James R. Dunn, Ph.D. CIHR-PHAC Chair in Applied Public Health

1. Place-Based Policy for Marginalized Populations: Research Questions from the Greater Toronto and Hamilton Region (GTAH) James R. Dunn, Ph.D. CIHR-PHAC Chair in Applied Public Health Associate Professor, of Health, Aging & Society, McMaster University Scientist, Centre for Research on Inner City Health, St. Michael’s Hospital Fellow, Successful Societies Program, Canadian Institute for Advanced Research

2. Place-Based Policy: An Overview • Place-based policy popular over last 15+ years in US, UK, Australia…now Canada • UK most active with ‘area-based initiatives’: • E.g., New Deal for Communities, Health Action Zones • Involves targeting defined areas for additional investment / programs to reduce inequalities • Canadian examples: Action for Neighbourhood Change (ANC); Priority Neighbourhoods Strategy (Toronto); Vancouver Agreement • Recommended by OECD Cities Report; McMurtry Report on Youth Violence, etc.

3. Rationale for Place-Based Policy • Identifiable geographical areas have high levels of social problems • Mainstream programs operate less effectively • Individual disadvantage is exacerbated by area disadvantage – magnifies problems • Important for social and political reasons to address disparities between areas • ‘hard to reach’ populations? i.e.  number of disadvantaged people touched by policy?

4. Rationale for Place-Based Policy • Area targeted programs often have ‘bottom up’ approach – unlike mainstream • Depends on partnerships and capacity • More effective problem identification and solution delivery? • Local programs can lead to  confidence & capacity to participate in the community • Successful area-based programs may act as pilots to change delivery of mainstream (from Smith, G.R. (1999) Area-Based Initiatives: The Rationale and Options for Area Targeting

5. Rationale Against Area-Based Policy • Most deprived people don’t live in deprived areas (other forms of marginalization?) • Area-based policies unfair to people not living in targeted areas • Area-based policies displace, disperse or dilute problems (e.g., unemployment) • Area-based policies may reduce the urgency to do things at other levels (from Smith, G.R. (1999) Area-Based Initiatives: The Rationale and Options for Area Targeting

6. ‘Place Effects’ & Health • Scholarly resurgence of interest in how places shapes health & well-being since early 1990s • heavy emphasis on ‘compositional effects’ – places shape health because of who lives there • Macintyre began studying direct effects of local social and physical env’ts that may shape health • debate over ‘contextual’ vs. ‘compositional’ effects • can these be separated? can compositional features be emergent as contextual effects? • now appears that there is no single ‘universal’ effect of area on health • i.e., ‘do n’hoods affect health?’ is unanswerable • there are some area effects on some population groups in some places – a complex picture • all agree that better theory is needed - complexity

7. N Engl J Med, 345(2): 99-106, July 12, 2001

9. Do Urban Neighbourhoods Matter? • human life is intrinsically territorial • neighbourhoods initially envisioned as re-creating the dynamics of small-town life • despite romanticism, many people also like the anonymity of big city life • Wellman and Leighton (1979) argued the territorial basis of community life had been overtaken by networked social relations • but neighbourhoods appear to have had a re-birth – why do they matter? Wellman, B. and Leighton, B. 1979. Networks, neighborhoods, and communities: Approaches to the study of the community question. Urban Affairs Quarterly, 14(3): 363-390.

10. Neighbourhoods, Health and Human Development:Theory

11. The Importance of Residential Neighbourhoods • centre of the residential neighbourhood is someone’s home. The home is a site for: • wealth storage / accumulation • ‘social reproduction’ • the investment of meaning • the exercise of control • the centre point of purposeful activities outside the home – work, recreation, service need, etc. => its relative location matters

12. In what ways are place and n’hood effects unimportant? • examples of questions to pose: • health behaviours – is residential proximity to fast food, for instance, important? • does the importance of n’hood for shaping life chances differ from place to place? • depending on residential differentiation patterns, geography of the labour market, public transit, the public school system, the structure of local government, etc.? • will n’hoods matter to some people more than others? • e.g., seniors, young children, youth, low SES, immigrants, etc.

13. miasma competition theory neighbourhood deprivation neighbourhood affluence social capital collective efficacy social disorganization ‘broken windows’ community assets public services reputation of neighbourhood opportunity structures crime & delinquency child & youth early child dev’t mental health health behaviours coronary heart disease neural tube defects low birth weight incomes educational outcomes Neighbourhood Effects Theories

14. Neighbourhood environments and rules for access to resources Source: Bernard, et al. 2007

15. Place-Based Policy in CanadaTwo Examples

16. Toronto Action for Neighbourhood Change • Strengthened influence of local residents • Empowering belief residents can make a difference • Emergence of capable community leaders • Dependable support from politicians, police, schools • Enhanced quality of neighbourhood life • Enable residents to connect with & depend on each other • Shared public spaces that are well-maintained & used • Activities for children & youth, supports for seniors, welcoming to immigrants • Increased access to resources • New services & infrastructure for under-serviced areas • Neighbourhoods offer range of responsive services

17. Toronto ANC as a Place-Based Policy • Toronto Action for Neighbourhood Change is arguably about: • Changing local opportunity structures • Increasing access to resources for marginalizes groups, especially immigrants • Can use the Bernard model to evaluate the scope of ANC with a checklist: • Physical Domain (Proximity)  • Economic Domain (Price) • Institutional Domain (Rights) • Community Organizations Domain (Informal Reciprocity)  • Local Sociability Domain (Informal Reciprocity) 

18. Regent Park Redevelopment • home to 2,178 households & 7,500 people b/f demolition • Phase 1 will grow from 418 to 800+ households • one of Canada’s oldest and largest public housing developments • built in late 1940s / early 1950s based on ‘Garden City’ design principles • $400M+ demolition & redevelopment over next 10-12 years in 6 phases. New community will: • be mixed income: owners & subsidized renters 60-40 • use modern principles of urban design (new urbanism) • develop participatory governance institutions

21. Regent Park Revitalization Master Plan and Phasing

23. Regent Park as a Place-Based Policy Intervention • suspected mechanisms for building a healthy community: • social mix (mixed tenure / income) • urban design (through streets, mixed land use) • social development (e.g., job training / hiring) • community participation (in governance) • Bernard model checklist: • Physical Domain (Proximity)  • Economic Domain (Price) • Institutional Domain (Rights) • Community Organizations Domain (Informal Reciprocity)  • Local Sociability Domain (Informal Reciprocity) 

24. Research & Evaluation Strategies • Longitudinal data on individuals ‘exposed’ to the intervention and comparison groups are essential • Unintended consequence of area-based policy: it changes the incentive structure for residential moving (and staying) • Also known as ‘demographic churn’ • New Deal for Communities (UK) is exemplary for its evaluation • Lead organization is Joseph Rowntree Foundation • Without rigorous evaluation => trapped in perpetual pilot project / experimentation

25. Conclusions • Great potential for place-based policy • Canada is a relatively late-adopter, so can learn from elsewhere • Need to be concerned about both the ‘how’ (governance’ and the ‘what’ (content) • Bernard model focusing on areas as opportunity structures very helpful • Need to consider domains of activity and rules that govern access to resources in a complete manner • Need rigorous research & evaluation and a vehicle for learning from experience

26. jim.dunn@mcmaster.ca