the shift towards integrated area-based interventions followed by a summary of the key urban renewal plans of Geuzenveld. The purpose is getting a better understanding of the process of renewal and what can be expected in terms of home and neighbourhood renewal and their approach to health. Finally a current snapshot of Geuzenveld will be presented including health indicators, and will set the context for the findings of this paper.

4.2 History of Geuzenveld

Geuzenveld is a small neighbourhood in the New West of Amsterdam, surrounded on the south, north and west sides by major green areas such as Sloterpark, Concord Park, Bretten and the West Gardens. The parks and open space surrounding Geuzenveld and the New West dates back to the planning of the ‘Westelijke Tuinsteden’ (Western Garden Cities) in the1930’s and the extension of Amsterdam post Second World War. In terms of urban design and planning the ‘Amsterdam Uitbreidingsplan’ (AUP, Amsterdam extension Plan), of which the Western Garden Cities formed a significant expansion, departed from the centuries old concentric development of the city (Aalbers et al, 2003). Figure 4 details the AUP extension

Figure 4: AUP Extension Plan Source: Mooij & Van Uitert, 2015

From 1865 to 1923 the Amsterdam population grew from 265,000 to 700,000 inhabitants, most of whom were housed in small houses, with a lack of space and bad sanitary conditions (Mooij & Van Uitert, 2015). The Housing Act of 1901 was the starting point for the influence of government in urban planning and due to the unsanitary and cramped housing conditions environmental health

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featured heavily in the new urban design principles. As a reply to the densely populated and unhygienic neighbourhoods of the 19th century, the new housing environment was designed for ‘licht, lucht en ruimte’ (light, fresh air and room/space)(Mooij & Van Uitert, 2015). Amsterdam, for the first time, was to become an ‘open city’, groups of flats were built in rows or at right angles to each other and streets gave way to open spaces consisting of roads and green and interlinking squares.

The New West was constructed in the 1950s and 60s to revised and more austere plans than what was originally envisaged. 55 000 housing units were built and were targeted at working Dutch families and employees. Rents were deliberately left low in account for the national policy which kept wages low to improve the export position of the country (Aalbers et al, 2003) For the New West the revised plans meant smaller units, more mid-rise building and cheaper urban design solutions, although the amount of green space was not cut and remained as per the pre-war plans. The construction of Geuzenveld was completed in 1962, at its completion it had 4433 houses, 100,000 trees, 40 playground, 56 craft rooms, 127 shops, 6 and 2 churches (Teijmant, 2009) . Almost all the building where built for social housing created for Dutch families. The architects of

Geuzenveld wanted to create an “organic unity” for life, many of these features parallel the ‘health enabling’ neighbourhood requirements discussed previously in Chapter 2, such as schools, churches, shops, sports facilities and lots of greenery. Playgrounds were built for every 100 households and green spaces were always available at a maximum distance of 400 metres. The architects were keen on developing neighbourhood connections between residents and planned various facilities for people to meet (Teijmant, 2009)

The New West started to change in the 1970s with the original population moving out and guest workers and their families moving in, consisting primarily of low-income families of mainly Turkish and Moroccan descent (Aalbers et al., 2005). The houses in New West and particularly in

Geuzenveld are larger than those closer to Amsterdam central, as a result many of the large

immigrant households were allocated social housing in the available larger houses in the New West. This trend continued into the 1980’s and 1990’s and concentration the low income households and high proportion of immigrant families Geuzenveld faced increasing social and economic problems. (Aalbers et al., 2005).

In the 2000’s Government policies aimed at improving ‘social mix’ through the demolition of social housing and construction of apartments for more affluent inhabitants was an attempt to break through the structural social problems in these deprived neighbourhoods with assumed positive social and economic effects (Platform 31, 2016b) Although the proportion of owner occupied

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is relatively cheap; the purchase value per square meter is about 800 euros below the urban average of 2,888 euros(Gemeente Amsterdam, 2014a). This influences the type of households moving into the area, in this case predominantly low-income households from non- western backgrounds. According to the City District of New West this has affected the social cohesion in the

neighbourhood, causing alienation and mutual tension between residents, which has had a negative impact on the perceived quality of life and safety in the neighbourhood (Gemeente Amsterdam, 2015).

4.3 The Dutch Approach to Urban Renewal

Concerns about spatial health inequalities have a long history in the Netherlands (Jongeneel-Grimen , 2014). Starting with the Housing Act of 1901 and continuing through to the 1980’s urban renewal in the Netherlands primarily focused on physical improvements. During the late 1980’s however it was realised that the focus on the purely physical aspects of urban renewal was not meeting the needs of disadvantaged areas experiencing degrading social cohesive ties and therefore a new focus of urban renewal was required (Musterd & Ostendorf, 2008). In 1994 the Dutch

government instigated a large scale urban renewal agenda in the four largest Dutch cities consisting of three pillars that were thought to be mutually reinforcing: social, economic and physical. Whereas previous plans had mostly focused on one aspect, the Big Cities Policy focused on integral plans, and although the focus was officially on the scale of the entire city, in practice it focused on deprived neighbourhoods (Musterd & Ostendorf, 2008). As the Policy progressed the role of different governments changed, it was recognised that municipalities and neighbourhoods face different problems and therefore governments at a lower spatial scale would be better equipped to decide what the goals of the development plans should be and how to achieve them. Officially this change took place in 2010 when The Big Cities policy was renamed and shifted to a more

decentralised model in which the municipalities took full responsibility of the urban policy funds, with this shift came a decrease in the funds available (VROM, 2009).

