Social Science & Medicine 318 (2023) 115634 Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed The right to the unhealthy deprived city: An exploration into the impacts of state-led redevelopment projects on the determinants of mental health Ella O’Neill a, b, *, Helen V.S. Cole a, b, Melissa García-Lamarca a, b, Isabelle Anguelovski a, b, c, Pedro Gullón d, e, Margarita Triguero-Mas f, a, b a Universitat Autònoma de Barcelona (UAB), Institute for Environmental Science and Technology (ICTA), Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193, Cerdanyola del Vallès, Barcelona, Spain b Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNUEJ), Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain c Catalan Institution for Research and Advanced Studies (ICREA), Spain d Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain e Unidad Docente Medicina Preventiva y Salud Pública, National School of Public Health, Madrid, Spain f Mariana Arcaya’s Research Lab, Massachusetts Institute of Technology Department of Urban Studies and Planning, Cambridge, MA, USA A R T I C L E I N F O A B S T R A C T Handling Editor: S Susan J Elliott Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Sub­ sequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to Keywords: provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving Mental health residents’ health. However, recent research suggests that redevelopment/regeneration schemes often trigger Redevelopment gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, Gentrification including mental health, for long-term neighborhood residents. Using the right to the city and situating this within Right to the city Displacement the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential Disempowerment mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of Capitalist hegemony redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow — North Accumulation by dispossession Glasgow and East End – and conducted a strong qualitative study based on 25 in-depth semi-structured in­ terviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) out­ comes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood res­ idents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative conse­ quences for the determinants of mental health, reinforcing existing inequalities, disempowering original long- term neighborhood residents and only providing the “right” to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations. 1. Introduction profoundly impacts participation in health promoting behaviors, impacting physical health conditions such as cardiovascular, respiratory Mental health disorders play a considerable role in the “global and infectious diseases, diabetes and hypertension (World Health Or­ burden of disease” (Cohen-Cline et al., 2015). Poor mental health ganization (WHO), 2021). Also notable, is the co-occurrence of alcohol * Corresponding author. Edifici ICTA-ICP, Carrer de les Columnes s/n, Campus de la UAB, 08193 Cerdanyola del Vallès, Barcelona, Spain E-mail addresses: ella.oneill@uab.cat (E. O’Neill), helen.cole@uab.cat (H.V.S. Cole), melissa.garcialamarca@uab.cat (M. García-Lamarca), isabelle.anguelovski@ uab.cat (I. Anguelovski), pedro.gullon@uah.es (P. Gullón), mtrigueromas@gmail.com (M. Triguero-Mas). https://doi.org/10.1016/j.socscimed.2022.115634 Received 12 May 2022; Received in revised form 19 November 2022; Accepted 23 December 2022 Available online 26 December 2022 0277-9536/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 and substance abuse disorder with mental health problems (ibid). afford rent or council and property taxes, while attracting higher income Moreover, mental health inequities can be found within the same city and educated residents (Lees et al., 2008; Gray, 2018; Tach and Emory, between neighborhoods of extreme deprivation and wealthy areas 2017). Equally, state-led redevelopment/regeneration schemes have (Seaman et al., 2015). The co-occurrence of mental illness, worse been known to focus their efforts on new housing developments, physical health and inadequate health promoting behaviors can result in demolishing existing council housing to make space for expensive new early mortality, with up to a 25-year life expectancy reduction (Roberts builds, often unaffordable for original residents (Ferreri, 2020; Lees and et al., 2017). This paper contributes to this body of work by exploring Ferreri, 2016). Furthermore, those able to physically stay in the neigh­ some of the determinants of mental health that are impacted by urban borhood may be exposed to social friction between classes, feelings of development processes. We explore these primarily through the mech­ exclusion, lack of belonging and further marginalization (Anguelovski anism of disempowerment, theoretically situating our analysis within et al., 2020). the framework of the right to the city, to suggest to what extent local Regarding health impacts, existing research shows a strong positive residents have a right to good (mental) health outcomes (or not). We association between living in a gentrified neighborhood and serious offer a novel qualitative exploration depicting processes of dis­ psychological distress of low-income residents (Tran et al., 2020). For empowerment for local residents, in light of capitalist hegemonic profit example, in New York, hospitalizations for mental health reasons were accumulation through dispossession. more likely among residents displaced from gentrifying neighborhoods There is considerable literature establishing the link between mental (Lim et al., 2017). Similarly, it has been reported that urban renewal health and physical environments (Wolch et al., 2014; Anguelovski policies that fail to center vulnerable populations, are more likely to et al., 2021; Ribeiro et al., 2021). Strong relationships have been found initiate processes of gentrification and negatively impact health (Meh­ between poor neighborhood aesthetic qualities and poor mental well­ dipanah, 2018). For urban renewal programs to benefit the health of all being (Bond et al., 2012). For example, poor-quality housing can be seen residents, they need to overcome barriers to issues of wider accessibility to contribute directly to emotional stress, anxiety and depression (Li and and inclusivity, ensuring feelings of safety and security are felt by all Liu, 2018). Long-term exposure to noise — including road traffic, (Mehdipanah et al., 2015). Nonetheless, beyond these findings, the in­ aircraft noise and railway noise — has been linked to increased rates of terconnections between redevelopment/regeneration projects and depression and anxiety, increased mental health-related medication use mental health are still widely unexplored. and childhood emotional and developmental problems (Clark and In turn, the social exclusion and ensuing poor mental health impacts Paunovic, 2018). Long-term exposure to air pollution has also been of redevelopment/regeneration schemes calls into question the rights of found to negatively impact mental health outcomes (Klompmaker et al., socially vulnerable