Building health equity into healthy built environments: A Saskatoon perspective
Author Cora Janzen works as a population health promoter in Population and Public Health for the Saskatchewan Health Authority. She is the lead for Healthy Transportation Networks and Healthy Neighbourhood Design for Saskatoon and area.
Health begins in the communities where we live, work, learn and play. The vast majority of factors that contribute to health status and outcomes are influenced by elements such as urban planning, employment, education (which, in addition to employment, factors into income potential), housing and social networks, among others. [1,2]
Over the past decade, Saskatoon Population and Public Health (Saskatoon PPH) has focused more attention on improving built environments to be health promoting. To deepen this work, the team has prioritized the integration of health equity1 into built environments based on inequities observed within local environments, such as decreased levels of physical activity, chronic disease prevalence and transportation-related injuries in lower-income quintiles and areas of deprivation. [3,4,5]
In addition, Saskatoon PPH’s work regarding healthy built environments increasingly includes health equity touchpoints across other institutions and sectors. The goal of these efforts, which reflect the inclusion of health equity in the Saskatoon PPH mandate, is to promote more inclusive physical and social environments for all.
Two examples are discussed in more detail below.
The Saskatoon Poverty Reduction Partnership (SPRP) is a comprehensive partnership involving various stakeholders, including community services agencies, Indigenous populations, municipal governments, school divisions, poverty advocacy groups and individuals with a lived experience of poverty. The SPRP’s current focus is on developing a locally focused poverty-reduction strategy for Saskatoon. Its considerations include a number of priority areas that are connected directly to HBE concepts, such as transportation, housing, homelessness and food security. Other priority areas being discussed for inclusion in the strategy are employment, education, income, early years and health and well-being, which are indirectly impacted by HBE concepts and interventions.
The role of population and public health practitioners
Saskatoon PPH has been involved as a main partner of the SPRP, but additional PPH practitioners have been engaged in informing the local poverty reduction strategy as it develops. These practitioners have been specifically addressing the priority areas that are directly connected to HBE concepts and have proposed activities for consideration within the poverty-reduction strategy. Saskatoon PPH practitioners also provided access to content knowledge, their networks and local data that could be used to inform the strategy.
New synergies are also being independently forged between the PPH practitioners and some individual SPRP members to further deepen the connections that are not directly linked to the poverty reduction strategy. In addition, discussion has started regarding identifying improvements for knowledge sharing mechanisms and interconnecting processes and practitioners.
Inclusion of first voice
“Hearing from the people who access the services and programs you provide, or who are impacted by policies, is essential if you want your organization to be as relevant and effective as possible. Individuals with lived experience bring knowledge, experience and skills that those without this experience lack. Nothing teaches us better than learning from experiences.” [7 p3]
As our team has developed our health equity strategy for built environments, we have sought to include the voices of those with lived experience as a way to help produce better outcomes for the communities involved. For this reason, we are striving to incorporate the concept of First Voice, which is designed to include individuals with the lived experience of the issues being targeted (e.g., lived experience of poverty, disability) in processes. This approach is imperative to prevent the organizing groups or institutions from making assumptions while also providing an opportunity for these voices to be included.
Saskatoon PPH adopted a First Voice process around 2010 and has continued to support this initiative to encourage participation, information-sharing and guidance from people with lived experience of poverty in targeted community initiatives. Saskatoon PPH was a collaborator in creating the SPRP’s Creating a Culture of Inclusion guide.  This is a practical tool for community groups and employers to include people with lived experience of poverty in their work.
‘Nothing about us without us’
An example of where we are hoping that the Creating a Culture of Inclusion guide can be meaningfully applied is the City of Saskatoon’s goal to incorporate a Vision Zero plan — a collaborative and multi-disciplinary road safety approach with the goal of eliminating transportation-related fatalities or severe injuries. This new approach for their overarching transportation safety plan is a data-driven process and based on local hospitalization and emergency room data, suggesting that people living in the lower-income quintiles tend to carry a heavier burden of transportation-related injury. In the interest of addressing health inequities observed within sub-populations, PPH practitioners involved will advocate for the use of First Voice in that process and to include First Voice at the discussion and decision-making tables.
In summary, to foster better health for all within HBE work, health equity must be at the forefront of a population health promotion strategy and multi-pronged health equity approaches are needed. Saskatoon PPH has undertaken a number of initiatives in Saskatoon to do just that, which you can read about in our recent Canadian Journal of Public Health article: Embedding health equity strategically within built environments.
To learn more about promoting equity in the built environment, check out the July 2018 NCCDH blog post.
Photo credit: The StarPhoenix
[1.] Institute for Clinical Systems Improvement. Going beyond clinical walls: solving complex problems [Internet]. Bloomington, MN: ICSI; 2014 [cited 2018 Oct 26]. Available from: https://www.icsi.org/_asset/w6zn9x/solvcomplexproblems.pdf
[2.] Canadian Institute of Planners. Health equity and community design: what is the Canadian evidence saying? [Internet]. Ottawa, ON: CIP; [date unknown] [cited 2018 Oct 26]. Available from: https://www.cip-icu.ca/Files/Healthy-Communities/FACTSHEETS-Equity-FINALenglish.aspx
[3.] C Neudorf, J Kryzanowski, J Marko, C Ugolini, A Brown, D Fuller, L Murphy. Better health for all: health status reporting series six: health behaviors and risk conditions [Internet]. Saskatoon, SK: Saskatoon Health Region; 2015 [cited 2018 Oct 26]. Available from: https://www.saskatoonhealthregion.ca/locations_services/Services/Health-Observatory/Documents/Reports-Publications/2015_shr_series6_hsrmessage.pdf
[4.] C Neudorf, M Schwandt, J Marko, A Brown, L Murphy. Better health for all: health status reporting series seven: unintentional injuries [Internet]. Saskatoon, SK: Saskatoon Health Region; 2016 [cited 2018 Oct 26]. Available from: https://www.saskatoonhealthregion.ca/locations_services/Services/Health-Observatory/Documents/Reports-Publications/2016_shr_series7_hsrmessagerevised.pdf
[5.] C Neudorf, J Marko, J Wright, C Ugolini, T Kershaw, S Whitehead, J Opondo, R Findlater. Health status report 2008: a report of the chief medical health officer [Internet]. Saskatoon, SK: Saskatoon Health Region; 2009 [cited 2018 Oct 26]. Available from: https://www.saskatoonhealthregion.ca/locations_services/Services/Health-Observatory/Documents/Reports-Publications/shr_health_status_report_2008_full.pdf
[6.] Saskatoon Health Region, Public Health Observatory, CommunityView Collaboration. Advancing health equity in health care: what is health equity? A primer for the health care system [Internet]. Saskatoon, SK: Saskatoon Health Region; 2014 [cited 2018 Oct 26]. Available from: https://www.communityview.ca/pdfs/2014_shr_phase3_whatishealthequity.pdf
[7.] Saskatoon Poverty Reduction Partnership. Creating a culture of inclusion: a practical guide for community groups & employers to include people with the lived experience of poverty in their work [Internet]. Saskatoon, SK: SPRP; 2017 [cited 2018 Oct 26]. Available from: http://www.communityview.ca/Catalogue/Document/DownloadFile/1000317?docNumber=1