Out of our inner city backyards: Re-scaling urban environmental health inequity assessment

In this paper, we report the results of a three-year research project (2008–2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city.

► A comparative adaptation of the Photovoice method provides a novel approach to assess health inequity at the scale of the city.
► Health inequities can be described as relational constructs, as seen through observable differences in environmental conditions between less and more affluent neighbourhoods.
► The research approach provides insight for community-driven policy action aimed at resolving health inequities in cities.