residents to remain within neighborhoods and 2019). benefit from (new) supportive urban amenities. The right to the city can Furthermore, mental health can be linked to socioeconomic factors, be defined as the ability to appropriate urban space, to make demands to both on an environmental and individual level. Poor social neighbor­ remedy spatial inequality and to build collective life (Lefebvre, 1968; hood environments in deprived areas have been linked to increased Lefebvre, 1996). It is a right to material opportunities, public space, social disorder, paranoia among residents and a lack of social cohesion goods and services (Marcuse, 2009). Other scholars (e.g., Purcell, 2002) (McElroy et al., 2019). Similarly, the physical environment has been interpret Lefebvre’s concept as enfranchisement, where those that found to contribute to antisocial behavior and facilitate crime/violence contribute to the body of urban lived experience can claim the right to in its material make up: for example derelict land spaces can encourage the city. Relevant to the topic at hand, Harvey (2003) brought the illicit activities while greened and cleaned up land has been associated concept back to social relations, depicting it as the ability to “make and with lower drug-related crime and assaults (Kondo et al., 2018) How­ remake our cities and ourselves” with the freedom to produce and ever, studies to date often explain differences in mental health outcomes reproduce socially contextualized urban space. In the context of rede­ purely by socioeconomic conditions, describing differences as a lack of velopment/regeneration projects, we rely on Harvey’s definition of the resources or general deprivation (Marmot, 2017), but fall short of right to the city to guide our analysis, however we also draw from others, examining the fully complex picture of underlying forces in which in­ particularly Purcell’s interpretation focusing on enfranchisement. equities are produced (Purtle et al., 2020). Additionally, Gray & Porter (2018) critically depict how state-led To improve physical and social-environmental conditions, govern­ gentrification processes through redevelopment/regeneration projects ments often target historically marginalized and disinvested working- reaffirm capitalist hegemonic power structures. In line with Gramscian class neighborhoods with redevelopment/regeneration schemes aim­ theorists on cultural hegemony, projects exclude and repress other so­ ing to boost economic growth (Anguelovski et al., 2020). Primarily cioeconomic or socio-spatial possibilities (Mouffe, 2005) and undermine targeting environmental and economic development is presumed to the citizenship of certain classes (Paton, 2016). There is evidence that have a knock-on effect on social conditions, positively impacting powerful state actors diminish working class relations of belonging (mental) health (Gray and Mooney, 2011). However, increasingly – through processes of stigmatization and forced removal from place, particularly in the field of urban environmental justice – some question under the promise of improvement (ibid). Through processes of accu­ the capacity of redevelopment/regeneration schemes to improve the mulation by dispossession (Harvey, 2003), working class people are conditions of existing residents and decrease social and health inequities continually excluded through an ideological policy tool. As the pursuit (e.g., Anguelovski et al., 2020; Sims, 2021; Anguelovski, 2013). Such of profit expands into these ‘peripheral’ neighborhoods, the right to the schemes exemplify the trade-offs between prioritizing the economic and city is therefore under threat. This results in further socioeconomic environmental pillars of sustainability and addressing deeper social deprivation, and more importantly in the scope of this paper, results in vulnerabilities and needs (ibid). further socio-spatial deprivation, having a considerable impact on More specifically, despite redevelopment/regeneration projects mental health. improving environmental quality and economically developing the area, Drawing on these concepts, particularly that of the right to the city, whether neighborhoods are healthy and just has been questioned. paves the way for a better understanding of the relationship between Scholars in geography, urban planning and critical public health have physical, socioeconomic and mental health factors in the face of urban argued that redevelopment/regeneration projects contribute to gentri­ development processes. Acknowledging who is able to contribute to the fication, both exacerbating existing and creating new types of social, (re)making of urban spaces, and who benefits and is harmed, can pro­ environmental and health injustices (Cole et al., 2019, 2021; Cole, 2020; vide an avenue to assess the structural and systemic drivers of social and Triguero-Mas et al., 2021). That is, the influx of wealth initiates pro­ spatial inequalities in the face of justice, where rights and access to the cesses such as increasing land speculation and housing prices, that may city is a right to empowerment. By depicting this as capitalist hegemonic in turn end up evicting lower class residents who are no longer able to accumulation, we are able to illustrate how and why urban planning 2 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 decisions impact the most socially vulnerable residents and can begin to power structures, allows us to hone in on these dynamics assessing who better understand the mental health impacts and disenfranchisement redevelopment/regeneration projects assign rights to and the potential that might occur as a result of redevelopment/regeneration projects. associated mental health outcomes of this. We focused on a single case To do this, we used qualitative data to carry out an in-depth inves­ study in order to fully delve into the data and analyze in-depth the re­ tigation of the potential mechanisms in which poor mental health out­ lationships between phenomena, context and people. This allowed us to comes may endure in certain neighborhoods, despite the variety of posit potential explanations for the how and why behind the above sta­ large-scale redevelopment/regeneration projects linked to livability tistics, and what might differentiate Glasgow’s case from others, for and health that certain cities implement. Using Glasgow’s recent example Liverpool and Manchester. regeneration as a case study, we addressed the following questions: 1) What is the relationship between the history of disinvestment and 2.2. The East End and North Glasgow environmental degradation and excess mental health-related mortality in Glasgow? 2) How are urban redevelopment/regeneration initiatives This study focuses on two areas: East End (Bridgeton, Calton, Dal­ potentially linked to excess mental health-related mortality in Glasgow? marnock) and North Glasgow (including all areas adjacent to the Forth and Clyde Canal). These two historically marginalized and working- 2. Methods class areas feature low-quality open spaces; roughly 8 or 9 out of 10 people live within 500 m of vacant or derelict land spaces (Gray, 2008). 