Patricia A. Collins

Does deliberation make a difference? Results from a citizens panel study of health goals priority setting

How to involve the public in setting health and health care priorities is a constant challenge for health system decisions. Policy maker interest in involving the public in increasingly complex and value-laden priority setting processes has led to the use of deliberative public involvement methods designed to promote discussion and debate among participants with the objective of obtaining more informed and consensual views. These methods have not been evaluated rigorously using controlled designs with pre- and post-test measurements. We examined, using a controlled design, the effects of introducing different opportunities for deliberation into a process for obtaining public input into a community health goals priority setting process. Our findings indicate that deliberation does make a difference to participant views. As more deliberation is introduced, participant views may be more amenable to change. Deliberation also offers the potential for views to become more rather than less entrenched. While we are beginning to understand the difference deliberation makes to participant views, we are still at an early stage in understanding the process through which these differences come about and what difference deliberation makes to broader outcomes such as civic competence, civic engagement and health policy decisions.

Neighbourhood quality and self-rated health : A survey of eight suburban neighbourhoods in the Vancouver Census Metropolitan Area

We investigated the relationship between perceptions of neighbourhood quality and self-rated health for residents of eight suburban neighbourhoods with modestly contrasting income profiles in the Vancouver Census Metropolitan Area. Survey respondents from lower income neighbourhoods more often rated their health as fair/poor, and perceived their neighbourhood to be of poor quality. The strongest predictors for fair/poor health status were employment status, body mass index, neighbourhood satisfaction, and age, while modest predictors were annual household income, neighbourhood median income profile, and perceptions of neighbourhood safety. The unique contribution of this study is its demonstration that social gradients in self-rated health are observable between neighbourhoods of even modestly contrasting income profiles.

Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis

The experiences of settlement in a new country (e.g., securing housing and employment, language barriers) pose numerous challenges for recent immigrants that can impede their health and well-being. Lack of social support upon arrival and during settlement may help to explain why immigrant mental health status declines over time. While most urban centers in Canada offer some settlement services, little is known about how the availability of social supports, and the health statuses of recent immigrants, varies by city size. The objective of this mixed-methods study was to examine the relationship between self-perceived mental health (SPMH), social support availability, and urban center size, for recent immigrants to Canada. The quantitative component involved analysis of 2009-2010 Canadian Community Health Survey data, selecting for only recent immigrants and for those living in either large or small urban centers. The qualitative component involved in-depth interviews with managers of settlement service organizations located in three large and three small urban centers in Canada. The quantitative analysis revealed that social support availability is positively associated with higher SPMH status, and is higher in small urban centers. In support of these findings, our interviews revealed that settlement service organizations operating in small urban centers offer more intensive social supports; interviewees attributed this difference to personal relationships in small cities, and the ease with which they can connect to other agencies to provide clients with necessary supports. Logistic regression analysis revealed, however, that recent immigrants in small urban centers are twice as likely to report low SPMH compared to those living in large urban centers. Thus, while the scope and nature of settlements services appears to vary by city size in Canada, more research is needed to understand what effect settlement services have on the health status of recent immigrants to Canada, especially in smaller urban centers.

Municipal-level responses to household food insecurity in Canada: A call for critical, evaluative research

Household food insecurity (HFI) is a persistent public health problem affecting 3.8 million Canadians. While the causes of HFI are rooted in income insecurity, solutions to HFI have been primarily food-based, with the bulk of activity occurring at the municipal level across Canada. We conceptualize these municipal-level actions as falling within three models: “charitablerd, “household improvements and supportsrd and “community food systemsrd. Many initiatives, especially non-charitable ones, generate widespread support, as they aim to increase participants’ food security using an empowering and dignified approach. While these initiatives may offer some benefits to their participants, preliminary research suggests that any food-based solution to an income-based problem will have limited reach to food-insecure households and limited impact on participants’ experience of HFI. We suspect that widespread support for the local-level food-based approach to HFI has impeded critical judgement of the true potential of these activities to reduce HFI. As these initiatives grow in number across Canada, we are in urgent need of comprehensive and comparative research to evaluate their impact on HFI and to ensure that municipal-level action on HFI is evidence-based.RésuméL’insécurité alimentaire des ménages (IAM) est un problème de santé publique tenace qui touche 3,8 millions de Canadiens. Ses causes sont ancrées dans l’insécurité financière, mais ses solutions sont principalement fondées sur l’alimentation, le gros des efforts étant entrepris à l’échelle municipale au Canada. Nous avons classé ces actions municipales en trois modèles possibles: «bienfaisance», «améliorations et mesures de soutien aux ménages» et «systèmes alimentaires communautaires». De nombreuses initiatives, surtout celles sans vocation de bienfaisance, reçoivent un appui massif, car elles visent à accroître la sécurité alimentaire des participants selon une démarche d’autonomisation et de respect de la dignité. Ces initiatives peuvent procurer certains avantages à leurs participants, mais selon des études préliminaires, toute solution fondée sur l’alimentation à un problème lié au revenu aura une portée limitée auprès des ménages aux prises avec l’insécurité alimentaire et un impact limité sur l’expérience d’IAM des participants. Nous soupçonnons que l’appui massif aux démarches alimentaires locales pour contrer l’IAM entrave le jugement critique du véritable potentiel de ces activités pour réduire l’IAM. Avec l’augmentation du nombre de ces initiatives au Canada, il existe un urgent besoin de mener des études complètes et comparatives pour en évaluer l’impact sur l’IAM et pour s’assurer que l’action municipale de lutte contre l’IAM est fondée sur des données probantes.

