City deals and health equity in Sydney, Australia

Patrick Harris; Matt Fisher; Sharon Friel; Peter Sainsbury; Elizabeth Harris; Evelyne De Leeuw; Fran Baum

doi:10.1016/j.healthplace.2021.102711

City deals and health equity in Sydney, Australia

Health Place. 2022 Jan:73:102711. doi: 10.1016/j.healthplace.2021.102711. Epub 2021 Nov 20.

Authors

Patrick Harris¹, Matt Fisher², Sharon Friel³, Peter Sainsbury⁴, Elizabeth Harris⁵, Evelyne De Leeuw⁴, Fran Baum²

Affiliations

¹ Centre for Health Equity Training, Research & Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health A Member of the Ingham Institute, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia. Electronic address: patrick.harris@unsw.edu.au.
² Southgate Institute for Health, Society and Equity, Flinders University, Australia.
³ REGNET, Australian National University Sydney University, School of Public Health, Australia.
⁴ Centre for Health Equity Training, Research & Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health A Member of the Ingham Institute, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
⁵ Health and Equity Research and Development Unit, Sydney Local Health District and Centre for Primary Health Care and Equity, UNSW, Australia.

PMID: 34814070
DOI: 10.1016/j.healthplace.2021.102711

Abstract

'City Deals' are new governance instruments for urban development. Vast evidence exists on the relationship between urban factors and health equity, but little research applies a health equity lens to urban policy-making. This paper does precisely that for the Western Sydney City Deal (WSCD) in Australia. We conducted a critical discourse analysis of publicly available documents and interviews with the WSCD's main architects, applying insights from relevant theories. We find 'pro-growth' discourse to encourage economic investment dominates any references to disadvantage. Interviewees maintained the WSCDs fundamental purpose is to rebalance urban investment toward the historically disadvantaged West. However, the WSCD makes limited reference to health and none to equity. Institutionalised governance practices that favour private investments in infrastructure remain the dominant force behind the WSCD. We document how a shift to 'place-based' infrastructure has promise for equity but struggles to overcome institutionalised approaches to urban investments.

Keywords: Cities; City deals; Equity; Governance; Health; Infrastructure; Place; Policy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Cities
Health Equity*
Humans
Policy Making
Urban Health