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Mesa-Vieira C, Gonzalez-Jaramillo N, Díaz-Ríos C, Pano O, Meyer S, Menassa M, Minder B, Lin V, Franco OH, Frahsa A. Urban Governance, Multisectoral Action, and Civic Engagement for Population Health, Wellbeing, and Equity in Urban Settings: A Systematic Review. Int J Public Health 2023; 68:1605772. [PMID: 37719658 PMCID: PMC10500609 DOI: 10.3389/ijph.2023.1605772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/21/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives: To identify the validated and reliable indicators and tools to assess good governance for population health, wellbeing, and equity in urban settings, and assess processes of multisectoral action and civic engagement as reported by peer-reviewed articles. Methods: We conducted a systematic review searching six databases for observational studies reporting strategies of either urban health, multisectoral action or civic engagement for wellbeing, health, or equity. Results: Out of 8,154 studies initially identified we included 17. From the included studies, 14 presented information about high-income countries. The general population was the main target in most studies. Multisectoral action was the most frequently reported strategy (14 studies). Three studies used Urban Health Equity Assessment and Response Tool (Urban HEART). Health indicators were the most frequently represented (6 studies). Barriers and facilitators for the implementation of participatory health governance strategies were reported in 12 studies. Conclusion: Data on the implementation of participatory health governance strategies has been mainly reported in high-income countries. Updated and reliable data, measured repeatedly, is needed to closely monitor these processes and further develop indicators to assess their impact on population health, wellbeing, and equity.
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Affiliation(s)
- Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Catalina Díaz-Ríos
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Octavio Pano
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sophie Meyer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marilyne Menassa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Vivian Lin
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Borrell C, Palència L, Marí-Dell’Olmo M, Bartoll X, Gotsens M, Pasarín MI, Artazcoz L, Rodríguez-Sanz M, López MJ, Pérez K. A City Surveillance System for Social Health Inequalities: The Case of Barcelona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3536. [PMID: 36834231 PMCID: PMC9961633 DOI: 10.3390/ijerph20043536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. METHODS The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. RESULTS The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. CONCLUSION The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - Marc Marí-Dell’Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - M. Isabel Pasarín
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
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Amri M, Mohamood L, Mansilla C, Barrett K, Bump JB. Conceptual approaches in combating health inequity: A scoping review protocol. PLoS One 2023; 18:e0282858. [PMID: 36920932 PMCID: PMC10016682 DOI: 10.1371/journal.pone.0282858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION What are the different ways in which health equity can be sought through policy and programs? Although there is a central focus on health equity in global and public health, we recognize that stakeholders can understand health equity as taking different approaches and that there is not a single conceptual approach. However, information on conceptual categories of actions to improve health equity and/or reduce health inequity is scarce. Therefore, this study asks the research question: "what conceptual approaches exist in striving for health equity and/or reducing health inequity?" with the aim of presenting a comprehensive overview of approaches. METHODS A scoping review will be undertaken following the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) and in consultation with a research librarian. Both the peer-reviewed and grey literatures will be searched using: Ovid MEDLINE, Scopus, PAIS Index (ProQuest), JSTOR, Canadian Public Documents Collection, the World Health Organization IRIS (Institutional Repository for Information Sharing), and supplemented by a Google Advanced Search. Screening will be conducted by two independent reviewers and data will be charted, coded, and narratively synthesized. DISCUSSION We anticipate developing a foundational document compiling categories of approaches and discussing the nuances inherent in each conceptualization to promote clarified and united action.
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Affiliation(s)
- Michelle Amri
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- * E-mail:
| | - Liban Mohamood
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Cristián Mansilla
- McMaster Health Forum, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Kathryn Barrett
- University of Toronto Scarborough Library, Scarborough, ON, Canada
| | - Jesse B. Bump
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Couso-Viana S, Bentué-Martínez C, Delgado-Martín MV, Cabeza-Irigoyen E, León-Latre M, Concheiro-Guisán A, Rodríguez-Álvarez MX, Román-Rodríguez M, Roca-Pardiñas J, Zúñiga-Antón M, García-Flaquer A, Pericàs-Pulido P, Sánchez-Recio R, González-Álvarez B, Rodríguez-Pastoriza S, Gómez-Gómez I, Motrico E, Jiménez-Murillo JL, Rabanaque I, Clavería A. Analysis of the impact of social determinants and primary care morbidity on population health outcomes by combining big data: A research protocol. Front Med (Lausanne) 2022; 9:1012437. [PMID: 36590942 PMCID: PMC9800778 DOI: 10.3389/fmed.2022.1012437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background In recent years, different tools have been developed to facilitate analysis of social determinants of health (SDH) and apply this to health policy. The possibility of generating predictive models of health outcomes which combine a wide range of socioeconomic indicators with health problems is an approach that is receiving increasing attention. Our objectives are twofold: (1) to predict population health outcomes measured as hospital morbidity, taking primary care (PC) morbidity adjusted for SDH as predictors; and (2) to analyze the geographic variability of the impact of SDH-adjusted PC morbidity on hospital morbidity, by combining data sourced from electronic health records and selected operations of the National Statistics Institute (Instituto Nacional de Estadística/INE). Methods The following will be conducted: a qualitative study to select socio-health indicators using RAND methodology in accordance with SDH frameworks, based on indicators published by the INE in selected operations; and a quantitative study combining two large databases drawn from different Spain's Autonomous Regions (ARs) to enable hospital morbidity to be ascertained, i.e., PC electronic health records and the minimum basic data set (MBDS) for hospital discharges. These will be linked to socioeconomic indicators, previously selected by geographic unit. The outcome variable will be hospital morbidity, and the independent variables will be age, sex, PC morbidity, geographic unit, and socioeconomic indicators. Analysis To achieve the first objective, predictive models will be used, with a test-and-training technique, fitting multiple logistic regression models. In the analysis of geographic variability, penalized mixed models will be used, with geographic units considered as random effects and independent predictors as fixed effects. Discussion This study seeks to show the relationship between SDH and population health, and the geographic differences determined by such determinants. The main limitations are posed by the collection of data for healthcare as opposed to research purposes, and the time lag between collection and publication of data, sampling errors and missing data in registries and surveys. The main strength lies in the project's multidisciplinary nature (family medicine, pediatrics, public health, nursing, psychology, engineering, geography).