Embracing sustainability: the incorporation of sustainability principles in municipal planning and policy in four mid-sized municipalities in Ontario, Canada

The issue of planning for sustainability is becoming more established within Canadian municipal planning. As municipalities begin to align their planning policy to reflect a more sustainable approach, there is an increased interest in how sustainability is being operationalised within municipal documents. This research aims to better understand how principles of sustainability are imbedded within Ontario municipal documents, with a specific focus on the Integrated Sustainability Community Planning approach that has emerged in Canada. Drawing on a nested comparative case study of four mid-sized municipalities, we uncover the language and strategies employed by the municipalities as they relate to the principles of sustainability developed by Gibson [2006a. Sustainability assessment: basic components of a practical approach. Impact Assessment and Project Appraisal, 24 (3), 170–182]. The findings suggest that current policy-based approaches to sustainability are considering more socially oriented strategies focused on promoting community involvement, inclusive decision-making, equity, socio-ecological civility, long-term integrative planning, and responsibility through stewardship. However, there are potential limitations that will require future research to examine policy outcomes associated with sustainability uptake. The ICSP approach must still overcome the issues relating to lack of regulatory authority and the incorporation of policies based on popular trends rather than empirical evidence.

A Passion for Gambling: A Generation-Specific Conceptual Analysis and Review of Gambling Among Older Adults in Canada

The proliferation of gambling opportunities in Canada, coupled with an aging population, has led to an increased prevalence of gambling among older adults. Encouraged by this trend, gambling industries have modified their activities to attract and market to this group. Yet, older adults are not a homogeneous group. The life experiences, values, and attitudes shared by generations make a cohort-specific analysis of gambling among older adults a worthwhile pursuit. Drawing from the Dualistic Model of Passion (Vallerand et al. in J Pers Soc Psychol 85(4):756–767, 2003), we discuss the role of passion in shaping gambling behaviours, and the implications of a harmonious or obsessive passion on the benefits and risks to two distinct generations of older adults. Based on their generational attributes, we posit that members of the Silent Generation (those born between 1925 and 1942) stand to gain more from the benefits of recreational gambling, but also stand lose more from problem gambling, than their children’s generation, the Baby Boomers (those born between 1942 and 1964). Preventative strategies to assist problem gambling seniors, along with recommendations for further research, are discussed.

Examining the capacities of municipal governments to reduce health inequities: a survey of municipal actors' perceptions in Metro Vancouver.

