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Table 1 Barriers to equitable decision-making and concrete health equity outcomes in the context of participation processes

From: Bringing stakeholders together for urban health equity: hallmarks of a compromised process

Cluster A: Process structure, resourcing and capacity

Cluster B: Stakeholder representation and participation

o Process is not binding [2326].

o Process is occurring at the wrong scale (e.g. relevant decisions/resources concentrated at another level of government or inequities generated by globalized processes) [5, 23, 28].

o Process is entirely controlled by convener [23].

o Limited range of potential outcomes (due to convener or funder restrictions, pre-existing policy decisions, framing information provided to participants, etc.) [5, 21, 22, 24].

o Key conversations had/decisions made outside of process [24].

o Not enough time for discussion, reflection; process too short and/or insufficiently iterative [23, 32].

o No or insufficient resources provided to ensure bargaining power of grassroots stakeholders (e.g. outreach, facilitation, community organizing, training) [23].

o No or insufficient resources for neighbourhood-level data collection (e.g. population and infrastructure) [26].

o Inability to deliver targeted outcomes (e.g. lack of capacity to address land title, hire independent consultants) [18, 23].

o Diversity of grassroots stakeholders not represented, including diversity within distinct groups [24].

o Grassroots stakeholders represented by groups funded by government or industry [5, 18, 19].

o Process favours stakeholders with pre-exiting capacity to organize/participate [2224].

o Bureaucracy, planning professionals and/or industry over-represented in numbers or voice [22, 24].

o Overall group membership reproduces existing power structures [20, 21].

o Lack of practical resources such as child care, meals and transportation limits participation by grassroots stakeholders [39].

o Forum time/location limits participation by grassroots stakeholders [18].

o Demands for volunteer labour place a particular burden on or serve to limit participation of those with little to no leisure time [20, 22, 24].

Cluster C: Information-sharing and gathering

Cluster D: Implementation

o Infrequent information sharing (gaps and silences) [26].

o Information shared is vague (e.g. language is confusing or inconsistent, lack of detail) [26].

o Information and meetings in language of dominant group [18, 20].

o Information sharing limits audience (e.g. only sent to people via email) [18, 25].

o Technical information provided by consultants who lack independence (e.g. funded by industry) [18].

o Forums structured so as to limit types of input and/or speakers considered legitimate [22, 24].

o Forms/paperwork built into process limit types of input [32].

o Excessive focus on consensus, conflict seen as antithetical to process [21, 24].

o Participatory aspect of process includes planning but not implementation [19, 23, 26].

o No plan to monitor and report back on implementation.

o No accountability to stakeholders following deliberation process.

  1. Grassroots stakeholders do not have sufficient independence and/or capacity to apply pressure to process/organize outside of process