Abstract
Objective
To identify factors which limit the ability of local governments to make appropriate investments in the built environment to promote youth health and reduce obesity outcomes in Atlantic Canada.
Method
Policy-makers and professionals participated in focus groups to discuss the receptiveness of local governments to introducing health considerations into decision-making. Seven facilitated focus groups involved 44 participants from Atlantic Canada. Thematic discourse analysis of the meeting transcripts identified systemic barriers to creating a built environment that fosters health for youth aged 12–15 years.
Results
Participants consistently identified four categories of barriers. Financial barriers limit the capacities of local government to build, maintain and operate appropriate facilities. Legacy issues mean that communities inherit a built environment designed to facilitate car use, with inadequate zoning authority to control fast food outlets, and without the means to determine where schools are built or how they are used. Governance barriers derive from government departments with distinct and competing mandates, with a professional structure that privileges engineering, and with funding programs that encourage competition between municipalities. Cultural factors and values affect outcomes: people have adapted to car-oriented living; poverty reduces options for many families; parental fears limit children’s mobility; youth receive limited priority in built environment investments.
Conclusion
Participants indicated that health issues have increasing profile within local government, making this an opportune time to discuss strategies for optimizing investments in the built environment. The focus group method can foster mutual learning among professionals within government in ways that could advance health promotion.
Key words: Policy-makers, youth, obesity, built environment, focus groups
Résumé
Objectifs
Déterminer les facteurs qui limitent la capacité des administrations locales d’investir comme il convient dans le milieu bâti pour promouvoir la santé des jeunes et réduire les effets de l’obésité sur la santé au Canada atlantique.
Méthode
Des décideurs et des professionnels ont pris part à des groupes de discussion pour parler de la réceptivité des administrations locales à tenir compte de la santé dans leurs processus décisionnels. Sept groupes de discussion avec animateur ont réuni 44 participants du Canada atlantique. L’analyse thématique des transcriptions de ces réunions a mis en évidence des obstacles institutionnels à la création d’un milieu bâti favorisant la santé des jeunes de 12 à 15 ans.
Résultats
Les participants ont uniformément relevé quatre catégories d’obstacles. Les obstacles financiers limitent la capacité des administrations locales de construire, d’entretenir et d’administrer les installations qu’il faudrait. Par ailleurs, les municipalités ont hérité d’un milieu bâti conçu pour faciliter les déplacements en voiture, et de règlements de zonage inaptes à contrôler la prolifération des restaurants rapides et à déterminer où les écoles sont construites et comment elles sont utilisées. Les obstacles gouvernementaux viennent du fait que les ministères ont des mandats distincts et concurrents, avec une structure professionnelle qui favorise l’aspect technique et des programmes de financement qui encouragent la concurrence entre les municipalités. Les valeurs et les facteurs culturels influencent aussi les résultats: les gens se sont adaptés à la vie axée sur l’automobile; la pauvreté limite les options de nombreuses familles; les craintes parentales limitent la mobilité des enfants; et les jeunes sont peu considérés lorsqu’on investit dans le milieu bâti.
Conclusions
Selon les participants, les questions de santé gagnent en visibilité dans les administrations locales; le moment est donc bien choisi pour débattre de stratégies d’optimisation des investissements dans le milieu bâti. La méthode des groupes de discussion peut favoriser l’apprentissage mutuel entre les professionnels de l’administration publique de manière à favoriser la promotion de la santé.
Mots clés: décideurs, jeunes, obésité, milieu bâti, groupes de discussion
Footnotes
Acknowledgements: This research was supported by the Canadian Institutes of Health Research (CIHR) — Institute of Human Development, Child and Youth Health and Institute of Nutrition, Metabolism and Diabetes, and the Heart and Stroke Foundation of Canada (HSFC), through the Built Environment, Obesity and Health initiative (2007-2010). The authors are grateful to the Co-Principal Investigator on the project, Renee Lyons, and to the other members of the project team: Mike Arthur, Chris Blanchard, Andrea Chircop, Trevor Dummer, Sara Kirk, Louise Parker, Robert Pitter, Daniel Rainham, Laurene Rehman, Cindy Shearer and Chris Shields.
Conflict of Interest: None to declare.
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