2.1. Case selection Historically, North Glasgow concentrated much of the industrial eco­ nomic growth of the city, with the surrounding residential areas housing This study is based on data from a research project that assessed if Protestant factory workers (Glasgow City Council, 2016). Friction be­ urban greening projects redistributed access and benefits for under­ tween local Protestants in the North and Irish Catholic migrants looking privileged residents in mid-sized cities in Canada, the United States and for work, meant the latter group was forced into the East End, expanding Western Europe. Fieldwork was conducted in 24 cities of various city Glasgow’s industries (Handley, 1943). The prevailing southwesterly typologies and geographic areas. Based on grey literature and discus­ wind meant that both the north and east contained the highest pollution sions with collaborators in each city, we identified specific historically levels in the city. marginalized districts or neighborhoods in each city experiencing re- Now, between the wealthier (West End) and the lower income areas naturalizing, redevelopment, and gentrification processes. of the city (North and East End), clear environmental and health in­ Out of the 24 cities studied we selected Glasgow, Scotland. It stands equalities exist. Glasgow’s West End is decidedly middle-class, with out as a critical case study to explore the aforementioned theoretical fewer, but higher-quality open spaces than North Glasgow and East End. ideas. Grey literature was used to build an understanding of this case Moreover, between areas there is roughly a 12-year difference in life study, giving us a lens in which to interpret our primary data collected. expectancy among adult males and slightly lower for females (Seaman Exhibiting a process labelled ‘The Glasgow Effect’, this postindustrial et al., 2015). In addition, a strong correlation can be seen between area city has incredibly high excess general and mental health-related mor­ deprivation and poor mental health. Those in the most deprived quintile tality rates, beyond those ordinarily associated with socioeconomic in Glasgow were twice as likely to suffer from mental health issues than deprivation (Walsh et al., 2010). Walsh et al. (ibid) quantitatively those in the least deprived (Shipton et al., 2011). Comparatively, you illustrate the differences between Glasgow and similarly comparable can see stark inequalities in mental health outcomes in relation to area cities. For example, Liverpool and Manchester have similar industrial deprivation. histories as well as population sizes and levels of socioeconomic depri­ Consequently, North Glasgow and East End particularly have thus vation. However, Glasgow exhibits much higher morbidity and mortality been the focus of a number of redevelopment/regeneration projects rates than the other two cities. Statistics show that, in comparison, since the early-mid 2000s. The Scottish Government has invested sub­ deaths in Glasgow are 70% higher for suicide, 32% higher for external stantially in tackling poor environmental conditions, with the national causes (including accidents, self-harm, assault, drowning, fire and planning strategy for the next 20–30 years depicting its investment in poisoning), 130% higher for alcohol-related causes and 150% higher for sustainability as “living environments foster[ing] better health and… drug-related causes (Hanlon, 2015). The majority of these deaths can be hav[ing] reduced spatial inequalities in well-being” (Scottish Govern­ attributed to poor mental health, for example suicide, and drugs and ment, 2014). These include recent regeneration projects such as: (i) alcohol-related poisoning (ibid). decontamination and green-blue infrastructure provision through the From the industrial revolution, Glasgow expanded rapidly, becoming Clyde Gateway project in East End, beginning with the 2014 Common­ a key global center for the production of chemicals, textiles and in en­ wealth Games and (ii) Forth and Clyde Canal regeneration project in gineering (Glasgow City Council, 2007). From the 1960s onwards, rapid North Glasgow (see Figs. 1, 2 and 3). deindustrialization meant high levels of unemployment, urban decay, The primary goal of the Commonwealth Games intervention was to population decline and overall poor health (ibid). In the second half of economically develop the area, for wealth to trickle down in the form of the century, Glasgow’s population halved from 1.1 million to 600,000 job opportunities, increase amenities, and general economic activity people (Hanlon, 2015). This combined with its industrial heritage left (Gray and Porter, 2018). Moreover, the project aimed to address the Glasgow with multiple vacant and derelict land spaces, many of which poor-quality of public spaces and “enhance health and wellbeing” remain highly contaminated (Maantay, 2017). Approximately 60% of (Glasgow City Council, 2014). This project was largely considered a Glasgow’s local population live within 500 m of a derelict space and success by its developers. However, social housing developments were 92% live within 1000 m, particularly Glasgow’s poorest residents, demolished displacing a large number of long-term neighborhood resi­ reducing overall quality of life and health (ibid). dents (ibid). Glasgow exhibits an extreme example of some of the dynamics The purpose of the Forth and Clyde Canal regeneration was to con­ depicted in related studies of the right to the city. The coining of the term nect North Glasgow with the city center, focusing on creating economic the ‘Glasgow Effect’ by Public Health specialists was an attempt to shed corridors of activity to address social aims including health and well­ light on the uniqueness of the case, where socioeconomic deprivation being in relation to environmental space (Glasgow City Council, 2014). does not account for the shorter lifespans and health disparity found in Despite large-scale projects, in 2016, Glasgow City Council established Glasgow (Walsh et al., 2010). That being said, despite expansive rede­ that poor environmental conditions were related to continued socioeco­ velopment plans initiated in the city to tackle this, the Glasgow Effect nomic deprivation, attributed to fragmented ownership of urban land persists, begging the question; what dynamics are really at play here? (with multiple sites having multiple different owners, contributing to The right to the city, understood in the context of capitalist hegemonic difficulties around land governance), poor postindustrial ground 3 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 Fig. 1. Map of deprivation in Scotland. The most deprived areas are indicated in dark red and the least deprived in dark blue. ‘A’ indicates the Commonwealth games site, including the Athlete’s Village and ‘B’ to ‘C’ indicates the Forth and Clyde Canal regeneration project from Maryhill to Port Dundas. Data source: Scottish Index of Multiple Deprivation (2020). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.) conditions, and inadequate investment in infrastructure. addressing social and health justice concerns. The interview questions also pertained to broader perspectives in knowledge of the city, region 2.3. Study sample and data collection or policy or planning processes. Each interview lasted between 40 and 90 min and was audio- During mid-2019, over approximately one month, 25 semi- recorded. Interviewees were able to stop the interview or choose to structured interviews were carried out with key stakeholders, not answer questions at any time. They were not compensated for their including long-term neighborhood residents and other community participation. Each interviewee was informed about the purpose and members, activists, city employees and elected officials, developers and procedures of the project and gave written consent accordingly. This project managers, and representatives of non-profit organizations (see study received ethics approval from our institution’s ethics committee Fig. 4 and Supplementary Material 1.1). All participants were either (Nº 678034). long-term neighborhood residents or professionals. The professionals were specialist and knowledgeable in their roles, and were able to 2.4. Analysis and interpretation of results comment on the lived experience of long-term neighborhood residents having worked closely with residents, observing their lives and listening All interviews were recorded and transcribed. As part of the parent firsthand experiences. Participants were identified through online project, a mixed inductive-deductive coding was used, based in thematic research, media articles or through the researcher’s own knowledge of and grounded theory. We used thematic coding to clarify the initial the city. The snowball approach was used to find other participants. deductive codes from the literature guiding the project’s framing, and Interviews were carried out until saturation was reached; where addi­ then used grounded theory to inductively code thematically within tional interviews would be unlikely to produce new data and ensured at those codes. Multiple rounds of coding were carried out, resulting in the least 4–5 participants from each category were interviewed (see Fig. 4). development of a detailed coding scheme including key themes such as; We determined saturation when multiple interviewees shared the same city/area context, community mobilization, policy measures, municipal perspective on a theme and no new perspectives emerged from addi­ processes and support towards green equity and municipality- tional interviews or “spark[ed] new theoretical insights…reveal[ing] community relations. Health-related answers were also coded as a new properties of [the] core theoretical categories” (Charmaz, 2006, general code, and then recoded under these four most salient codes; 1) p.113). Themes included mental health problems, affordability of Impacts of gentrification on health: mechanisms, 2) Mental Health, 4) housing and segregation. Physical health and 4) Gentrification as modifier of relationship between The semi-structured interviews were based on a question guide (see green space and health. For this study, we selected specific codes to delve Supplementary Material – page 2). Follow up questions or prompts were further into to explore the themes of this paper. All interviews were used for clarity. The following themes were covered: history of local coded using NVivo software. The results reflect respondents’ recurring urban development, baseline and changes in environmental exposures responses in relation to the coding matrix (see Supplementary Material – for residents, development of new environmental amenities, inclusion page 9). and equity issues regarding changes and developments, health impacts for residents, policy and community responses and challenges 4 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 Fig. 2. Map of Glasgow health inequalities. The dark pink indicates the most deprived in respect to health and the dark green indicates the least deprived in respect to health. ‘A’ indicates the Commonwealth games site, including the Athlete’s Village and ‘B’ to ‘C’ indicates the Forth and Clyde Canal regeneration project from Maryhill to Port Dundas. Source: Scottish Index of Multiple Deprivation, 2021 3. Results North Glasgow and the East End, built for maximum functionality to accommodate the expansive population, remained in extreme depriva­ The results depicted multiple mechanisms negatively impacting tion. Transformation Regeneration Areas (TRAs) were the city’s some of the social determinants of mental health, where contributing to response to poorly maintained low-quality social and affordable hous­ social and health inequalities may enhance poor mental health outcomes ing, where original housing was demolished and replaced with mixed where redevelopment/regeneration projects have been implemented. housing. Many new developments consisted of majority private market Firstly, poor-quality post-war social housing lacking basic amenities and housing and reduced social housing, with ‘mid-market’ rent properties surrounding postindustrial vacant and derelict land spaces leant them­ targeting young professionals rather than catering for original long-term selves to anti-social behavior and discouraged health-promoting out­ neighborhood residents. One city council planner explained the cycle door activities. Moreover, where redevelopment/regeneration projects they witnessed trapping residents, where new developments failed to targeted poor-quality urban areas, economic strategies were used to meet original residents’ needs; “[in] Glasgow we pushed [residents] out address social and health inequalities, hoping that by injecting invest­ to the peripheries, we broke up […] social networks … and that com­ ment it would “trickle-down” to poorer residents. Instead, this strategy pounds the problem time and time again…once you start to gentrify an increased inequalities, physically displacing some residents. Addition­ area all that happens is those that can’t afford it will move out to [other] ally, a slow influx of higher income “creative” classes came to newly …deprived areas”. generated areas resulting in remaining original residents feeling socio­ Respondents reported that residents of Glasgow’s poorest areas culturally displaced and excluded. Lastly, exclusion from urban plan­ lacked easy access to good-quality green space, with the majority of ning decision-making was also highlighted as a relevant element. accessible outdoor space in the form of vacant and derelict land sites. Without access to space of adequate size and quality, or nature-based 3.1. Poor housing and urban environmental conditions facilities, some long-term neighborhood residents reported feeling discouraged from physical and mental health-promoting activities. They Interviewees highlighted how postindustrial housing and urban felt unable to comfortably exercise, including running and walking, and environmental conditions contributed greatly to some determinants of carrying out daily activities (such as walking to school