Bringing stakeholders together for urban health equity: hallmarks of a compromised process

Abstract

There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. We explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. We conclude that participation processes often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice.

“One program that could improve health in this neighbourhood is ____?” using concept mapping to engage communities as part of a health and human services needs assessment

“…In the U.S., community health needs assessments and improvement plans are required of health care organizations and public health agencies to maintain tax-exempt status and accreditation [ 1 , 39 , 40 ]. Widely-used assessment frameworks such as The Mobilizing for Action through Planning and Partnership process [ 41 ] place community engagement squarely at the core of effective assessment, yet these assessments, when done using common approaches to focus groups and community surveys, run the risk of only involving the partners who are traditionally involved in service delivery, without truly engaging a broad spectrum of community residents [ 42 , 43 ]. The work presented here, as well as that of Burke and colleagues [ 22 ] illustrates how concept mapping methods can be used to engage a large and diverse cross-section of communities in the process of assessing and prioritizing issues related to health.…”

“…In particular, this method was a rapid and efficient means of incorporating the perspectives and preferences of many of the priority populations for the Local Health Integration Network such as those who are not housed or those who do not speak any of the official languages. Time and expense are often cited as a reason to not engage broadly with priority populations, and true community based participatory research methods are often labor, time, and resource intensive to do well [ 42 , 44 ]. Concept mapping activities could be a means to overcome these barriers.…”

“…Despite the short time frame, researchers managed to engage widely throughout the community, reaching out to several hundred residents and service providers within the area, as a result of a targeted recruitment process. Usually when communities are consulted, residents are asked to come to a meeting to provide input, severely limiting the population providing feedback [ 42 , 44 ]. In our case, community animators went to the community, to places where residents lived, worked, shopped, and received services.…”

Community participation for transformative action on women’s, children’s and adolescents’ health

“…We need to understand what works, how different approaches can work in different contexts and what factors need to be taken into account for future scaling up and sustainability of interventions. 47 …”

Spatial Equity and Influencing Factors of Coupling Coordination Degree of Healthcare Resources Allocation and Service Utilization in China

“…The medical service utilization research mainly discusses the bed utilization rate of different levels of health institutions [20] , urban and rural residents' medical service utilization preference [21] and inequality issues [22] . In terms of factors influencing the equity of healthcare resources allocation, local economic level [23] , demographic characteristics [24] , decision-making mechanism [25] , terrain conditions [16] , information asymmetry and adverse selection [26] are considered to be the main factors. In terms of factors influencing the equity of utilization of healthcare services, demographic characteristics [ 27 ] , urban-rural differences [ 28 ] , institutional equity, income levels [ 29 ] , and medical insurance [ 30 ] are considered to be the main factors.However, there is still a lack of quantitative analysis of the relationship between healthcare resources allocation and service utilization.So what is the relationship between the allocation and utilization of healthcare resources in China; how is this relationship evolving; whether there is a spatial inequity or not; how is this relationship affected by the influencing factors of healthcare resources allocation and service utilization, there is still no reasonable answer.…”