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Equity Lens in Healthy Built Environments Initiatives

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Equity Lens in Healthy Built Environments Initiatives PLANNING FOR HEALTHY AND EQUITABLE COMMUNITIES IN BRITISH COLUMBIA: A CRITICAL ANALYSIS OF THE IMPLEMENTATION OF AN EQUITY LENS IN HEALTHY BUILT ENVIRONMENTS INITIATIVES by VICTORIA JANE BARR BSc (Honours), Queen’s University, 1991 MHSc, University of Toronto, 1999 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Planning) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) September 2016 © Victoria J. Barr, 2016 Abstract British Columbia’s communities, as settings in which we work, learn, and play, have a significant role in shaping our health and well-being. Recently, the provincial government has encouraged health authorities to join with local government planners to create local Healthy Built Environment (HBE) teams, so that they can work together for healthier communities. Within our communities, there are significant differences in health status that are unjust or unfair, and are rooted in underlying socio-political processes. International research suggests that we must reduce those inequities if we are to improve health for all. To help address health inequities, researchers have suggested that public health practitioners use an ‘equity lens’ in their day-to-day work. Yet implementing such a lens is challenging. This case study explored the implementation of an equity lens in HBE work in BC. The project examined the work of intersectoral HBE teams at the provincial and local levels, through an in-depth examination of HBE projects within three different BC communities. Data was collected through interviews, participant observation, and the collection of key documents, maps, and photographs. The main research question was: How is an ‘equity lens’ being implemented in association with Healthy Built Environments work in British Columbia? Influenced by the shifting strategic direction of the provincial government, HBE teams reported only limited progress in actively considering equity as integral to their work. The key elements of the implementation of an equity lens included targeting specific, ‘vulnerable’ populations and using community health data to monitor key outcomes. In general, however, the political will to more fully consider equity as integral to HBE work was just not present at either local or provincial levels. There was hope, however, in the form of champions, who worked to re-frame equity issues in more palatable ways, and the desire to explore new tools to better understand equity issues at the local level. There is also evidence of a growing desire within HBE teams to build meaningful, authentic, partnerships, consistent with a broad Healthy Communities approach. The development of those partnerships will be key to collectively building more just, inclusive, and healthier communities. ii Preface This dissertation is original, unpublished, independent work by the author, Victoria J. Barr. The study was approved by the University of British Columbia Behavioural Research Ethics Board, Certificate number H11-02897. iii Table of Contents Abstract ......................................................................................................................................... ii Preface ......................................................................................................................................... iii Table of Contents ......................................................................................................................... iv List of Tables .............................................................................................................................. viii List of Figures ............................................................................................................................... ix List of Images ................................................................................................................................ x List of Maps .................................................................................................................................. xi Acknowledgements ..................................................................................................................... xii Chapter 1: Introduction ................................................................................................................ 1 1.1 Purpose and Research Questions .................................................................................. 6 1.2 Structure of this Dissertation ......................................................................................... 7 Chapter 2: Literature Review & Theoretical Framework .............................................................. 9 2.1 Understanding the Complex Influences on Health ........................................................ 9 2.2 Key Definitions and Concepts ...................................................................................... 11 2.3 The State of the Literature: Three Sets Overlapping ................................................... 14 2.3.1 Connections between Planning and Public Health: The Birth and Rebirth of a Partnership .......................................................................................................................... 16 2.3.2 Connections between Equity, Social Justice and Planning ........................................ 26 2.3.3 Equity, Social Justice, and Public Health .................................................................... 35 2.3.4 The Convergence of Equity and Social Justice, Public Health, and Planning – Connections Among all Three ............................................................................................. 41 2.3.5 Review of Key Gaps in the Literature......................................................................... 53 2.4 Theoretical Frame ........................................................................................................ 58 2.4.1 The Nutcracker Effect: Top Down and Bottom Up Action for Health Equity ............ 60 2.4.2 Kingdon’s Multiple Streams Model of Public Policy .................................................. 61 2.5 Summary ...................................................................................................................... 64 Chapter 3: Context ...................................................................................................................... 65 3.1 The Three Case Study Communities ............................................................................ 65 iv 3.1.1 Surrey, BC ................................................................................................................... 66 3.1.2 Kelowna, BC ............................................................................................................... 69 3.1.3 Terrace, BC ................................................................................................................. 71 3.2 Policy Context ............................................................................................................... 73 3.3 Summary ...................................................................................................................... 77 Chapter 4: Methodology ............................................................................................................. 78 4.1 Research Design and Case Selection ............................................................................ 78 4.1.1 Provincial and Local Levels ......................................................................................... 82 4.2 Data Collection Procedures .......................................................................................... 86 4.2.1 Provincial Level .......................................................................................................... 86 4.2.2. Local Level ................................................................................................................. 94 4.2.3. Summary of Data Collection Methods .................................................................... 107 4.3 Data Analysis Procedures ........................................................................................... 109 4.4 Ethical Considerations ................................................................................................ 111 4.5 Validation of Findings ................................................................................................. 112 4.6 Limitations .................................................................................................................. 113 4.7 Summary .................................................................................................................... 116 Chapter 5: How the Lens has been Defined and Used ............................................................. 117 5.1 Language and Framing: How the Equity Lens has been Defined ............................... 117 5.2 Strategies Used to Implement an Equity Lens into Healthy Built Environments Work …………………………………………………………………………………………………………………………….. 121 5.2.1 Community Participation in Planning Processes ..................................................... 122 5.2.2 Targeting Specific Populations in Planning Work .................................................... 126 5.2.3 Monitoring and Evaluating Outcomes ..................................................................... 135 5.2.4 Use of Equity-Focused Tools ...................................................................................
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