Heather A. Smith

Even in Canada? 1 The Multiscalar Construction and Experience of Concentrated Immigrant Poverty in Gateway Cities

This article examines the importance of place at multiple scales in the construction and experience of concentrated immigrant poverty and social exclusion in the Canadian metropolitan areas of Toronto and Vancouver. We emphasize four contributions: first, recognition that place has a profound effect on the shaping of immigrant lives; second, consideration of the multiple geographical scales implicated in the construction and experience of poverty; third, setting the immigrant experience in Canada in the broader comparative context of immigrant outcomes in the United States and western Europe; and fourth, complementing quantitative analyses of poverty effects with a qualitative methodology using focus groups to generate narratives that offer insight on the meaning of concentrated poverty in everyday life. The gateway cities of Toronto and Vancouver display an increasing spatial (and statistical) association between immigrant distributions and areas of concentrated poverty. Through focus groups with newcomers to Canada in nine poverty districts in Toronto and Vancouver we identify the role of the nation-state in shaping immigrant opportunities; sociospatial exclusion as it varies between city and suburban sites; and the penalties of living in neighborhoods of concentrated poverty, including the stigmatizing effects of neighborhood labeling by gatekeepers such as the media, police, and educators. At the same time, different sites display variable effects. We conclude by isolating neighborhood spaces of hope, where respondents offered more positive assessments.

Using Geographic Information Systems (GIS) to Understand a Community's Primary Care Needs

Introduction: A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. Methods: GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Results: Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Conclusions: Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

Gentrification as Corporate Growth Strategy: The Strange Case of Charlotte, North Carolina and the Bank of America

ABSTRACT: In keeping with calls for gentrification research to show greater sensitivity to contextuality, this article uses Charlotte, North Carolina as a case study to illustrate a geography of gentrification in which motivations to gentrify and stage trajectories do not quite fit traditional expectations. In this mid-sized Southern city, gentrification was first introduced in the early 1970s when corporate leaders recognized the importance of revitalizing central city space in a manner that would enhance their corporate identity and advance their strategic goals. Early stage gentrification in Charlotte was characterized by the production of gentrifiable space in one of the city’s most deteriorated districts, the absence of marginal gentrifiers and traditional urban pioneers, unconventional profit motives, and significant deviations from traditional stage theory. Beyond providing an analysis of gentrification at a level of the urban hierarchy (and in a region) that has long been overlooked, the article contributes a critical and contextual perspective to our understanding of gentrification’s causality and process.

Geographic Information Systems (GIS) Demonstrating Primary Care Needs for a Transitioning Hispanic Community

Background: Hispanics are the largest and fastest growing minority group in the United States. Charlotte, NC, had the 4th fastest growing Hispanic community in the nation between 1990 to 2000. Gaining understanding of the patterns of health care use for this changing population is a key step toward designing improved primary care access and community health. Methods: The Multiple Attribute Primary Care Targeting Strategy process was applied to key patient- and community-level attributes describing the Charlotte Hispanic community. Maps were created based on socioeconomic status, population density, insurance status, and use of the emergency department as a primary care safety net. Each of these variables was weighed and added to create a single composite map. Results: Individual attribute maps and the composite map identified geographic locations where Hispanic community members would most benefit from increased access to primary care services. Conclusions: Using the Multiple Attribute Primary Care Targeting Strategy process we were able to identify geographic areas within our community where many Hispanic immigrants face barriers to accessing appropriate primary care services. These areas can subsequently be targeted for interventions that improve access to primary care and reduce emergency department use. The geospatial model created through this process can be monitored over time to determine the effectiveness of these interventions.

A trans-disciplinary approach to the evaluation of social determinants of health in a hispanic population

BackgroundIndividual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants.Methods/designThis project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services.DiscussionThe results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.

A community based participatory approach to improving health in a Hispanic population