or running er­ mental health. They explained how post-war modernist housing in rands) felt much less appealing or safe. One local councilor described an 5 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 Fig. 3. Scottish Government Vacant and Derelict Land Survey Map. Yellow areas indicate vacant land and orange areas indicate derelict land. ‘A’ indicates the Commonwealth games site, including the Athlete’s Village and ‘B’ to ‘C’ indicates the Forth and Clyde Canal regeneration project from Maryhill to Port Dundas. Source: Scottish Government, 2017 Fig. 4. Table of participants interviewed by the researchers. example of these neighborhood spaces that they had come across; “[the] park but it was…being allowed to overgrow, there [were] people place was a mess, people were using it as a dumping ground, folk were sleeping in it, there was drug activity going on [and] prostitute activity going up and putting old tires there.” In opposition, new developments going on”. Some local community members reported feeling “fearful exhibited high-quality green spaces with “wooden fences right round the or…vulnerable” walking through these spaces, particularly after dark. A outside…[with] no interaction with that existing local community,” city council planner who worked closely with the local community explained one project manager of a development project who had explained how people had reported to them that they “fe[lt] less observed this spatial division. comfortable, less safe, less sure of [their] being”. Neighborhood resi­ Furthermore, interviewees indicated that the low-quality vacant and dents had explained that their restricted perception of a safe outdoor derelict land leant itself to antisocial behavior and illegal activity. Long- environment critically impacted their movement outside of their homes. term neighborhood residents described these spaces as focal points of Conversely, one resident and member of the local community center fights, gang violence, drug-related crime, drug taking and binge drink­ reported that as vacant and derelict land spaces were cleared up, “the ing. A senior manager of a regeneration scheme described what they police told [them] that anti-social behavior was going down because knew of one space that “had been … transformed into a sort of quasi- people could see into [spaces] now so it wasn’t such a safe place to hide 6 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 so things like people using drugs in your front garden, people having sex capital positively impacted the whole community. As areas underwent and paying for sex in your garden stopped.” Yet, displaced original long- processes of redevelopment/regeneration, long-term neighborhood term residents were often unable to experience these improvements. residents were physically displaced where new developments had These determinants, such as loss of social networks and poor environ­ replaced social housing and increased the attractiveness of an area, mental quality resulting in people feeling less safe and comfortable raising local house prices. Our data shows that by prioritizing economic carrying out health promoting behaviors in their neighborhood, can gain within housing, it contributed to unaffordability, where residents’ have consequences for mental health outcomes. homes were demolished without access to what was erected in its place; redeveloped housing failed to include a ‘right to return’ policy. These 3.2. The uneven impacts of redevelopment/regeneration projects perceived processes of gentrification meant that any intended social and prioritizing economic goals health benefits were not linked by long-term neighborhood residents. Furthermore, Glasgow’s industrial legacy of vacant and derelict land Furthermore, interviewees reported that many redevelopment/ sites, and those that later social housing was built upon, were still highly regeneration projects targeting poor postindustrial environmental con­ contaminated. Limited council funds meant decontaminated land was ditions focused too heavily on economic aims rather than addressing often instead developed with Scottish government funds – e.g., large social (health) inequalities and determinants. An example of this was scale projects coordinated by Clyde Gateway in the East End, or by TRAs where affordable housing was often redeveloped prioritizing pri­ private developers, with only a small portion of new developments vate market housing and focused on new amenities appealing to middle- dedicated to affordable housing. One interviewee from a city council class residents, increasing average neighborhood wealth. That is, re­ regeneration initiative elaborated on this. He explained that new de­ spondents reported that redevelopment/regeneration projects often velopments contained approximately 20% social housing and 80% pri­ increased or improved amenities, such as high-quality green and blue vate accommodation: “they’ve just put affordable housing in my village spaces (parks, canals, etc.), shops, medical services, and transport links at £175,000 right, that’s not affordable for 80–90% of the population but in closer proximity to new housing developments, as an indirect way to housing in general is not affordable…so salaries for the last 10 years address living standards for all residents. have gone up by 1 or 2% and housing’s gone up 40, 50%.” Interviewees also noted that redevelopment/regeneration projects The threat of being displaced was associated with increased anxiety directly targeted vacant and derelict land spaces, making areas more and feelings of increased marginalization and isolation among our in­ aesthetically appealing. They explained how this attracted wealthier terviewees. A couple of interviewees, including the CEO of an East End residents who had the financial power to sustain new local amenities housing association that works closely with community residents, through consumption. This was conceptualized as part of a “trickle- explained that as older social housing developments were knocked down” strategy to address inequities by increasing overall economic down, tenant relocation options were further out; enclaves of socio­ growth, where wealth would trickle down to lower income residents and economic deprivation were simply moved but as original residents were increase quality of life and (mental) health benefits. The Forth and Clyde scattered, social networks were broken and anxiety, depression and Canal regeneration project was an example of this. Described by a isolation increased among traditional residents. In another vein, a Scottish Canals employee as a “corridor(…) of economic activity”, its number of different respondents, including a local resident and a com­ primary goals were to bring economic activity to the area and push the munity center worker, highlighted that residents who were not physi­ development of amenities such as shops and transport links, decreasing cally displaced felt socioculturally displaced from their neighborhood, health inequalities, and “bring[ing]…about positive change for the which included feeling