OBJECTIVES: Canada is an increasingly urban nation, with considerable health inequities (HI) within its urban centres. While Canadian municipalities have a range of policy and planning levers that could reduce the burden of HI, little is known about how municipal employees perceive the capacities of municipal governments to address HI within their jurisdictions. This study sought to capture these perceptions through a survey of politicians and senior-level staff working in Metro Vancouver municipalities.METHODS: The survey was administered by mail to 637 politicians and senior-level staff from 17 municipal governments in Metro Vancouver. The survey captured respondents’ perceptions on the responsibilities of, opportunities for, and constraints on, municipal-level action to address HI, as well as respondents’ input on existing municipal policies and programs that could reduce HI in their jurisdictions.RESULTS: Respondents perceived senior governments to bear greater responsibility for reducing HI than municipalities. Investing in “parks &recreation facilities” was considered the most promising policy lever for addressing HI, while “insufficient federal and provincial funding” was perceived to be the greatest constraint on municipal action. “Affordable housing” and “recreational programs” were the most commonly identified existing strategies to address HI in the municipalities sampled.CONCLUSIONS: Our findings revealed concerns about inter-governmental downloading of responsibilities, and behaviour-based assumptions of disease etiology. To advance an urban health equity agenda, more work is needed to engage and educate municipal actors from a range of departments on the social determinants of health inequities.RésuméOBJECTIFS: Le Canada s’urbanise de plus en plus, ce qui crée d’importantes iniquités face à la santé (IFS) dans les centres urbains. Les municipalités canadiennes disposent de divers leviers stratégiques et de planification qui pourraient réduire le fardeau des IFS, mais on en sait peu sur la façon dont les employés municipaux perçoivent la capacité des administrations municipales de redresser les IFS sur leur territoire. Nous avons cherché à recueillir ces perceptions au moyen d’une enquête auprès des élus et des hauts fonctionnaires des municipalités du Grand Vancouver.MÉTHODE: L’enquête a été administrée par la poste à 637 élus et hauts fonctionnaires de 17 administrations municipales du district régional du Grand Vancouver. Les répondants ont été interrogés sur leurs perceptions des responsabilités, des possibilités et des contraintes de l’action municipale pour redresser les IFS, et nous leur avons demandé leur avis sur les politiques et les programmes existants susceptibles de réduire les IFS sur leur territoire.RÉSULTATS: Les répondants percevaient les paliers de gouvernement supérieurs comme ayant une responsabilité plus grande que celle des municipalités à l’égard de la réduction des IFS. L’investissement dans « les parcs et installations de loisir » était considéré comme le levier stratégique le plus prometteur pour redresser les IFS, tandis que « le financement fédéral et provincial insuffisant » était perçu comme le plus grand obstacle à l’action municipale. « Les logements à prix abordable » et « les programmes de loisirs » étaient les stratégies existantes les plus communément citées pour redresser les IFS dans les municipalités échantillonnées.CONCLUSIONS: Nos constatations font état de préoccupations sur le transfert des responsabilités entre les ordres de gouvernement et d’hypothèses comportementales sur l’étiologie des maladies. Pour promulguer un programme d’équité en santé en milieu urbain, il faut faire davantage d’efforts pour mobiliser et sensibiliser les acteurs municipaux, travaillant dans un éventail de services, à la question des déterminants sociaux des iniquités en santé.

Should Canadian health promoters support a food stamp-style program to address food insecurity?

Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

Impacts of public transit improvements on ridership, and implications for physical activity, in a low-density Canadian city

Public transit ridership offers valuable opportunities for modest amounts of daily physical activity (PA). Transit is a more feasible option for most Canadian commuters who live too far from work to walk or cycle, yet public transit usage in midsized Canadian cities has historically remained low due to inefficient transit service. The objectives of this longitudinal study were threefold: to assess whether the introduction of express transit service in the low-density city of Kingston, Ontario, has translated to greater transit use among a targeted employee group; to document the characteristics of those employees that have shifted to transit; and to examine the PA levels of employees using transit compared to other commute modes. An online survey was administered in October 2013 and October 2014 to all non-student employees at Queens University. 1356 employees completed the survey in 2013, and 1123 in 2014; 656 of these employees completed the survey both years, constituting our longitudinal sample. Year-round transit ridership increased from 5.5% in 2013 to 8.5% in 2014 (p < 0.001). Employees who shifted to transit had fewer household-level opportunities to drive to work and more positive attitudes toward transit. Transit commuters accrued an average of 80 minutes/week of commute-related PA, and 50 minutes/week more total PA than those that commuted entirely passively. Kingston Transits express service has stimulated an increase in transit ridership among one of their target employers, Queens University. The findings from this study suggest that shifting to transit from entirely passive commuting can generate higher overall PA levels.

Implementing integrated community sustainability planning: a comparative case study of three mid-sized municipalities in Ontario, Canada

Around the world, municipal governments are engaging with sustainability in daily practices. One approach gaining momentum in Canada is integrated community sustainability (ICS) planning, which involves integration of all sustainability pillars into policies and plans for more coordinated, inclusive approaches to planning and management. Drawing from established elements of effective ICS planning, we examined the implementation strategies of three mid-sized Ontario municipalities that use contrasting ICS planning approaches. While the cities studied address most elements of our analytical framework, each offers unique strengths and weaknesses. Overall, ICS planning appears flexible and adaptive enabling tailored approaches to unique political and fiscal realities.