The Role of Urban Municipal Governments in Reducing Health Inequities: A Meta-Narrative Mapping Analysis

Background:The 1986 Ottawa Charter for Health Promotion coincided with a preponderance of research, worldwide,on the social determinants of health and health inequities. Despite the establishment of a 'health inequities knowledgebase', the precise roles for municipal governments in reducing health inequities at the local level remain poorlydefined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to trackscholarly prescriptions for municipal government intervention on local health inequities.Methods:Using meta-narrative mapping, four bodies of scholarly literature - 'health promotion', 'Healthy Cities','population health' and 'urban health' - that have made substantial contributions to the health inequities knowledgebase were analyzed over the 1986-2006 timeframe. Article abstracts were retrieved from the four literature bodiesusing three electronic databases (PubMed, Sociological Abstracts, Web of Science), and coded for bibliographiccharacteristics, article themes and determinants of health profiles, and prescriptions for municipal governmentinterventions on health inequities.Results:1004 journal abstracts pertaining to health inequities were analyzed. The overall quantity of abstractsincreased considerably over the 20 year timeframe, and emerged primarily from the 'health promotion' and'population health' literatures. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasized themes in theabstracts. Only 17% of the abstracts articulated prescriptions for municipal government interventions on local healthinequities. Such interventions included public health campaigns, partnering with other governments and nongovernmentalorganizations for health interventions, and delivering effectively on existing responsibilities to improvehealth outcomes and reduce inequities. Abstracts originating from Europe, and from the 'Healthy Cities' and 'urbanhealth' literatures, were most vocal regarding potential avenues for municipal government involvement on healthinequities.Conclusions:This study has demonstrated a pervasiveness of 'behavioural' and 'biomedical' perspectives, and a lack ofconsideration afforded to the roles and responsibilities of municipal governments, among the health inequitiesscholarly community. Thus, despite considerable research activity over the past two decades, the 'health inequitiesknowledge base' inadequately reflects the complex aetiology of, and solutions to, population health inequities.