Under examination: Multilevel models, geography and health research

Since the 1990s, multilevel models have become popular tools for looking at contextual effects upon health. However, the way that geography is incorporated into these models has received criticism due to somewhat arbitrary definitions of what counts as context, the models’ discrete and, arguably, aspatial view of geographical effects, and the lack of any clear theoretical specification of the processes involved. This review draws together and extends these criticisms, arguing that while currently there are problems with how geography is conceived within multilevel models, there are ways of addressing them, and indeed that it is important to do so.