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2018
Benmarhnia, T, Alexander S, Price K, Smargiassi A, King N, Kaufman JS.  2018.  The heterogeneity of vulnerability in public health: a heat wave action plan as a case study. Critical Public Health. 28:619-625.   10.1080/09581596.2017.1322176   AbstractWebsite

The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated.

2015
Cartier, Y, Benmarhnia T, Brousselle A.  2015.  Tool for assessing health and equity impacts of interventions modifying air quality in urban environments. Evaluation and Program Planning. 53:1-9.   10.1016/j.evalprogplan.2015.07.004   AbstractWebsite

Background: Urban outdoor air pollution (AP) is a major public health concern but the mechanisms by which interventions impact health and social inequities are rarely assessed. Health and equity impacts of policies and interventions are questioned, but managers and policy agents in various institutional contexts have very few practical tools to help them better orient interventions in sectors other than the health sector. Our objective was to create such a tool to facilitate the assessment of health impacts of urban outdoor AP interventions by non-public health experts.Methods: An iterative process of reviewing the academic literature, brainstorming, and consultation with experts was used to identify the chain of effects of urban outdoor AP and the major modifying factors. To test its applicability, the tool was applied to two interventions, the London Low Emission Zone and the Montreal BIXI public bicycle-sharing program.Results: We identify the chain of effects, six categories of modifying factors: those controlling the source of emissions, the quantity of emissions, concentrations of emitted pollutants, their spatial distribution, personal exposure, and individual vulnerability. Modifiable and non-modifiable factors are also identified. Results are presented in the text but also graphically, as we wanted it to be a practical tool, from pollution sources to emission, exposure, and finally, health effects.Conclusion: The tool represents a practical first step to assessing AP-related interventions for health and equity impacts. Understanding how different factors affect health and equity through air pollution can provide insight to city policymakers pursuing Health in All Policies. (C) 2015 The Authors. Published by Elsevier Ltd.

2014
Benmarhnia, T, Rey L, Cartier Y, Clary CM, Deguen S, Brousselle A.  2014.  Addressing equity in interventions to reduce air pollution in urban areas: a systematic review. International Journal of Public Health. 59:933-944.   10.1007/s00038-014-0608-0   AbstractWebsite

Integration of equity in evidence-based public health is a great challenge nowadays. In this review we draw attention to the importance of considering equity in air pollution interventions. We also propose further methodological and theoretical challenges when assessing equity in interventions to reduce air pollution and we present opportunities to develop this research area.