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While some public interventions are implemented across a whole country and concern everyone, many public interventions focus only on a segment of the population (priority groups) or a part of the territory (priority areas). Targeting groups (ie, children, elderly people, pregnant women, smokers, migrants, etc.) has long been a strategy to reduce social and health issues. Recently, targeting areas has emerged as an attractive way to implement public action. However, area-based interventions raise significant challenges for policy-makers, especially when they want to kill two birds with one stone by combining two targets: priority groups (ie, for whom health issues are frequent) and priority areas (ie, for whose attributes impacting health outcomes gain to be modified).
Area-based initiatives: what make them so appealing?
In many countries, policies targeting a limited number of specific areas have gained in importance. These area-based initiatives result from two rationales. Some areas are targeted because they are places where there is a concentration of people affected by health problems (cf. spatial segregation). Other areas are targeted because the area attributes themselves are involved in the production of health problems (cf. neighbourhood effects). Beyond these two not necessarily convergent rationales, at least five driving factors explain why policymakers find area-based initiatives appealing1–3: (1) area attributes appear to be more easily modifiable and controllable than individual attributes, (2) implementing initiatives in a limited number of areas seems to be cost-effective notably when issues are spatially concentrated and cumulative, (3) functioning as a politically correct euphemism, it conveniently avoids the formulation of issues explicitly linked with ‘minority groups’, (4) ongoing decentralisation processes (meeting citizen expectations for enhanced local democracy and community empowerment) leave local governance structures with the task of designing initiatives in the areas where needs are found to be the greatest and (5) with the increasing …
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