Abstract

Objectives: To identify plausible mechanisms by which resilience (low mortality rates despite persistent economic adversity) was achieved in some areas in Britain between 1971 and 2001.

Methods: Mixed method observational study, combining quantitative analyses of cause- and age group-specific mortality rates, and area sociodemographic and environmental characteristics, with case studies of resilient areas which included in-depth interviews.

Results: The causes of death, and age groups, contributing most to resilience varied markedly between the 18 resilient areas; as disease aetiology varies, a range of protective processes must be in operation. Four area characteristics, which plausibly contributed to resilience, emerged from the in-depth interviews: population composition; retaining or attracting population; environment and housing; and social cohesion. Quantitative analyses demonstrated significant difference between resilient and non-resilient areas in retaining or attracting population only.

Conclusions: While we identified plausible area characteristics through which resilience was achieved, there does not appear to be a definitive set that reliably produces resilience, and resilient and non-resilient areas did not differ significantly in their possession of most of these characteristics. If such characteristics do have a role 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.