Health and equity considerations in policy and practice related to sustainable transportation interventions in four Canadian cities

Cities around the world are making major investments in sustainable transportation infrastructure in response to diverse societal challenges. These projects have the potential to advance healthy cities, but it is unknown to what extent municipalities incorporate health and equity goals into sustainable transportation policy and practice. We provide an empirical analysis of how health and equity were understood, operationalized, and measured in the planning, design, and implementation of four sustainable transportation projects in four Canadian cities, Victoria, Vancouver, Saskatoon, and Montreal, as part of the INTerventions, Equity, Research, and Action in Cities Team (INTERACT) project. We reviewed nine policy documents that guided the sustainable transportation interventions and conducted content analysis to understand how health and equity were referred to within public-facing policy documents. We also interviewed 23 city staff, councillors, or members of advocacy groups who were involved in the planning, design, and implementation of these interventions and conducted framework analysis on the transcripts. We developed themes from integrated findings of our policy scan and interviews with practitioners. We found that health was broadly used in the policy framing, and that safety and modal shift towards active modes were key health outcomes in both policy and practice. Other health outcomes were described as co-benefits but were minimally operationalized and had limited influence on the prioritization of municipal investments. Equity priorities in policies and practice centered on design and implementation features geared towards equity-deserving groups and accessibility for all ages and abilities. Participants emphasized the importance of policy and political will for advancing equity goals and navigating trade-offs between prioritizing high-use or equity-focused routes. Participants also described challenges with measuring health (due to institutional mandates) and equity (due to lack of disaggregated data). These findings highlight the opportunities for clearer direction in policy and practice in relation to health and equity goals in sustainable transportation interventions. • Health and equity considerations in sustainable transportation planning can have widespread impacts. • In policy and practice, health was primarily considered as safety and modal shift. • Policies considered equity through the needs of equity-deserving groups and establishing a hierarchy of modes. • City staff also considered spatial equity and need for equitable engagement. • Municipalities face challenges in measuring health and equity outcomes.