Social change or business as usual at city hall? Examining an urban municipal government's response to neighbourhood-level health inequities

There is a renewed interest in the potential of municipal governments working collaboratively with local communities to address health inequities. A growing body of literature has also highlighted the benefits and limitations of participatory approaches in neighbourhood interventions initiated by municipal governments. However, few studies have investigated how neighbourhood interventions tackling health inequities work in real-time and in context, from the perspectives of Community Developers (CDs) who promote community participation. This study uses a process evaluation approach and semi-structured interviews with CDs to explore the challenges they face in implementing a community development, participatory process in the City of Hamilton's strategy to reduce health inequities – Neighbourhood Action. Findings demonstrate that municipal government can facilitate and suppress community participation in complex ways. CDs serve as significant but conflicted intermediaries as they negotiate and navigate power differentials between city and community actors, while also facing structural challenges. We conclude that community participation is important to bottom-up, resident-led social change, and that CDs are central to this work.