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Affiliation(s)
- Sabela Couso-Viana
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Carmen Bentué-Martínez
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - María Victoria Delgado-Martín
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain,Moaña Health Center, Vigo Area, SERGAS, Vigo, Spain,*Correspondence: María Victoria Delgado-Martín,
| | - Elena Cabeza-Irigoyen
- Health Promotion Service, Ministry of Health and Consumer Affairs, Public Health Research Group (Grup d’Investigació en Salud Pública/GISPIB), Balearic Islands Health Research Institute (IdISBa), Balearic Islands, Spain
| | | | - Ana Concheiro-Guisán
- Department of Pediatrics, Álvaro Cunqueiro Hospital, SERGAS, Vigo, Spain,Rare Diseases and Pediatric Medicine Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - María Xosé Rodríguez-Álvarez
- Department of Statistics and Operations Research, Biomedical Research Center (Centro de Investigacións Biomédicas/CINBIO), University of Vigo, Vigo, Spain,Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Vigo, Spain
| | - Miguel Román-Rodríguez
- Primary Care Management of Mallorca, Balearic Islands Health Research Institute, Balearic Islands, Spain
| | - Javier Roca-Pardiñas
- Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Vigo, Spain,Department of Statistics and Operations Research, University of Vigo, Vigo, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain
| | - María Zúñiga-Antón
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - Ana García-Flaquer
- Balearic Islands Health Research Platform (Plataforma de Investigación en Información en Salud de Las Islas Baleares/PRISIB), Balearic Islands, Spain
| | - Pau Pericàs-Pulido
- Balearic Islands Health Research Platform (Plataforma de Investigación en Información en Salud de Las Islas Baleares/PRISIB), Balearic Islands, Spain
| | - Raquel Sánchez-Recio
- Aragon Health Services Research Group (Grupo de Investigación en Servicios Sanitarios de Aragón/GRISSA), Aragon, Spain,Aragonese Institute of Health, Aragon, Spain
| | | | - Sara Rodríguez-Pastoriza
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Irene Gómez-Gómez
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain,Department of Psychology, Loyola University Andalusia, Seville, Spain
| | - Emma Motrico
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain,Department of Psychology, Loyola University Andalusia, Seville, Spain
| | | | - Isabel Rabanaque
- Department of Geography, Aragon University Environmental Sciences Research Institute (Instituto Universitario de Investigación en Ciencias Ambientales de Aragón/IUCA), University of Zaragoza, Zaragoza, Spain
| | - Ana Clavería
- I-Saúde Group, South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), SERGAS-UVIGO, Vigo, Spain,Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Galicia, Spain
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Amri M, O’Campo P, Enright T, Siddiqi A, Di Ruggiero E, Bump JB. Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative. BMC Public Health 2022; 22:1989. [PMID: 36316679 PMCID: PMC9620663 DOI: 10.1186/s12889-022-14395-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.
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Affiliation(s)
- Michelle Amri
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Patricia O’Campo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, M5B 1T8 Toronto, ON Canada
| | - Theresa Enright
- grid.17063.330000 0001 2157 2938Department of Political Science, University of Toronto, 100 St George Street, M5S 3G3 Toronto, ON Canada
| | - Arjumand Siddiqi
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Jesse Boardman Bump
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.7914.b0000 0004 1936 7443Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Pérez G, Pasarín MI, Puig-Barrachina V, Pérez K, Rodríguez-Sanz M, Artazcoz L, Borrell C. Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency. Int J Equity Health 2022; 21:129. [PMID: 36088347 PMCID: PMC9463672 DOI: 10.1186/s12939-022-01724-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. Methods The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). Results Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. Conclusions The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.
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Urban HEART Detroit: the Application of a Health Equity Assessment Tool. J Urban Health 2021; 98:146-157. [PMID: 33398612 PMCID: PMC7781400 DOI: 10.1007/s11524-020-00503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit's health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.
