Healthy Cities: What will it take? Leah Steimel, MPH Urban Health Partners UNM Health Sciences Center Office for Community Health April Leah Steimel, MPH Urban Health Partners UNM Health Sciences Center Office for Community Health April

Social Exclusion and inclusion as a means to health Partici- pation Access Health

Social Exclusion: “… a multi-dimensional process in which various forms of exclusion are combined: participation in decision making and political process; access to employment and material resources; integration into common cultural processes. When combined, they create acute forms of exclusion that form a spatial representation in particular neighborhoods.” (Madanipour, Cars, & Allen, 1998) “… a multi-dimensional process in which various forms of exclusion are combined: participation in decision making and political process; access to employment and material resources; integration into common cultural processes. When combined, they create acute forms of exclusion that form a spatial representation in particular neighborhoods.” (Madanipour, Cars, & Allen, 1998)

Link between social exclusion & health Prime social determinant of individual & community health Societal factors- not lifestyle choices- primary determinants of cardiovascular disease ~ Dennis Raphael Prime social determinant of individual & community health Societal factors- not lifestyle choices- primary determinants of cardiovascular disease ~ Dennis Raphael

Low Income Unhealthy Behaviors Excessive Psychosocial Stress Material Deprivation Cardiovascular Disease How the process of Social Exclusion contributes to the mechanisms by which low income causes Cardiovascular Disease

Major Driver of Health Inequity “the empowerment of individuals to challenge and change the unfair and steeply graded distribution of social resources to which everyone has an equal claims and rights.” WHO Commission on SDOH 2008

“The best local governance can help produce 75 years or more of life expectancy; with bad urban governance, life expectancy can be as low as 35 years.” “The best local governance can help produce 75 years or more of life expectancy; with bad urban governance, life expectancy can be as low as 35 years.” Report of Knowledge Network on Urban Settings, WHO Commission on Social Determinants of Health, 2008

What facilitates social inclusion?

Healthy Governance AND Community organization and participation for problem definition and community empowerment Identifying interventions based on scientific-technical evidence ↓ Availability of financial resources to draw upon for implementation ↓ Implementation for and with community ↓ Monitoring and evaluation of health and social impact

21 st century participation Pathologies of legally required participation methods ___achieves genuine participation? ___satisfies members of public? ___improves decisions made? ___involves broad spectrum of public? Pathologies of legally required participation methods ___achieves genuine participation? ___satisfies members of public? ___improves decisions made? ___involves broad spectrum of public?

Arnstein, 1969

Collaborative Participation One way talk dialogue Elite or self-selected diverse participants Reactive involved at the outset Top-down education mutually shared knowledge One-shot activities continuous engagement Controversial choices routine activities One way talk dialogue Elite or self-selected diverse participants Reactive involved at the outset Top-down education mutually shared knowledge One-shot activities continuous engagement Controversial choices routine activities

Research Questions What are prominent indicators of social exclusion in our city and where are the “hot spots” for taking action? Participation is a building block for the City of the Future. What are the competencies for Participation and how do we build them?

Other Disciplines to Collaborate UNM Architecture & Planning Economics & Business Sociology Political Science Public Administration Architecture & Planning Economics & Business Sociology Political Science Public Administration