Considering culture and context when supporting the development of communities

In order to improve population health, public health authorities in the province of Quebec (Canada) have integrated in 2003 a crosscutting health promotion strategy in their public health plans: "Support for the development of communities". Although it has been in the plans for several years, its implementation had not yet been documented. Using an ethnographic case study, the project aimed at answering the following question: How does the implementation of a community development initiative, as defined in the official documents of public health authorities in Quebec, actually occurs? After 32 months of participant observation and 14 semi-structured interviews with key informants, it was possible to describe how it happened in an inner-city neighborhood of Quebec City, chosen as an exemplary case to study. The results revealed that such an initiative is significantly conditioned by a neighborhood's culture and that the context in which the process occurs needs to be centrally taken into account. Authors advocate for a culturally sensitive strategy that focuses on the contexts where the action take place and considers the culture of place as a central element when wanting to improve population health and health equity.