Examining the capacities of municipal governments to reduce health inequities: a survey of municipal actors' perceptions in Metro Vancouver.

OBJECTIVES Canada is an increasingly urban nation, with considerable health inequities (HI) within its urban centres. While Canadian municipalities have a range of policy and planning levers that could reduce the burden of HI, little is known about how municipal employees perceive the capacities of municipal governments to address HI within their jurisdictions. This study sought to capture these perceptions through a survey of politicians and senior-level staff working in Metro Vancouver municipalities. METHODS The survey was administered by mail to 637 politicians and senior-level staff from 17 municipal governments in Metro Vancouver. The survey captured respondents' perceptions on the responsibilities of, opportunities for, and constraints on, municipal-level action to address HI, as well as respondents' input on existing municipal policies and programs that could reduce HI in their jurisdictions. RESULTS Respondents perceived senior governments to bear greater responsibility for reducing HI than municipalities. Investing in "parks & recreation facilities" was considered the most promising policy lever for addressing HI, while "insufficient federal and provincial funding" was perceived to be the greatest constraint on municipal action. "Affordable housing" and "recreational programs" were the most commonly identified existing strategies to address HI in the municipalities sampled. CONCLUSIONS Our findings revealed concerns about inter-governmental downloading of responsibilities, and behaviour-based assumptions of disease etiology. To advance an urban health equity agenda, more work is needed to engage and educate municipal actors from a range of departments on the social determinants of health inequities.