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

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.