excluded, marginalized, isolated and generally communities that live around the canals, something that creates op­ disempowered. If we look closer at the tensions in different perceptions portunities for health, for recreation, and also for employment”. of the changes taking place, we can start to see this. For example, one A number of people on the project teams of new redevelopment/ senior manager from the Clyde Gateway regeneration scheme explained regeneration projects regarded these projects as successful, without how they encouraged people from the film industry to relocate to the detailing the indicators to gauge this, other than economic achieve­ East End to try to promote an evening economy in the area, refurbishing ments. One developer described a project’s success in the East End in buildings and “making [them] cool and funky.” As the area was bringing expensive housing to the area; “they are private[ly] sold, some perceived as safer, but still remained comparatively cheaper to the rest of them are social rent, some of them are mid-market rent and that was a of Glasgow, the attractiveness of the area brought investment in coffee very successful development so it just shows that if you build, the market shops, artisan shops, vintage clothing, music and a different variety of will create itself.” In contrast, other interviewees involved in the pro­ activities, where middle class tastes, consumption behavior, and cultural jects’ development noted the lack of social or health indicators used to identities shaped the growth of the area. However, on the other hand, measure its success, where these factors were originally cited as aims, one local community gardener shared their opinion on the changes with a particular lack of mental health indicators. One project officer taking place in the Barras, East End: “definitely I do see that big divide, I explained: “we never produce a report about successes and failures really do see it…people round here are worried that they’re going to lose because we don’t want to advertise the failures”. Conversely, long-term what the Barras is about, the history…so who are you appealing to? And neighborhood residents noted many negative social and health-related as much as we have the vintage whatever going on a Saturday in the impacts on account of new initiatives failing to connect with original Barra’s, pop up gin whatever, it’s not really the people here, it’s still long-term residents. One local grassroots community worker explained those people from the West End [coming] over”. Some interviewees that “what they do is really impressive…but…they…struggle connect­ explained that as the middle classes migrated to North Glasgow and East ing with a lot of the residents…it takes years of…genuine work, to build End, long-term lower-class neighborhood residents felt forced to adapt up these relationships…you have to build trust and for people to feel to the tastes of new residents or felt excluded. comfortable about coming in and feeling like they have access and they Furthermore, long-term neighborhood residents commented on feel welcome and that does take a long time.” neighborhoods feeling increasingly segregated due to exacerbated eco­ nomic inequalities. For example, the Athlete’s Village, built as part of 3.3. Perceived gentrification and community friction the Commonwealth Games development, was depicted by a spatial planning officer focused on building trusting relationships with the local Similarly, between interviewees, the main discrepancy was not community to better meet needs, as a segregated community or whether processes of gentrification had taken place (as even those that “ghetto”: “it’s like a gated community, [new residents] will ignore the refuted the word cited evidence of it), but conflicting views on the value fact they’re in the East End”. Although the goal was to diversify the area, of redevelopments/regeneration projects, and whether the influx of attracting the middle classes and increasing the average wealth of a 7 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 neighborhood, one city council spatial planner, working in consultation illustrating how lower-class residents are excluded from decision- with local residents, observed that as wealthier residents moved in, they making processes. Both of these pathways challenge the ability to (re) appeared to ignore where they were and simply “g[o]t in their car[s] and produce a sense of place and belonging. These disempowering processes dr[o]ve somewhere else” to spend their money. Moreover, social hous­ contribute to feelings of disenfranchisement, that can often be a key ing was of lower quality than private, with more poorly maintained determinant of poor mental health outcomes (Marmot, 2017). Conse­ green spaces outside their homes. Social housing residents were also quently, our findings indicate that, in areas such as North Glasgow and generally more likely to experience poor access to amenities without East End, the “right to the unhealthy deprived city” prevails. private cars and poor street lighting negatively affecting mobility. Res­ idents thus described a two-speed, or two-sided neighborhood where 4.1. Exclusion from access and subsequent disempowerment they felt marginalized and their interests sidelined. Our findings are consistent with previous research. Residents indi­ 3.4. Nonexistent or poor-quality community engagement in decision- cated that their low-quality of life was linked to low-quality housing and making their surrounding urban environment. Inadequate housing can create long-term stress in adults and poses a challenge to cognitive, emotional In addition, community engagement in decision-making was re­ and physical development in children (Li and Liu, 2018; Anguelovski ported to be poor, both in terms of the opportunities offered and the et al., 2021). Moreover, evidence supports that vacant and derelict land take-up of opportunities by local long-term residents. One council can poorly impact mental health and the poor remediation of them can planner, speaking from experience, explained “what we end up with is, have significant impacts on depression rates (South et al., 2018). Other we always do for the affluent communities what they want but we never studies depict how vacant land impacts community mental wellbeing, assess what the less affluent communities value”. Similarly, another attracting crime and instilling anxiety and fear in residents (Garvin depicted how their community engagement strategy aimed to help the et al., 2012). Our results echo findings where, despite redevelopmen­ community understand why they were making chosen decisions, rather t/regeneration projects, Glasgow’s lower-class residents are persistently than involving residents in the process itself: “not everything can be exposed to poor-quality land uses. about the community actually deciding well maybe they don’t want Beyond socioeconomic environmental deprivation, our results reflect [that] … we’re helping the community understand why those decisions”. other studies, highlighting how redevelopment/regeneration