Exploring the roles of urban municipal governments in addressing population health inequities: prescriptions, capacities, and intentions

The 1986 Ottawa Charter for Health Promotion inspired an outpouring of research on the social determinants of health (SDOH) and health inequities (HI), much of it implicating cities as important sites for intervention. Health promotion and the Healthy Cities movement constituted an initial wave of research activity, while population health and urban health dominated a second wave. Yet, this research has inadequately translated into policy action on HI in Canada, and the roles that urban municipalities can play in addressing HI are vague. Thus, the objectives of this mixed-methods research program were threefold: 1) to identify prescriptions made in the HI literatures for municipal government intervention; 2) to assess capacities for intervention based on perceptions held by influential municipal actors; and 3) to assess intentions of selected Metro Vancouver municipalities to address HI in their jurisdictions. Phase One reviewed article abstracts from the HI literatures for SDOH profiles and prescriptions for municipal intervention. Phase Two surveyed politicians and senior-level staff of Metro Vancouver municipalities regarding their views on the SDOH and roles of municipal governments in addressing HI. Phase Three examined Official Community Plans (OCPs) of five Metro Vancouver municipalities for intentions to engage in interventions prescribed in Phase One. Prescriptions articulated for municipal intervention included health-focused interventions, relationship building, and delivering on slated responsibilities. Capacities and intentions for intervention on HI were mixed. Actors identified numerous existing policies that could reduce HI, and governments articulated strong intentions to deliver on slated responsibilities and engage citizens. In contrast, indicators of low capacity arose from actors’ individualistic SDOH attitudes and perceptions that municipal governments bear little responsibility for HI, and from governments’ limited intention to build community partnerships, or engage in health-focused interventions. Common themes were incongruence between scholarly and policy discourse on HI and municipal interventions; individualistic and environmental perspectives towards the SDOH and HI; engaging in status quo interventions and forming relationships with other governments; and concerns about offloading of responsibilities from senior governments. More critical perspectives on challenges to knowledge translation are needed if municipalities are expected to address local HI.