Living environments and heath at the local level - The case of three localities in the Quebec City region

Background: To arrive at a better understanding of the combined impact of social health determinants on health inequities a research project was carried out in three localities in the Quebec city region. This paper aims to show how residents' health status and health determinants can be explored through various data sources and analytic perspectives, and how these can then be combined to create a more comprehensive picture of health status at the local level. Methods: A multidisciplinary approach was adopted. Both quantitative and qualitative methods were used: information from databases entered into a geographic information system, telephone survey and face-to-face interviews with key informants, telephone surveys with representative samples of the population in each locality and in-depth interviews with citizens. The localities were subdivided into neighbourhood units to refine the analysis on local environment. Results: The results obtained in the locality of Saint-Louis, which displays the worst scores of the three localities, illustrate the research strategy's potential. Socio-economic and health indicators show that Saint-Louis is less well-off than the two other localities and that huge disparities among neighbourhoods are present within this locality. Results from the interviews with key informants, the telephone survey and interviews with citizens confirm this overall picture, raising many hypotheses about the various factors interacting to contribute to levels of health. Interpretation: Two main methodological conclusions can also be drawn from this study: that defining the appropriate spatial scale to study the impact of living environments is crucially important, and that a life course approach is essential to understanding how inequities develop.