BackgroundThe Charlotte-Mecklenburg region has one of the fastest growing Hispanic communities in the country. This population has experienced disparities in health outcomes and diminished ability to access healthcare services. This city is home to an established practice-based research network (PBRN) that includes community representatives, health services researchers, and primary care providers. The aims of this project are: to use key principles of community-based participatory research (CBPR) within a practice-based research network (PBRN) to identify a single disease or condition that negatively affects the Charlotte Hispanic community; to develop a community-based intervention that positively impacts the chosen condition and improves overall community health; and to disseminate findings to all stakeholders.Methods/designThis project is designed as CBPR. The CBPR process creates new social networks and connections between participants that can potentially alter patterns of healthcare utilization and other health-related behaviors. The first step is the development of equitable partnerships between community representatives, providers, and researchers. This process is central to the CBPR process and will occur at three levels -- community members trained as researchers and outreach workers, a community advisory board (CAB), and a community forum. Qualitative data on health issues facing the community -- and possible solutions -- will be collected at all three levels through focus groups, key informant interviews and surveys. The CAB will meet monthly to guide the project and oversee data collection, data analysis, participant recruitment, implementation of the community forum, and intervention deployment. The selection of the health condition and framework for the intervention will occur at the level of a community-wide forum. Outcomes of the study will be measured using indicators developed by the participants as well as geospatial modeling.On completion, this study will: determine the feasibility of the CBPR process to design interventions; demonstrate the feasibility of geographic models to monitor CBPR-derived interventions; and further establish mechanisms for implementation of the CBPR framework within a PBRN.

The Corporate (Re) Construction of a New South City: Great Banks Need Great Cities

Charlottes emergence as a major financial center has triggered the rapid and comprehensive revitalization of its urban core. The citys sleepy Southern image and sprawling suburban development pattern made it difficult for expansionary corporate interests to attract the human capital necessary for growth. In response to this challenge local banks and government formed a unique partnership that facilitated the remaking of Charlottes city center in order to create a new urban image more palatable to financial sector workers. In Charlotte, leading and extended corporate involvement, an absence of conventional gentrifying pioneers, incumbent resident upgrading, the production of gentrifiable space and unconventional profit motives all combine to challenge theories of revitalization developed in other systematic or regional contexts. Beyond providing an overview of Charlottes under-researched and inadequately understood restructuring processes, this paper contributes to a broadened understanding of the New South and addresses a level and region of the urban hierarchy that has long been overlooked.

Belonging in charlotte: multiscalar differences in local immigration politics and policies

In the context of Charlotte, North Carolinas, emergence as a “globalizing” pre‐emergent immigrant gateway, this paper focuses on a complex and multiscalar set of governmental policies and community‐development dynamics that are shaping localized response to Hispanic/Latino immigration. Specifically, we explore how these policies and dynamics play out spatially in the context of two Charlotte neighborhoods, both of which have similar historical roots and have become magnets for Latino settlement, yet display divergent contemporary place‐making paths. Our exploration reveals the ways in which contexts of receptivity and spaces of both exclusion and inclusion are created by the socio‐spatial components of public policy and the localized response to that policy at the intraurban level. Reinforcing the importance of space and place in the construction of receptivity contexts, the compared stories of Eastside and South Charlotte reveal that neighborhoods are never the product of one transformational force but of many—no matter how they may be perceived in the public imaginary.

Speaking of Change in Charlotte, North Carolina: How Museums Can Shape Immigrant Receptivity in a Community Navigating Rapid Cultural Change

Abstract To what degree can a museum impact cultural change in a community? Drawing from an evaluation of Levine Museum of the New Souths Speaking of Change program, this article – which is the outcome of a community engaged partnership between museum staff, urban social geographers, and urban education scholars – describes one museums community practice in shaping receptivity toward newcomers in a new immigrant gateway. Specifically, we demonstrate how through its exhibit and dialogue programming, the museum deepened understanding of immigration in ways that led to a warmer welcome and proactive inclusion. This research illuminates the critical role of museums in guiding community receptivity towards immigrants in a way that provides counterbalance to reactive or hostile responses.

Por nuestros ojos: understanding social determinants of health through the eyes of youth

Background: Understanding the social determinants underlying health disparities benefits from a mixed-methods, participatory research approach. Objectives: Photovoice was used in a research project seeking to identify and validate existing data and models used to address socio-spatial determinants of health in at-risk neighborhoods. Methods: High-risk neighborhoods were identified using geospatial models of pre-identified social determinants of health. Students living within these neighborhoods were trained in Photovoice, and asked to take pictures of elements that influence their neighborhood’s health and to create narratives explaining the photographs. Results: Students took 300 photographs showing elements that they perceived affected community health. Negative factors included poor pedestrian access, inadequate property maintenance, pollution, and evidence of gangs, criminal activity, and vagrancy. Positive features included public service infrastructure and outdoor recreation. Photovoice data confirmed and contextualized the geospatial models while building community awareness and capacity. Conclusions: Photovoice can be a useful research tool for building community capacity and validating quantitative data describing social determinants of health.