Canadian Institute for Health Information

1. Canadian Institute for Health Information

2. Urban Physical Environments and Health Inequalities: Scoping Review of Interventions

3. Report Purpose and Breakdown • Introduction • Section 1: Describing Interventions in the Urban Physical Environment • Section 2: Applying an Equity Lens to the Review of Interventions • Conclusions

4. Scoping Review Method • Develop appropriate questions • Identify relevant studies • Select studies • Chart information • Consult • Summarize and report

5. Our Methodology • Selection of Themes and Research Questions • Review and Synthesis • Refined Framework and Equity-Oriented Synthesis • Identifying and Selecting Interventions • Additional Identification and Selection of Interventions • Preliminary Framework and Initial Synthesis • Policy Dialogue/ Consultation

6. Evaluation 15% of sample had been evaluated These evaluations assessed behaviour, process, health, health-related and environmental outcomes Focus was mostly on uptake and adoption There was little on long-term impact

7. Guiding Themes Urban built environment (33%) Urban form (10%) Heat (14%) Pollution (38%) Green space (5%)

8. Adapting a Typology Adapted from L. Pal, Beyond Policy Analysis: Public Issue Management in Turbulent Times (Toronto, Ont.: Thomas Nelson, 2006).

9. Procedural • 50% of sample • Many examples of guidebooks, plans, organization-level policies • Popular instrument type at the municipal and provincial levels

10. Informational • 40% of sample • Focus on public awareness of common risks • Evaluated for uptake, usefulness and impact

11. Fiscal • 10% of sample • Money is central instrument • Mainly involved awards and grants offered for vitalization and development

12. Regulatory • No examples from the initial sample • Consultations indicated others have conducted extensive reviews • Prevention Policies Directory, a searchable database of Canadian policies by Cancer View Canada (www.cancerview.ca/portal/server.pt/community/prevention_policies/464) • The National Collaborating Centre for Environmental Health’s list of federal, provincial and territorial acts and regulations related to environmental health in Canada (http://ncceh.ca/en/eh_organization/legislation)

13. Jurisdiction Collaboration and shared responsibility were common themes A wide range of actors was involved Action led mainly by municipal and provincial players

14. Refining the Equity Lens • Need to extend discussion beyond the identification of vulnerable populations • Applying a more comprehensive equity lens involved five dimensions • Addressing determinants • Identifying at-risk groups • Assessing equity outcomes • Planning for unintended consequences • Ensuring community engagement

15. Addressing Determinants • 36 of 58 interventions focused on determinants • Many provided guidance; few implemented action • Interventions addressed determinants by • Mitigating factors that impede uptake • Focusing on broader structural factors that influence health, such as housing and employment

16. At-Risk Groups • 32 of 58 interventions identified at least one population as vulnerable • Groups were identified as vulnerable either through • Physiological characteristics • Social characteristics

17. Equity Outcomes • 26 of 58 interventions discussed assessment, including physical environment, health or social environment outcomes • Limited assessment of differential impact • When equity was assessed, changes between deprived neighbourhoods and national averages or differential uptake and use of intervention-related information were measured

18. Unintended Consequences • Limited number identified strategies to address positive and negative impacts (13/58) • Some outlined strategies to address inaccessible information and barriers that may complicate healthy and sustainable development

19. Community Engagement • Many interventions had some kind of engagement process (35/58) • Interventions engaged multiple types of communities through • Visioning resources • Network development • Partnership in development planning • Communities were engaged through consultation and more active involvement

20. Conclusions Mostly process-oriented evaluations; limited outcome evaluations Gaps in assessing implementation challenges, successes, maintenance, scale-up and sustainability of interventions Urban built environment and outdoor air pollution most common; gaps in heat, green space, and urban building and development Most interventions were procedural and informational, pointing to generally non-binding nature of action Identifying and working with at-risk groups most common ways to address equity Gaps in action related to determinants of health Gaps in evidence involving equity outcomes and unintended consequences

21. Questions and Comments

22. Thank You