1. 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

2. 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.

3. 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?

4. 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

5. 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

6. ‘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

7. N Engl J Med, 345(2): , July 12, 2001

9. 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 Networks, neighborhoods, and communities: Approaches to the
study of the community question. Urban Affairs Quarterly, 14(3):

10. Neighbourhoods, Health and Human Development: Theory

11. 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

12. In what ways are place and n’hood effects unimportant?
examples of questions to pose:
health behaviours – is residential proximity to fast food, for instance, important?
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.

13. 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

14. Neighbourhood environments and rules for access to resources
Source: Bernard, et al. 2007

15. Place-Based Policy in Canada Two Examples

16. 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

17. 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) 

18. 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 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

21. Regent Park Revitalization Master Plan and Phasing
PRINT

23. Regent Park as a Place-Based Policy Intervention
suspected mechanisms for building a healthy community:
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) 

24. 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

25. 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