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Building healthier cities and communities: Professor Patricia O’Campo

"Achieving health equity involves more than providing equitable access to health care"

Students and colleagues at the University of Toronto know her as a social epidemiologist striving to reduce health inequalities. Now, Professor Patricia O’Campo has taken on the role of chair in Intesectoral Solutions to Urban Health Problems at St. Michael’s Hospital

A member of the Dalla Lana School of Public Health’s Social and Behavioural Health Sciences Division, O'Campo is also Healthier Cities and Communities Hub co-lead and director of the Centre for Research on Inner City Health (CRICH) at St. Mike’s.

O’Campo says she studies the ‘causes of the causes.’ For example, traditional epidemiology might describe the ways in which unemployment is bad for your health. But what causes unemployment, and what are the conditions and policies that prevent it or reduce its impacts? When we can describe the causes of the causes, we’ll know where and how to make change.

Writer Nicole Bodnar of the Dalla Lana School of Public Health sat down with O’Campo to find out more about her new role, the healthier cities initiative and what motivates her.

What is intersectoral research?

Intersectoral is short for Intersectoral Action for Health (ISA), which refers to collaborative approaches to policy and program development. ISA addresses complex problems that cannot be solved by a single region, government, department or sector.

Intersectoral action has been brought to bear on specific determinants of health, diseases, populations (e.g. Indigenous peoples, children), geographic communities, health behaviours and risk factors. Although the arguments in favour of ISA for health equity are compelling, the challenges of implementing, sustaining and evaluating the costs and benefits of intersectoral initiatives are immense and knowledge to guide ISA planning is lacking.

What inspired you to pursue this type of work?

While I was an undergraduate, I worked for community organizations and discovered that research is a powerful way to reveal urban health problems that aren’t raised in everyday conversations, in the media or by politicians. I stayed in research because I realized that there was too little data to shed light on what is really going on for people in inner cities and how to solve the tough problems. My heart is still in community work, and that’s what motivates me.

When I was younger, I thought some of these problems could be solved if we provided policy-makers with the right data. I don’t think that anymore. And I don’t think that any one field can do it, either. That’s why I’ve pushed for trans-disciplinary work and partnerships between health and non-health disciplines. The policy-making process is complex, the problems are complex, and we have to address that complexity in the way we approach our work.

What current research activities are underway?

This spring, we launched Urban HEART @ Toronto to measure how well Toronto’s 140 neighbourhoods are doing across a variety of policy domains, including economic opportunities, social and human development, civic engagement, physical environment and infrastructure, and population health. Urban HEART — Urban Health Equity Assessment and Response Tool — is a collaboration of 80 experts from more than 40 organizations, including community groups, academics, the private sector and government.

Urban HEART enabled us to look beyond the red flags in neighbourhoods as we learned that every neighbourhood in Toronto has strengths to build upon going forward.

We’re also turning our attention to policies that improve population health, and that have survived — or even expanded — in the face of austerity measures. Social programs are the first to be cut in economic downturns, but there are important occasions where opposition to cuts are effective and maintain critical support for citizens.  What are the conditions and mechanisms that protect policies that keep people healthy? How do we replicate those successes? It’s an emerging area, and we are working with universities across Europe to develop new tools to explore it as we go along.

Building healthier cities is a major priority for U of T.  What role does public health play in growing healthier cities?

Limited research has been conducted to understand the pathways through which social and economic policies affect population health. Even less research has evaluated the impacts of intersectoral initiatives to improve health and explained the mechanisms that lead to success or failure.

That’s where universities and academia come in. Over the last five years, U of T and CRICH scientists have developed reputations as Canadian leaders in the analysis of intersectoral interventions to address health equity.  They have also established an internationally competitive post-doctoral fellowship curriculum focused on skills development in working with stakeholders outside of the health sector, and in pursuing population health interventions research.

As Canada’s largest urban metropolis, Torontonians have a lot to gain from this research.  In your mind, what comprises a “healthy city?”

A healthy city is one in that promotes health equity for all citizens, meaning that every person has the right to live in circumstances that promote good health and has the resources and means to thrive and take advantage of all our great city has to offer.

Achieving health equity involves more than providing equitable access to health care. We also need healthy urban infrastructure, safe recreation, access to good jobs, and an end to violence, racism, isolation and community disenfranchisement.