Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project (original) (raw)
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Journal of Urban Health, 2011
Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges-economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-inhand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower-and middleincome countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central policy goals for urban management.
Closing the gap in urban health inequities
Journal of Public Health Policy, 2009
The recently released report, 'Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health' (hereafter, the Report), 1 issued by the World Health Organization's Commission on Social Determinants of Health (hereafter, the Commission), provides actionable recommendations for achieving health equity on a global scale, and doing so with urgency: within one generation. In framing health inequality as an issue of social justice and by addressing the structural drivers of health inequity, the Commission acknowledges that we must expand on the traditional approach of highlighting biomedical pathways and their proximate causes. This acknowledgment, and the focus on timely action, must be applauded. Several key areas in the Report, however, could be improved.
Equity and the Social Determinants of Health in European Cities
Journal of Urban Health, 2012
Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30 years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003IV ( -2008 of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.
The European Journal of Public Health, 2015
Background: An overarching recommendation of the global Commission on Social Determinants of Health was to measure and understand health inequalities and assess the impact of action. In a rapidly urbanising world, now is the time for Urban HIA. This article describes the development of robust and easy-to-use HIA tools to identify and address health inequalities from new urban policies. Methods: Rapid reviews and consultation with experts identified existing HIA screening tools and methodologies which were then analyzed against predefined selection criteria. A draft Urban HIA Screening Tool (UrHIST) and Urban HIA methodology (UrHIA) were synthesised. The draft tools were tested and refined using a modified Delphi approach that included input from urban and public health experts, practitioners and policy makers. Results: The outputs were two easy-to-use stand-alone urban HIA tools. The reviews and consultations identified an underpinning conceptual framework. The screening tool is used to determine whether a full HIA is required, or for a brief assessment. Urban health indicators are a readily available and efficient means of identifying variations in the health of populations potentially affected by policies. Indicators are, however, currently underutilised in HIA practice. This may limit the identification of health inequalities by HIA and production of recommendations. The new tools utilise health indicator data more fully. UrHIA also incorporates a hierarchy of evidence for use during impact analysis. Conclusion: The new urban HIA tools have the potential to enhance the rigour of HIAs and improve the identification and amelioration of health inequalities generated by urban policies.
Health Promotion International, 2015
The WHO European Healthy Cities Network has from its inception aimed at tackling inequalities in health. In carrying out an evaluation of Phase V of the project (2009-13), an attempt was made to examine how far the concept of equity in health is understood and accepted; whether cities had moved further from a disease/medical model to looking at the social determinants of inequalities in health; how far the HC project contributed to cities determining the extent and causes of inequalities in health; what efforts were made to tackle such inequalities and how far inequalities in health may have increased or decreased during Phase V. A broader range of resources was utilized for this evaluation than in previous phases of the project. These indicated that most cities were definitely looking at the broader determinants. Equality in health was better understood and had been included as a value in a range of city policies. This was facilitated by stronger involvement of the HC project in city planning processes. Although almost half the cities participating had prepared a City Health Profile, only few cities had the necessary local level data to monitor changes in inequalities in health.
Journal of Urban Health, 2011
The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a "natural" or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low-and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.
2018
1School of Public Health, MRC-PHE Centre for Environment and Health, WHO Collaborating Centre on Non-Communicable Disease Surveillance and Epidemiology, Imperial College London,; 2Faculty of Architecture, The University of Hong Kong, Hong Kong, China; 3Public Health England, London, UK; 4James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh; 5Centre for Urban Management Studies, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Accra, Ghana; 6LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China