An emphasis on a ‘comprehensive’ approach

By Ted Bruce

As a public health professional, I normally argue that mixed neighbourhoods where low income people live side by side with higher income people is a good thing. There is evidence to support this such as the findings published by the late Dr. Clyde Hertzman of UBC.

Key findings from the Vancouver Early Development Index research by the late Dr. Clyde Hertzman. Read the full report:

He points out that “segregated neighbourhoods are at the highest risk – mixed neighbourhoods lead to lower levels of developmental vulnerability than economically segregated poor neighbourhoods”.

The importance of the built environment has led to a great deal of research on the neighbourhood effects on health. A new study in the Journal of the American Medical Association provides some interesting insights. This rigorous longitudinal study showed that there were positive effects for girls (protective factors) and negative or harmful effects for boys when low income families reside in higher income neighbourhoods. This particular study concentrated on measures of mental health. Also, these were actually families given a housing incentive to move into higher income neighbourhoods. It should be noted there are numerous limitations to this U.S. based study and the literature on neighbourhood effects is very robust so this is just one more study that will contribute to our understanding of neighbourhood effects on health and the value of mixed neighbourhoods. I have the pleasure of being on the Advisory Board of the CIHR Institute of Population and Public Health with a researcher in this field so I look forward to some “robust” discussion with him on these findings.

What is perhaps most encouraging about this study for me was the approach used to understanding the pathway to the impact. The research explored the results with the adolescents themselves to understand that the differing perceptions of the community towards poor boys (delinquents) versus poor girls (needing help) may have contributed to the effect. The complexity of any environment is such that we have to be cautious about drawing simple solutions and that there is seldom any one magic bullet that will eliminate the health inequities we see between low income and high income communities.

That is why when we look at poverty reduction, public health emphasizes the need for a “comprehensive” approach and not little bits and pieces of policy interventions that may have minor or even unintended negative consequences. We need to start with a goal such as positive early childhood experiences and build a policy environment around that goal. In the area of poverty reduction, public health should advocate for an approach that brings together a comprehensive plan and one that engages people with lived experience to help shape the initiatives. This is surely not asking for too much and is the route the evidence points us towards.

– Ted Bruce is the past-President of the PHABC