Reducing social inequalities in health: the role of research in decision-making Nathalie Pinsonnault The Léa Roback Research Centre on Social Inequalities in Health of Montreal Forgotten Families: Globalization and the Health of Canadians Edmonton / 6-8 February 2007

PRESENTATION OUTLINE 1- The background of the Léa Roback name 2- Mission and objectives of the Centre 3- Health disparities in Montréal 4- Research opportunities related to social inequalities in health (SIH) 5- Distinctive characteristics of the Centre 6- Conclusion

Léa Roback ( ) An inspiring Montréal activist who fought for many causes The background of the Léa Roback name

Mission and objectives of the Léa Roback Research Centre Mission To help reduce social inequalities in health and improve living conditions

Mission 1) to facilitate research on social inequalities in health shaped by living conditions in the Montreal community; 2) to develop a critical mass of researchers; 3) to develop alliances among researchers from diverse fields, public policymakers and professionals in institutional and community settings to support the conduct and application of such research; 4) to enhance knowledge transfer so research results can be transformed into action. Mission and objectives of the Léa Roback Research Centre

An interdisciplinary research network 38 researchers (seniors, postdoc fellowships, …) Operates in an environment of proximity to decision-making (e.g. Montréal Public Health Department) Mission and objectives of the Léa Roback Research Centre

Questions referring to research on SIH –How do social inequalities become health inequalities? –How can we reduce social inequalities in health? –How can we diminish the impact of social inequalities on health? –How can we reduce the impact of health problems on social inequalities? Mission and objectives of the Léa Roback Research Centre

Health disparities in Montréal Life expectancy at birth for both sexes combined (CLSC Montréal-Centre, 2003)

Research opportunities related to social inequalities in health Momentum : researchers, practionners and decision-makers Different fields of research –Spatial patterns of health –Welfare regimes (comparison with Nordic countries) –Environmental health –Mental health –Service organisation, … Individual and contextual factors

1- Partnership support via production and knowledge exchange processes; 2- Current and potential benefits of parterships. WHAT MAKES THE CENTRE DISTINCTIVE

1- Partnership support ’Montreal’ develops relationships and negotiations in order to understand SIH on its territory Partnerships oriented towards knowledge acquisition and pooling of competencies

2- Current and potential benefits of partnerships 2-1 Knowledge-exchange activities with decision- makers 2-2 Development of structuring projects 2-3 Integration of knowledge into practice WHAT MAKES THE CENTRE DISTINCTIVE

2-1 Knowledge-exchange activities with decision-makers Free-trade area : workshops intended for public health practitioners and planners Future projects : Works-in-progress presented to decision-makers for comments Research in action: Conference clearly oriented towards the identification of possible interventions. Understanding Montreal: Breakfast given by the Centre for high-level decision-makers: Centraide, Director of social development, Director of environment,...

2-2 Development of structuring projects Development of a survey : conceptual framework, scoping reviews Atlas project & documentary database Common goal Understanding how inequalites in health are created in neighbourhoods

2-2 Development of structuring projects Particularity of the scoping reviews: working group Composition: Montréal Public Health Department, the City of Montréal, Centraide, the Conférence régionale des élus de Montréal, and the Institut de la statistique du Québec. SIH themes examined: Basic notions of SIH, obesity, Themes for the future: Urban transportation (related to physical activity, respiratory diseases, traffic injuries, social exclusion). Smoking (upcoming pilot project)

2-2 Development of structuring projects Conceptual framework: presented in various forums 2 articles in preparation Bernard, P., Charafeddine, R., Potvin, L., Frohlich, K.L., Daniel, M., Kestens, Y. (2006) Health Inequalities and Place: A Theoretical Conception of Neighbourhood. Submitted for a special issue of Social Science and Medicine. Frohlich, K. L., Bernard, P., Charafeddine, R., Potvin, L., Daniel, M., Kestens, Y., Seguin, A-M.. A theoretical framework for understanding how inequities in health are created in neighbourhoods. Social Science & Medicine, Draft manuscrit. Info : Rana Charafeddine /

2-2 Development of structuring projects Involves the mobilization of actors because… structuring projects guide the research; structures exchanges; also depend on a network of researchers, decision- makers and practitioners.

2-2 Development of structuring projects Provides opportunities for transfer and exchange in advance of researchers’ and planners’ needs (scientific commitees, working committees with groups of planners and decision-makers) by involving people in charge, who work in Montréal on social, economic and urban planning levels.

2-2 Development of structuring projects For a long-term outlook … - on SIH research: shared reflection on the impact of a neighbourhood’s environment on health; - of decision-making on SIH issues: based on the willingness to act in neighbourhoods.

2-3 Integration of knowledge into practice How to present the conditions for integration? Involve decision-makers in the research process

2-3 Integration of knowledge into practice Set the agenda e.g., urban transportation Public Health Department’s Annual Report and research on walking in an urban environment, on safety, on destination densities, etc.)

2-3 Integration of knowledge into practice Common objectives e.g., the neighbourhood (living conditions) Access to healthy food (local markets, collective gardens, etc.) Building social capital (social mixing through housing, accessible services, etc.) Neighbourhood development (walking, security, etc.).

Conclusion Research on SIH has the capacity to support decision-making if … –Structuring projects; –Privileged access to the decision-makers (e.g. Public Health Department); –Working committees and exchange activities; –Common objective: Montreal and its neighbourhoods Closely related to the decision-makers’ immediate areas of concern.

Acknowledgements Marie-France Raynault, Executive Director Louise Potvin, Scientific Director Isabelle Thérien, Administrative Assistant Rana Charafeddine, Postdoctoral Fellow Christiane Montpetit, Research Agent Éric Robitaille, Doctoral Candidate

CONTACT INFORMATION Nathalie Pinsonnault Programming Assistant Isabelle Thérien Administrative Assistant