Stories Over Stats: Health Equity in Toronto

In many ways, Toronto is a model for the World Health Organization’s Healthy Cities Movement, putting residents’ physical and social well-being high on the political agendas of its municipal government. Yet, according to Rackham Ph.D. student Brianne Brenneman, the reality of living in Canada’s most populous city requires many residents to navigate a complex landscape of social inequity. 

Despite Toronto’s publicly funded healthcare system and significant investment into equitable urban development, Brenneman says, those in marginalized neighborhoods still contend with a myriad of embedded health disparities.

She says that when people experience barriers to accessing healthy food, safe and affordable housing, and/or meaningful work—as marginalized people do in most major cities worldwide—they often experience poor health outcomes as a result, including higher rates of asthma, cancer, and mental illness.

Brenneman, who studies urban and regional planning, explains, “Healthcare itself is only one small piece of what determines people’s health.”

The City of Toronto and United Way recently partnered to develop the Toronto Neighborhood Assessment Framework (TNAF), a tool that uses health equity data to identify areas for investment to improve health equity. According to Brenneman, prior versions of this tool, similar to many other tools used in cities across the world, unintentionally amplified negative perceptions of marginalized communities, reinforcing stigma.

By ranking neighborhoods based on deficit oriented statistics like crime or low education, the tool could lead people to label certain areas as “bad,” ignoring the vibrant community work and assets already present. This stigma can also lead to community divestment as people choose to send their kids to other schools, not open businesses in the area, or municipalities ignoring the neighborhood as a site for civic investment.

“Quantitative data alone can collapse diverse experiences into a single story really easily, creating opportunities for people to leverage that data in potentially harmful ways,” Brenneman says.

Brenneman saw TNAF’s challenges as an opportunity to change how cities listen to their residents, a value she learned in a somewhat surprising place: a rural school kitchen in Nicaragua.

Growing up in the suburbs of Cincinnati, Brenneman originally planned to become a doctor. But while studying abroad during her time as an undergraduate student, she realized that the women preparing nutritious school lunches were doing just as much to determine children’s health as the doctors handing out medicine in clinics. 

“Through my experience in Nicaragua, I realized that impacting the places where people spend their time can determine people’s health just as much, or more, than healthcare,” she says.

Brenneman shifted her career ambitions towards public health and, eventually, Ph.D. studies at U-M, where she focuses on how the built and social environments of a city act as the true determinants of well-being.

“A Ph.D. in urban planning will give me the foundation to be able to speak the language of urban planners, and to be able to more respectfully partner with people working in urban planning and community development,” she explains.

Invited to collaborate with the City of Toronto’s Community Development Unit in 2025, Brenneman worked alongside city staff members to ensure that TNAF becomes beneficial tool for all residents, including the most marginalized populations.

Supported by a Rackham Public Scholarship Grant, Brenneman conducted 24 interviews and led four workshops with a diverse range of stakeholders, including city staff, local nonprofit leaders, and resident leaders, including youth. Her intervention sought to understand the “capabilities, motivations, and experiences” of the people who would actually be impacted by this framework in the future.

Central to her research was the idea that quantitative data—the numbers—often tells a “single story” that can be harmful. For instance, while quantitative data might show something like low car ownership in a particular neighborhood, it doesn’t explain why those residents don’t own cars, how the use of public transit factors in, and how lack of reliable transportation impacts their overall health and well-being. 

However, when residents’ transportation stories are combined with the stats on public transit usage, the city might see that a lack of usage isn’t just about bus schedules; it could be about residents feeling unsafe on their walk to the stop, leading to changes in infrastructure. Specific understandings of resident experiences can lead to tangible change. This is the type of example that motivates Brenneman to fill information gaps with qualitative data, creating responsive and relevant change.

While shifting city policy can be a slow process, Brenneman’s collaboration has already yielded vital takeaways. Her work provided the “research-backed data” city staff needed to convince policymakers that qualitative storytelling is essential for a tool to be truly useful.

The workshops also empowered residents to see their lived experience as a valid form of evidence, promoting “culturally responsive decision-making” where local people hold more power in the decisions that shape their lives. Furthermore, the research surfaced a major frustration among community leaders: the city’s need for recent data, some of which had not been updated since 2015. Hearing this directly from the community has helped city staff advocate for the funding necessary to keep these tools current.

Being an “outsider” in Toronto taught her that effective collaboration requires both flexibility and humility. She initiated the partnership with another project in mind, but pivoted once she realized what her collaborators truly needed.

“I try to be a very flexible learner and scholar,” she says, “I aim to meet project partners where they are at.”

She advises other scholars to pick their partners with care, looking for those who speak respectfully about the communities they serve. Brenneman also stresses the importance of trust: “Acknowledge that residents know so much more than you do about their own lives.”