Backgrounder Knowledge Leaders - Vancouver 2010

1. At the Margins and in Deep: the need to prioritize equity for children’s environmental
health
Our new national training program
By Tara Zupancic
Children lead complicated lives. They are profoundly shaped by their environment and yet,
simultaneously, have little control over it. Their food, home, school, neighborhood and play spaces set a
critical cast for their well-being and they depend on the collective vision of grown-ups for how it all pans
out. If it takes a village to raise a child, what is the legacy we have created in Canada? Research
documents a pocketed patchwork of better and worse places to grow up. So while healthy housing and
enriching outdoor spaces tend to co-exist in some neighborhoods, substandard housing, poor air quality,
industrial effluents and limited green-space are frequently knotted together in others (see Buzzelli,
2008). With 1 in 10 Canadian children living in poverty (1in 4 for First Nations children) it is not hard to
imagine which children are most vulnerable (see Campaign 2000). Socioeconomic status matters and the
austere reality is that poor children often endure more intense and chronic environmental health
burdens than others due to a clustering of environmental hazards and a deprivation of social supports
where they live
While it’s obvious that not all villages are created equal, we are short on analysis into the socioeconomic
forces that fortify environmental inequities in Canada (see review by Masuda, Zupancic et al, 2008). As a
consequence, the lived realities of children who are deepest in risk, and carrying the heaviest health
burdens, remain in the shadows. Without visibility or voice they face further risk of marginalization
instead of prioritization – a state that undermines a genuine commitment to improving health equity in
Canada. Our new project: Knowledge Leaders in Children’s Environmental Health is a pilot training
program that places equity front and centre of environmental health challenges by prioritizing the
knowledge, experience and expertise of communities who bear the brunt of environmental disparities.
The goal of the program is to build relationships and support collaborative action among research, policy,
and community leaders to improve the health of all Canadian children.
Why do we need a training program?
Over the past 30 years, there has been steady growth in Canadian environmental health research with
approximately 25% of the peer-reviewed literature focused on the unique vulnerabilities of children (see
systematic review). However, this body of work mainly focuses on exposure measures and risk
assessment of single contaminants and little is known about how these risks compound with social
vulnerabilities, such as socioeconomic position and ethnoracial status. In addition, very little of this
scholarship has engaged community-driven or participatory modes of investigation. In essence, children’s
environmental health in Canada has been examined primarily through a quantitative scientific frame.
The way a problem is framed has a direct influence on the range of solutions explored to address it.
Because environmental health studies typically focus on a single contaminant and centre on one of 4
main themes (hazard identification, exposure assessment, dose-response assessment, or risk
characterization), intervention strategies that flow from their findings generally revolve around: 1)
controlling the source; 2) controlling the pathway; 3) controlling at the level of the person; and, 4)
secondary prevention (see Kegler and Miner, 2004). Thus, a predominate emphasis on quantitative
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2. exposure data and risk assessment, lends itself to public health measures equally focused on exposure
remediation.
While reduced exposure to environmental hazards is beneficial, strategies to achieve that goal may not
be effective if they don’t tackle oblique entrenched obstacles faced by communities. To wit: How do you
tell a daycare to open windows to improve air quality when current-zoning practices have allowed an
industry to emit chemical solvents into the air right across the street? How do you encourage a family to
opt for healthier foods if there isn’t an affordable grocery store within walking distance? How do you
suggest that children get active outdoors if a neighborhood doesn’t feel safe or there is nowhere to play?
How do you ask a family to repair their lead-laden crumbling paint if they already have to decide between
buying bus tickets or paying rent? These are not fictitious examples but real challenges I have faced in
my own work as I attempted to ‘educate’ community members on how to improve children’s
environmental health. As it turns out, I was the one who got schooled.