In 2003 a stronger focus on area-based interventions and a district approach to urban renewal was introduced as part of the Big Cities Policy called the ‘56-wijkenaanpak’. This policy targeted 56 neighbourhoods across the Netherlands which showed concentrated problems on all three pillars and therefore needed extra attention (Platform31, 2016a) At least one neighbourhood from each of the 30 municipalities that were part of the Big Cities Policy were selected for interventions by the municipalities. In 2007, the area-based approach was given a major boost by the Dutch Government with the 40-wijkenaanpak policy. The aim was to improve the liveability by 2018 of the 40

neighbourhoods selected by focusing on problems with housing, residential environment, employment, education, social cohesion and safety. Unlike the 56-wijkenaanpak it was not the municipalities that selected the areas but a statistical methods was used to determine the 40 least

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liveable neighbourhoods in the Netherlands based on 18 indicators of deprivation. The

implementation of this initiative started approximately mid-2008. The interventions implemented under the auspices of the 40-wijkenaanpak policy were initiated additionally to interventions and policies that were already going on and included €300 million for the period from 2008 till 2011 (Droomers et al, 2014). Figure 6 shows a detailed timeline of the government policies of urban renewal from 1950-2015 and how they intersect and overlap. After 2011, the financial contribution of the national government for the social and economic pillars expired and has since maintained a contribution only through knowledge (Platform31, 2016a). The interventions included, among others, the creation or improvement of green spaces, housing renewal, safety initiatives and employment opportunities (see Droomers et al, 2014 for detailed information on the content and scale of implemented interventions). Each target district implemented selected interventions to suit the specific local needs therefore large variation existed in the number of residents reached by the interventions, or the number of changes in the neighbourhood environment, and/or the amount of different types of activities which were implemented (Droomers et al, 2014).

Figure 5: Timeline Government Policy Urban Renewal 1950-2015 Source: Platform 31, 2016b

Although not explicitly targeting health, based on the fact the district approach targeted not only the features of the neighbourhood environment that have been found to be important for the health of residents, including physical features, improving housing conditions, social-cultural conditions and the reputation of an area, but also invested in individuals such as education and employment, from a public health perspective it is not only likely that the interventions would improve the liveability of the neighbourhoods, but would also improve the health of their residents. To date however the research conducted on these 40 targeted neighbourhoods and effects on health and health behaviour have been mixed, (Droomers et al, 2014; Jongeneel-Grimen , 2014).

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26 4.4 Urban Renewal Plans of Geuzenveld

In order to tackle the multiple disadvantages in Geuzenveld a number of urban renewal plans have been made for the neighbourhood since the 1990s. Prior to the global financial crisis the primary urban renewal plans for the area were part of a wider plan for the entire New West area: Richting Parkstad 2015. This was created and established by a collaboration between the central municipality and the previous districts of what is now called New West. This plan was divided into renewal plans for designated parts of the New West and was an integral plan incorporating the three pillars: physical, social and economic (Bureau Parkstad, 2001). The focus for the physical pillar was to improve the quality of dwellings and differentiate the housing stock, improve the physical quality of the living environment and make the living environment healthy and sustainable (Municipality of Amsterdam, 2010). However the main aspect of these plans was on renovating and demolishing dwellings and replacing them with more expensive options for owner occupation and private rental. To achieve these goals, Richting Parkstad 2015 included several criteria which should be met by the renewal plans including, among others, the total number of dwellings to be demolished, the amount of socially rented dwellings to be sold and to be converted to private rental and the number of dwellings to be newly built in both the private and the social rental sector (Bureau Parkstad, 2007.) By the end of the 2000s, changes in the ways of thinking about urban renewal led to shift in focus of how renewal should be undertaken and implemented. The assumption that differentiating and improving the quality of the physical environment would help people to climb the socioeconomic ladder was heavily disputed (Platform 31, 2016b). Most significantlu however were consequences related to the financial crisis that hit the social housing sector. As a result of the crisis less money was available and plans were put on indefinite hold. (Gemeente Amsterdam, 2014b) In 2014 the renewal plans in Geuzenveld were reinitiated and led by the District of New West and housing organisation Stadgenoot. The new document is an update of the old renewal plans of the Richting Parkstad 2015 and is formulated as an Action Card and framework from which all other individual relevant policies, programs and interventions have been collated.

Action Card Geuzenveld, Confucius en Rousseaubuurt 2014-2020

The Action Card incorporates 5 key focus areas for improvement: more appropriate and improved housing; strengthening the quality of public space; a safer neighbourhood; better services and facilities; strengthening the social and economic position of occupants. Refer to Figure 6 for a visual map of the proposed interventions within the neighbourhood. By actively addressing the 5 key focus areas the primary objective is to improve the liveability of the area, with the specific aim for

Geuzenveld residents to rate the liveability on par with the Amsterdam average by 2020. Underlying the 5 key focus areas is the intention of residents to be actively involved in the process of improving

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the neighbourhood and improving the image and reputation on the neighbourhood. The key changes in the urban renewal approach are the scope and execution of the plans, focusing on renovations rather than demolition and new construction. At a social environmental level the aim is to encourage more ownership, participation and empowerment of current residents to improve the liveability of the area rather than improving liveability through diversifying the socioeconomic position of residents via social mix strategies.

Figure 6: Urban Renewal Interventions Geuzenveld 2014-2020 Source: Gemeente Amsterdam, 2014b

4.5 Geuzenveld Today

On a number of socioeconomic indicators Geuzenveld scores worse than in the average of

Amsterdam. Compared to Amsterdam there are more vulnerable households Geuzenveld; three out of ten households (28%) have a low income and low-educated head of household (compared to 15% average). Language deficiency is much higher than the Amsterdam average (37% compared to 16%),

Changing neighbourhoods, changing health? : residents’ experiences and expectations of urban renewal in their neighbourhood and influences on self-perceived health : the case of Geuzenveld