Meeting equitable (health) needs: a call for radical reflexivity in implementing interventions for just health outcomes

Abstract

Urban interventions for health are widespread, yet doubts exist about their capacity to address residents’ needs equitably. It is common for interventions to attempt some form of participation to include marginalised residents. Scholars emphasise the need for this to be meaningful. Nonetheless, despite the theorisation and subsequent recommendations on how participation should be carried out, it often continues to fall short in practice, as tokenistic or passive participation, with limited political impact. We reflect on a widely unexplored factor: how a lack of diversity in the decision-making teams of projects might shape participation. To do so, we reflect on our experiences working in health interventions teams, one in neighbourhood food environments in Amsterdam and the other in urban green spaces in London. Both projects had an explicit mandate to reach marginalised communities to address health inequities, using co-creation to achieve this. We unpack challenges brought by a lack of diversity in teams, identifying structural factors at play. We thus propose that a radical reflexivity in interventions should move beyond theory, to how participation unfolds in practice, and at least requires critically interrogating funding structures, hiring practices and team members’ positionalities.