Road safety, accessibility, and the built environment: Strategies for promoting health equity in five Canadian municipalities

Author(s): McCullogh, Macpherson, Richmond, Hagel, Pike, Fuselli, Torres, Pitt

Slidedeck Presentation:




Links between the built environment (BE), road safety, and health are well established. Scholars and public health researchers have recently drawn attention to the well-being of vulnerable populations and how they experience disproportionate risks to their health and safety due to the current design of the BE. Researchers have also begun to address these concerns using a health equity lens, which attends to the systematic disparities in health between groups occupying different locations on the social hierarchy. These concerns are affirmed by the World Health Organization’s (WHO) continuous efforts to assert health as a human right, as well as the Government of Canada’s actions to remove systematic barriers and biases in health research and applied practices.


The aim of this paper is to bolster health equity efforts in road safety, while also illustrating the urgent need to include accessibility and equity considerations in BE design and BE change processes in a pan-Canadian context.


Interview and focus group data were gathered from professionals and key informants (KI) working in policy/decision-making, transportation, police services, public health, non-profit, schools/school boards, and the private sector across five Canadian municipalities: Vancouver, Calgary, Peel, Toronto, and Montral. Data were analyzed using Braun and Clarke’s (2012) approach for thematic analysis to illustrate how participants’ perceived barriers and facilitators to BE change in reference to accessibility and health equity considerations.


Participants discussed accessibility and equity in relation to the BE in two primary ways: 1) the current BE and/or BE change process is not equitable and functions as a barrier to access for vulnerable groups; and 2) the major facilitator to overcome these barriers is making community consultation processes more accessible for vulnerable groups at local levels.


The geometric design of the current BE does not enable equitable access for all road users. This study highlights the vulnerability of specific road user groups: low socioeconomic status; people with disabilities; children; older adults; women; and newcomers (i.e., immigrants and new Canadians). Given the health benefits associated with accessing the BE to engage in active transportation (AT), as well as accessing food and essential services, it is imperative that strategies are developed to overcome barriers for these groups. Employing a health equity lens to examine participants’ responses not only highlights their concern as to the atrocious state of the current BE and associated health risks, but also empowers strategies that include marginalized groups in the consultation processes for BE change within these municipalities.


The results of this study show how issues of accessibility and equity for marginalized groups is shifting to the forefront of concern in road safety and injury prevention professions in Canada. However, this research also highlights the urgent need to make BE changes that serve the health needs of vulnerable groups, while also drawing attention to the inadequacy of current consultation processes. Thus, this research illuminates how Canadian municipalities are currently tackling this issue, while also providing examples for effective practice that can be used to inform strategies in other regions across Canada.