I learned quickly how the tapered gaze of scientific investigation, while necessary, can never tell the
entire story. For example, a quantitative environmental health study documenting relatively higher levels
of fine particulates in the air of a low-income neighbourhood provides evidence that a health inequity
may exist. However, in order to understand and address the problem, an entirely different mode of
inquiry is needed because the effect of air pollution is a collection of multiple systemic causes that
manifest in a local context – it may include the cost of fuel, the availability of public transportation,
historical and current zoning of roadways for industrial trucks, the concentration and regulation of local
industry, political influence of adjacent neighborhoods, investment in urban forestry programs, and the
walkability of the Neighbourhood (to name only a few). Without community knowledge to help discern
the social and economic roots of disparities, a grand fissure remains between what we know about the
distribution of an environmental problem and its underlying causes.
The current lack of community-driven or participatory investigation into children’s environmental health
means that the ideas and experiences of affected communities are underexplored and underrepresented
in the literature. In a domain where evidenced-based practice reigns paramount, how can we possibly be
responsive to the health needs of at-risk children if their lived experience is barely documented and
included as evidence? It is not simply about addressing poverty, as some may argue, but learning how
poverty engenders patterns of prejudice and neglect which may result in differential power and influence
over local environmental decisions – decisions that can deepen the effects of poverty but also limit the
effectiveness of well intentioned public health strategies.
Models for interrogating how power and social relationships influence the built environment are critical
for understanding underlying causes of inequity and possibilities for action. For example, Schultz and
Northridge’s, Social Determinants of Health and Environmental Health Promotion offers a framework to
explore how social relationships (re)produce systems of inequality that influence the built environment
and ultimately affect individual and population level health. They employ a systems approach that
provides multiple “theories of the problem” as well as “theories of action” that range from the
individual/community level to the policy level (see McLeroy, Bibeau et al, 1988). This model also helps
stakeholders to locate themselves within the system, and provide a common ground for discussion and
relationship building. However, because much of the research investigating health effects of the built
environment has been conducted in the absence of such transdisciplinary and community-driven
interaction and because there are very few training opportunities in Canada focused on children’s
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3. environmental health, there is a lack the capacity to assess structural inequities and legacies of
environmental development (see Srinivasan and Dearry, 2004 and Wiseman and Stephanovic, 2009).
Sustained improvement in children’s environmental health requires building capacity toward a more
robust interrogation of the possible biases and inequities of policies across multiple sectors that convene
to create a positive or negative environmental setting. We need to pull at the roots of local disparities to
unearth systems of inequity forged therein and there is no way to do that without amplifying the
knowledge, experience and expertise of those who bear the brunt of such burdens. To do otherwise is
like running a horse with its blinders on, we may get to a certain designated solution faster but we have
missed the context and landscape of the problem entirely. Therefore, we need multidimensional
perspectives – modes of interrogation that are as multilayered, multifaceted and complex as the
problems themselves. So how do we do that? We believe it starts with bringing together a novel mix of
knowledge leaders and system influencers to grapple with the environmental health complexities and
inequities faced by disadvantaged communities.
Our new project: Knowledge Leaders in Children’s Environmental Health is a training program invested
in building relationships to support equity-focused research and action in support of children’s
environmental health. We will bring together a community of emerging leaders in children’s
environmental health research, policy and activism; many of whom have contrasting knowledge,
experience, priorities, stories and opinions of environmental disadvantages to children and how to
address them. Together we will scrutinize existing frameworks and strategies for understanding the
problem, investigate immobile barriers to change, map dominant agendas and perspectives and highlight
missing voices. In short, we will be pushing each other to examine our own blind spots and the
limitations of our work to achieve new perspectives through the eyes of others. Our goal is to support
knowledge leaders to better understand the multiple intersecting social, cultural, and economic
pathways that determine and intensify children’s environmental health inequities and how these relate
to their own work in research, policy and community advocacy.
To learn more about the training program visit:
Knowledge Leaders in Children’s Environmental Health
Or contact:
Tara Zupancic, Associate Director
Centre for Environmental Health Equity
tara.zupancic (at) cehe.ca
www.cehe.ca
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