projects Furthermore, in community engagement forums where local may initiate processes of gentrification and have negative social impacts working-class residents were asked what improvements could be made on long-term neighborhood residents. For example, Anguelovski et al. to the local area, residents’ expectations and what they asked for were (2019, 2021) illustrate the multi-layered potential pathways in which much lower than when middle class residents were asked the same gentrification can cause detrimental physical and mental health out­ question. They were not encouraged further. One project manager comes including obesity, asthma, chronic stress and depression. This is explained the challenges in areas “of social and economic deprivation… seen in our results, where the fruits of redeveloped/regenerated areas people generally have very low aspirations about what might be feasible are mostly enjoyed by middle and creative classes. This also aligns with for their area…you go to affluent areas they’re not shy in telling you existing studies showing how underprivileged residents living in what they want because they’re able to articulate it and they feel gentrifying neighborhoods fail to benefit from processes of urban empowered to do that.” Our results showed that lower-class residents development, particularly green amenities (Triguero-Mas et al., 2021; failed to see an investment in their livelihoods, feeling as though Cole et al., 2019, 2021). neighborhood improvements often passed them by. That being said, the originality of our findings lies in highlighting a Repeatedly, working class people’s lives have been devalued in failure of assumed trickle-down strategies in relation to mental health, processes of redevelopment/regeneration. Since the industrial revolu­ where increased economic activity brought to an area fails to benefit tion, top-down orchestration of health and social benefits for all have original lower-class members of the neighborhood. These residents were failed to be truly manifested, on account of continual exclusion of either physically displaced or socioculturally displaced. Residents felt working class people from decision-making. The evidence provided in increasingly segregated or found new developments included less space this study shows how these mechanisms impact some of the key de­ for them, both quantitively, as well as inclusion in the urban environ­ terminants of mental health. Over time, community divisions, through ment. In redevelopment/regeneration projects where success was physical and sociocultural displacement have contributed to some social marked by the creation of markets, the free-market economy thus rele­ friction within newly generated neighborhoods and feelings of dis­ gated social and health challenges to self-regulation through the power empowerment. It was instead suggested by one sustainability and of the market. resilience officer how to approach community engagement more effec­ More specifically, a prioritization of economic goals lets the market tively; “you need to have the conversation which goes back to my issue dictate socio-spatial environments; those that can afford to participate, about empowerment … [you need to] humbly and openly go to talk to hold power and “rights”. Economic-first ideology, integral to market people and it takes a lot of effort, it takes a lot of organization and it’s not fundamentalism, maintains the capitalist hegemonic structures that very pleasant when people swear at you because they’re not happy with perpetuate unequal wealth distributions (Paton, 2016). It is in this sense the local services…and that’s fine, that’s ok”. Few respondents that Gray and Mooney (2011) depict gentrification as the “new urban mentioned being aware of such efforts. frontier”, as a “domestic form of Orientalism” (Said, 1978). “The frontier motif compounds a host of accumulated symbolic meanings, including 4. Discussion ‘the social differences between “us” and “them” … and the economic difference between existing market and profitable opportunity’” (Gray Our study of the determinants of mental health aligns well with and Mooney, 2011:9). “Conquering” land in the form of redevel­ previous research that illustrates how redevelopment/regeneration opment/regeneration projects such as those seen in Glasgow, thus projects initiate gentrification and can negatively impact health. Our displace and exclude original long-term residents, disbanding rights in contribution shows the failure of trickle-down economic strategy due to order to make social and physical space for capitalist accumulation. This displacement and depicts potential mechanisms in failing to address loss of the right to place-make and maintain a sense of belonging, sig­ (mental) health inequality. We also demonstrate how these dynamics nifies this transference of power, reallocating individual or collective are part of larger pervasive capitalist hegemonic structures, where rights from the lower-classes to the wealthier middle- and upper-classes. through accumulation by dispossession, original long-term residents In this sense, for original long-term residents, the right to the city is lose rights to place. Moreover, our study echoes previous research jeopardized at the expense of profit accumulation. 8 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 Such processes of accumulation by dispossession are disempowering neighborhood residents the freedom to create a sense of place and claim for lower-class residents, as disabling or denying rights are mechanisms the right to the city (Lefebvre, 1968). In failing to understand the which may lead to poor health outcomes, particularly mental health. socio-spatial nature of place as a product of human experience and vice Marmot (2017) depicts empowerment as having the freedom to lead a versa, urban development processes denied individuals the ability to life that one has reason to value, associating it with low mental dwell comfortably in their environment (Lefebvre, 1991). health-related mortality rates and good general health. By comparison, Instead, redevelopment/regeneration projects provide long-term the Glasgow population data exhibits considerably higher morbidity and underprivileged residents the “right” to the unhealthy deprived city, mortality rates attributed to mental health-related deaths, than cities defined as the impossibility to benefit from material opportunities, with similar industrial histories, population sizes and levels of socio­ public spaces, goods and services and the inability to shape city trans­ economic deprivation. Suicide rates are 70% higher in Glasgow, alcohol formations. The concept of the right to the unhealthy deprived city 130% higher and drug related causes 130% higher (Hanlon, 2015). Our provides a lens to observe power structures in order to better understand results depict how capitalist hegemonic urban development processes the potential impacts different mechanisms may have in determining strip long-term neighborhood residents of rights and instead leave res­ mental health outcomes. This suggests that what is behind Glasgow’s idents feeling disempowered and disenfranchised, exposed to unfavor­ high excess (mental health-related) mortality rates, is beyond standard able sociocultural, economic and environmental conditions. By socioeconomic deprivation. Although Glasgow’s case is extreme, this exploring these determinants of mental health, we provide evidence of theoretical connection paves the way for a more nuanced understanding the potential mechanisms at play that may be causing Glasgow’s poor of redevelopment/regeneration processes and mental health. mental health outcomes and subsequent shorter life spans. 