Place-Based Policy for Marginalized Populations: Research Questions from the Greater Toronto and Hamilton Region (GTAH)

James R. Dunn, Ph.D.

CIHR-PHAC Chair in Applied Public Health Associate Professor, of Health, Aging & Society, McMaster University Scientist, Centre for Research on Inner City Health, St. Michael’s Hospital Fellow, Successful Societies Program, Canadian Institute for Advanced Research

Place-Based Policy: An Overview

• Place-based policy popular over last 15+ years in US, UK, Australia…now Canada • UK most active with ‘area-based initiatives’: • E.g., New Deal for Communities, Health Action Zones • Involves targeting defined areas for additional investment / programs to reduce inequalities • Canadian examples: Action for Neighbourhood Change (ANC); Priority Neighbourhoods Strategy (Toronto); Vancouver Agreement • Recommended by OECD Cities Report; McMurtry Report on Youth Violence, etc.

Rationale for Place-Based Policy

• Identifiable geographical areas have high levels of social problems • Mainstream programs operate less effectively • Individual disadvantage is exacerbated by area disadvantage – magnifies problems • Important for social and political reasons to address disparities between areas • ‘hard to reach’ populations? i.e.  number of disadvantaged people touched by policy?

Rationale for Place-Based Policy

• Area targeted programs often have ‘bottom up’ approach – unlike mainstream • Depends on partnerships and capacity • More effective problem identification and solution delivery? • Local programs can lead to  confidence & capacity to participate in the community • Successful area-based programs may act as pilots to change delivery of mainstream (from Smith, G.R. (1999) Area-Based Initiatives: The Rationale and Options for Area Targeting

Rationale Against Area-Based Policy

• Most deprived people don’t live in deprived areas (other forms of marginalization?) • Area-based policies unfair to people not living in targeted areas • Area-based policies displace, disperse or dilute problems (e.g., unemployment) • Area-based policies may reduce the urgency to do things at other levels (from Smith, G.R. (1999) Area-Based Initiatives: The Rationale and Options for Area Targeting

‘Place Effects’ & Health

• Scholarly resurgence of interest in how places shapes health & well-being since early 1990s • heavy emphasis on ‘compositional effects’ – places shape health because of who lives there • Macintyre began studying direct effects of local social and physical env’ts that may shape health • debate over ‘contextual’ vs. ‘compositional’ effects • can these be separated? can compositional features be emergent as contextual effects?

• now appears that there is no single ‘universal’ effect of area on health • i.e., ‘do n’hoods affect health?’ is unanswerable • there are some area effects on some population groups in some places – a complex picture • all agree that better theory is needed - complexity

N Engl J Med, 345(2): 99-106, July 12, 2001

Do Urban Neighbourhoods Matter?

• human life is intrinsically territorial • neighbourhoods initially envisioned as re-creating the dynamics of small-town life • despite romanticism, many people also like the anonymity of big city life • Wellman and Leighton (1979) argued the territorial basis of community life had been overtaken by networked social relations • but neighbourhoods appear to have had a re birth – why do they matter?

Wellman, B. and Leighton, B. 1979. Networks, neighborhoods, and communities: Approaches to the study of the community question.

Urban Affairs Quarterly

, 14(3): 363-390.

Neighbourhoods, Health and Human Development: Theory

The Importance of

Residential

Neighbourhoods

• centre of the residential neighbourhood is someone’s home. The home is a site for: – wealth storage / accumulation – ‘social reproduction’ – the investment of meaning – the exercise of control – the centre point of purposeful activities outside the home – work, recreation, service need, etc. => its relative location matters

In what ways are place and n’hood effects unimportant?

• examples of questions to pose: • health behaviours – is residential proximity food, for instance, important?

to fast • does the importance of n’hood for shaping life chances differ from place to place?

• depending on residential differentiation patterns, geography of the labour market, public transit, the public school system, the structure of local government, etc.?

• will n’hoods matter to some people more than others? • e.g., seniors, young children, youth, low SES, immigrants, etc.

Neighbourhood Effects Theories

• miasma • competition theory • neighbourhood deprivation • neighbourhood affluence • social capital • collective efficacy • social disorganization • ‘broken windows’ • community assets • public services • reputation of neighbourhood • opportunity structures • crime & delinquency • child & youth • early child dev’t • mental health • health behaviours • coronary heart disease • neural tube defects • low birth weight • incomes • educational outcomes

Neighbourhood environments and rules for access to resources

Source: Bernard, et al. 2007

Place-Based Policy in Canada Two Examples

Toronto Action for Neighbourhood Change

• Strengthened influence of local residents • Empowering belief residents can make a difference • Emergence of capable community leaders • Dependable support from politicians, police, schools • Enhanced quality of neighbourhood life • Enable residents to connect with & depend on each other • Shared public spaces that are well-maintained & used • Activities for children & youth, supports for seniors, welcoming to immigrants • Increased access to resources • New services & infrastructure for under-serviced areas • Neighbourhoods offer range of responsive services

Toronto ANC as a Place-Based Policy

• Toronto Action for Neighbourhood Change is arguably about: • Changing local opportunity structures • Increasing access to resources for marginalizes groups, especially immigrants • Can use the Bernard model to evaluate the scope of ANC with a checklist: • Physical Domain (Proximity)  • Economic Domain (Price) • Institutional Domain (Rights) • Community Organizations Domain (Informal Reciprocity)  • Local Sociability Domain (Informal Reciprocity) 

Regent Park Redevelopment

• home to 2,178 households & 7,500 people b/f demolition – Phase 1 will grow from 418 to 800+ households • one of Canada’s oldest and largest public housing developments • built in late 1940s / early 1950s based on ‘Garden City’ design principles • $400M+ demolition & redevelopment over next 10-12 years in 6 phases. New community will: – be mixed income: owners & subsidized renters 60-40 – use modern principles of urban design (new urbanism) – develop participatory governance institutions

Regent Park Revitalization Master Plan and Phasing

Regent Park as a Place-Based Policy community: Intervention • suspected mechanisms for building a healthy • social mix (mixed tenure / income) • urban design (through streets, mixed land use) • social development (e.g., job training / hiring) • community participation (in governance) • Bernard model checklist: • Physical Domain (Proximity)  • Economic Domain (Price) • Institutional Domain (Rights) • Community Organizations Domain (Informal Reciprocity)  • Local Sociability Domain (Informal Reciprocity) 

Research & Evaluation Strategies

• Longitudinal data on individuals ‘exposed’ to the intervention and comparison groups are essential • Unintended consequence of area-based policy: it changes the incentive structure for residential moving (and staying) • Also known as ‘demographic churn’ • New Deal for Communities (UK) is exemplary for its evaluation • Lead organization is Joseph Rowntree Foundation • Without rigorous evaluation => trapped in perpetual pilot project / experimentation

Conclusions

• Great potential for place-based policy • Canada is a relatively late-adopter, so can learn from elsewhere • Need to be concerned about both the ‘how’ (governance’ and the ‘what’ (content) • Bernard model focusing on areas as opportunity structures very helpful • Need to consider domains of activity and rules that govern access to resources in a complete manner • Need rigorous research & evaluation and a vehicle for learning from experience

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