Thursday, August 16, 2012

[EQ] Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community

Why We Need Urban Health Equity Indicators:
Integrating Science, Policy, and Community

"….discuss the need for urban health equity indicators, which can capture the social determinants of health, track policy decisions, and promote greater urban health equity…."

Jason Corburn1*, Alison K. Cohen2

1 University of California Berkeley, Department of City and Regional Planning & School of Public Health, Berkeley, California, United States of America, 2 University of California Berkeley, School of Public Health, Division of Epidemiology, Berkeley, California, United States of America

PLoS Med 9(8): e1001285. doi:10.1371/journal.pmed.1001285 – August 14, 2012

Available online at:

"…..Measuring the forces that contribute to urban health is one challenge for promoting more healthy and equitable cities. Burden of disease estimates have tended to focus on the whole world or specific geographic regions [4],[5]. These data can mask intra-city differences and global data may not be relevant to inform national or municipal policy making.

Public health has developed metrics for single pathogenic exposures or risk factors, but these measures often ignore both community assets that promote health equity and the cumulative impacts on health from exposure to multiple urban environmental, economic, and social stressors [6],[7]. Recognizing these population health challenges, the United Nations (UN) Commission on Social Determinants of Health (2008) called for "health equity to become a marker of good government performance" and for the UN to "adopt health equity as a core global development goal and use a social determinants of health indicators framework to monitor progress"

More recently, the 2011 World Social Determinants of Health Conference and the Pan-American Health Organization's Urban Health Strategy called for the development of new urban health equity indicators that track the drivers of health inequities across place and time, particularly within a city neighborhood.


In this paper, we briefly outline an approach for promoting greater urban health equity through the drafting and monitoring of indicators. We draw examples from the cities of Richmond, California, and Nairobi, Kenya. More specifically, we argue that participatory indicator processes hold the potential to shape new healthy and equitable urban governance by:

- integrating science with democratic decision making;

- tracking policy decisions that shape the distribution of health outcomes; and

- including protocols for ongoing monitoring and adjusting of measures over time….."

Summary points:

As the urban population of the planet increases and puts new stressors on infrastructure and institutions and
exacerbates economic and social inequalities, public health and other disciplines must find new ways to address urban health equity.

Urban indicator processes focused on health equity can promote new modes of healthy urban governance, where the
formal functions of government combine with science and social movements to define a healthy community and direct policy action.

An inter-related set of urban health equity indicators that capture the social determinants of health, including community assets,
and track policy decisions, can help inform efforts to promote greater urban health equity.

Adaptive management, a strategy used globally by scientists, policy makers, and civil society groups to manage
complex ecological resources, is a potential model for developing and implementing urban health equity indicators.

Urban health equity indicators are lacking and needed within cities of both the global north and south,
but universal sets of indicators may be less useful than context-specific measures accountable to local needs…..



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