title: Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach.
abstract: BACKGROUND
  Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach.
  
  
  METHODS
  We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link.
  
  
  CONCLUSIONS
  In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security.
  
  
  CONCLUSIONS
  This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation.
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. Electronic address: rmehdipa.work@gmail.com.
authors.forename: Roshanak
authors.initials: R
authors.lastname: Mehdipanah
authors.affiliation: School of Sociology and Social Policy, University of Leeds, UK.
authors.forename: Ana
authors.initials: A
authors.lastname: Manzano
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain.
authors.forename: Davide
authors.initials: D
authors.lastname: Malmusi
authors.affiliation: Agència de Salut Pública de Barcelona, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Ciber de Epidemiología y Salud Publica (CIBERESP), Spain.
authors.forename: Maica
authors.initials: M
authors.lastname: Rodriguez-Sanz
authors.affiliation: School of Sociology and Social Policy, University of Leeds, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Greenhalgh
authors.affiliation: Bloomberg Faculty of Nursing, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Department of Psychiatry and Public Health Sciences, University of Toronto, Toronto, Canada.
authors.forename: Carles
authors.initials: C
authors.lastname: Muntaner
authors.affiliation: School of Sociology and Social Policy, University of Leeds, UK.
authors.forename: Ray
authors.initials: R
authors.lastname: Pawson
mesh_terms: D004779:Environment Design; D015438:Health Behavior; D006293:Health Promotion; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D012111:Residence Characteristics; D012931:Social Environment; D013030:Spain; D014505:Urban Population; D014506:Urban Renewal / Q000379:methods*
keywords: Evaluation; Health inequality; Public space; Theory-driven; Urban renewal