Abstract
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.
Key Words: Inequalities, municipal government, survey, British Columbia, Canada
Résumé
OBJECTIFS: 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.
Mots Clés: inégalités, administration municipale, enquêtes de santé, Colombie-Britannique, Canada
Footnotes
Conflict of Interest: None to declare.
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