4.4. Strengths and limitations 4.2. Exclusion from participation One of our key limitations is that the interviews carried out for the Further consolidating multiple processes of disempowerment, is the parent project, explored a broader range of topics than the ones present exclusion of long-term neighborhood residents from participation in in this paper, more generally focusing on health. This meant that our shaping urban development processes. These results echo previous dataset only supported exploring the potential impacts of different studies, for example Paton (2016) explores how working-class people mechanisms which may contribute to mental health rather than being are excluded through urban restructuring processes where decisions able to provide direct and explicit evidence on mental health outcomes. about working class lives are not being made or influenced by working Fortunately, the multi-thematic approach of interviews allowed re­ class people. Novel in our study is the discrepancy in views between spondents to connect different processes of redevelopment, greening, project orchestrators and long-term neighborhood residents on the exclusion, and determinants of mental health, which still contributes success of redevelopment/regeneration projects. Moreover, project significantly to the research gap. administration teams rarely used social or health indicators (or even Furthermore, our study’s strengths lie in our qualitative analysis, community engagement/participation) to gauge the success of projects, that illustrate the complexities of socio-spatial dynamics, filling the gaps while long-term residents cited multiple negative impacts on mecha­ where quantitative studies may fall short. Qualitative interviews deepen nisms that can worsen mental health. This disconnect indicates explic­ analysis, exploring the high excess mental health-related mortality sta­ itly how long-term residents’ needs were insufficiently met. This can be tistics reported in the initial Glasgow population studies report. Much put down to poor attempts at community engagement or a lack of research in health equity to date relies heavily on quantitative data, our involvement in decision making processes altogether. Superficially analysis explores in depth the mechanisms at play in the impacts of engaging with participation methods risks “reproducing an a-political urban development processes on mental health outcomes. Moreover, and even tokenistic use of the term” (Luger et al., 2022). topics around gentrification, redevelopment, and general health are Moreover, Willis (2019) elaborates on what Lefebvre describes as the particularly under-researched, let alone specifically focused on mental ‘right to the oeuvre, to participation and appropriation’ (1996, p.173), health. Our paper contributes to this gap. Lastly, one of our novel con­ explaining that inclusive and accessible participation holds potential to tributions is the critical urban (public) health analysis that we present transfer power to marginalized people in the context of urban space. To using approaches from health geography and public health to re-visit the be democratically involved in decisions about urban space, is to concept of “healthy cities” (World Health Organization (WHO), 2010). acknowledge the life that is lived within them, this is a political process This movement, centered on improving health through an understand­ that validates citizenship (McCann, 2002). Where lower-class residents ing of the social determinants of health, incorporates multiple disci­ are unable to claim the right to the city due to hegemonic processes of plines, strengthening our analysis. capitalist accumulation by dispossession, this lack of recognition thus has the ability to impact identity formation where people’s modalities 4.5. Future directions are dismissed and their citizenship invalidated. Individual identity in relation to a wider collective identity, determined by or connected to Echoing the above limitations, future studies would do well to go space, is subsequently challenged. These mechanisms can have consid­ beyond the conclusions of this paper to illustrate more in depth some the erable impacts on mental health. mental health outcomes related to the determinants discussed in this study. There is also a significant research gap noted in depicting longer- 4.3. The right to the city and poor mental health outcomes term health impacts in-depth (Kennelly, 2016). Moreover, studies could benefit from a comparative analysis in other Our findings add depth to understanding the potential dis­ post-industrial cities. For example, Manchester and Liverpool share empowering impacts of urban (re)development processes on mental similar industrial histories of disinvestment, deprivation levels and health outcomes. Through mechanisms of physical and sociocultural population sizes (Walsh et al., 2010). It could be beneficial to study how displacement, long-term neighborhood residents struggled to maintain urban redevelopment/regeneration projects are linked (or not) to existing social relations. Even where longer-term residents were able to persistent poor mental health in those contexts. These analyses could remain living in newly developed areas, feelings of segregation pro­ allow us to identify similar and differentiated patterns in these re­ hibited a right to neighborhood, where feeling a sense of belonging in a lationships operating within Glasgow, Manchester and Liverpool. wider community environment had been lost. These effects, and an More specifically, a further relevant study of interest would be an active exclusion from urban development processes, has meant that exploration into the chain of command in redevelopment/regeneration these multiple processes of disempowerment denied long-term projects from research to application. This would shed light on where 9 E. O’Neill et al. Social Science & Medicine 318 (2023) 115634 power congregates in the process and where dissent political voices, Anguelovski, I., et al., 2020. Expanding the boundaries of justice in urban greening scholarship: toward an emancipatory, antisubordination, intersectional, and including those focused on accurately depicting mental health issues and relational approach. Ann. Assoc. Am. Geogr. https://doi.org/10.1080/ phenomena, are silenced, exposing the different mechanisms at play. 24694452.2020.1740579. Anguelovski, I., et al., 2021. 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