Are place-based approaches to reducing health inequalities a highway to success or a policy dead-end?

Place-based approaches to reducing health inequalities have become increasingly common in the UK. It is likely that this is because area deprivation indices have highlighted spatial areas, rather than social groups, for policy focus; and because local agencies have until recently at least had a greater policy focus on reducing health inequalities than national government. Place-based approaches at the neighbourhood level have been characterised by a combination of civic-level, community-centred, and service-based interventions. We identify several important factors that limit their effectiveness for reducing health inequalities, including: socioeconomic and power relationships that are unrestricted by spatial boundaries; most disadvantaged individuals not living in areas with the highest deprivation scores; a pre-existing gradient in community capacity which many community development approaches exacerbate; stigmatisation of areas with high deprivation scores; and the potential for partnership approaches to undermine genuine community-led organisation and challenge. We argue that for place-based approaches to be successful in reducing health inequalities, they must challenge economic and power relationships that exacerbate inequalities and catalyse emancipation of currently disempowered and alienated communities.