Public policies can have a considerable effect on health outcomes. All too often, however, public policy and health are debated at a national level, creating a disconnect between local politics and actionable and meaningful health outcomes. This article draws on the results of a retroactive policy Health Impact Assessment (HIA) of a new hospital siting exercise to illustrate how local municipal policies can affect the social determinants of health. It will highlight and discuss results for the health of children. These results show that children's health is differentially affected across the new host (urban sprawl) and old host (downtown) neighbourhoods. A number of adverse impacts resulting from the shift in location and related development patterns have been generated across the city. Despite the direct relevance to the health sector and the significant control local authorities had over the development processes, development decisions and existing frameworks played a central role in a less than optimal result for children's health. Means of mitigating these effects and recommendations for future development are briefly considered.
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