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Freitas Â, Rodrigues TC, Santana P. Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project. J Urban Health 2020; 97:857-875. [PMID: 32860097 PMCID: PMC7454139 DOI: 10.1007/s11524-020-00471-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city-the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed to mitigate negative impacts and enhance positive impacts. Within the scope of the EU-funded project EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY), the City of Lisbon was selected as a case study to apply a multidimensional and participatory assessment approach of urban health whose purpose was to inform the evaluation of policies and interventions with potential to address local health gaps. In this paper, we present the set of indicators identified as drivers of urban health inequities within the City of Lisbon, exploring the added value of using a spatial indicator framework together with a participation process to orient a place-based assessment and to inform policies aimed at reducing health inequities. Two workshops with a panel of local stakeholders from health and social care services, municipal departments (e.g. urban planning, environment, social rights and education) and non-governmental and community-based organizations were organized. The aim was to engage local stakeholders to identify locally critical situations and select indicators of health determinants from a spatial equity perspective. To support the analysis, a matrix of 46 indicators of health determinants, with data disaggregated at the city neighbourhood scale, was constructed and was complemented with maps. The panel identified critical situations for urban health equity in 28 indicators across eight intervention axes: economic conditions, social protection and security; education; demographic change; lifestyles and behaviours; physical environment; built environment; road safety and healthcare resources and performance. The geographical distribution of identified critical situations showed that all 24 city neighbourhoods presented one or more problems. A group of neighbourhoods systematically perform worse in most indicators from different intervention axes, requiring not only priority action but mainly a multi- and intersectoral policy response. The indicator matrices and maps have provided a snapshot of urban inequities across different intervention axes, making a compelling argument for boosting intersectoral work across municipal departments and local stakeholders in the City of Lisbon. This study, by integrating local evidence in combination with social elements, pinpoints the importance of a place-based approach for assessing urban health equity.
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Affiliation(s)
- Ângela Freitas
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Teresa C Rodrigues
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Paula Santana
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
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Daban F, Pasarín MI, Borrell C, Artazcoz L, Pérez A, Fernández A, Porthé V, Díez E. Barcelona Salut als Barris: Twelve years' experience of tackling social health inequalities through community-based interventions. GACETA SANITARIA 2020; 35:282-288. [PMID: 32527681 DOI: 10.1016/j.gaceta.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work.
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Affiliation(s)
- Ferran Daban
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Anna Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Ana Fernández
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Victoria Porthé
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Elia Díez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Oliver-Parra A, González-Viana A. [Facilitating community oriented primary health care. Basic health indicators by small areas in Catalonia]. GACETA SANITARIA 2019; 34:204-207. [PMID: 31488325 DOI: 10.1016/j.gaceta.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
Health depends mostly on factors that lay outside the health system, such as socioeconomic determinants. Intersectorality and participation are key elements for an integrated care person and community centred. In Catalonia, the National Primary Health and Community Strategy aims to reinforce primary health care, so that it becomes the backbone of the health system and with a strong community orientation. To deploy a community oriented primary health care it is important to count with reliable and robust data by small areas. Thirty-eight basic indicators were selected for each of the 370 primary health care in Catalonia. Indicators were calculated and presented following the social determinants model: demographic (4), socioeconomic (3), morbidity (9), mortality (6), lifestyles (4), preventive practices (1), resources and use of health services (9) and physical environment (2). These indicators will allow health professionals to carry out local health assessments in a fast and systematic manner.
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Affiliation(s)
- Alba Oliver-Parra
- Agència de Salut Pública de Catalunya, Departament de Salut, Sub-direcció General de Promoció de la Salut, Generalitat de Catalunya, Barcelona, España
| | - Angelina González-Viana
- Agència de Salut Pública de Catalunya, Departament de Salut, Sub-direcció General de Promoció de la Salut, Generalitat de Catalunya, Barcelona, España.
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- Agència de Salut Pública de Catalunya, Departament de Salut, Sub-direcció General de Promoció de la Salut, Generalitat de Catalunya, Barcelona, España
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Borrell C, Pasarín MI, Díez E, Pérez K, Malmusi D, Pérez G, Artazcoz L. [Health inequalities as a political priority in Barcelona]. GACETA SANITARIA 2019; 34:69-76. [PMID: 31288951 DOI: 10.1016/j.gaceta.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.
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Affiliation(s)
- Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España.
| | - M Isabel Pasarín
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Elia Díez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Davide Malmusi
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Direcció de Serveis de Salut, Ajuntament de Barcelona, Barcelona, España
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España
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Fontcuberta-Famadas M, Serral G, López M, Balfagón P, García-Cid E, Caballé-Gavaldà L. Evaluation of an intervention to improve the management of allergens in school food services in the city of Barcelona. Allergol Immunopathol (Madr) 2018; 46:334-340. [PMID: 29456037 DOI: 10.1016/j.aller.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND An intervention to promote the development of an allergen control plan (ACP) and preventive measures for the management of allergens in school food services was implemented in all schools of Barcelona city over a three-year period (2013-2015) by the public health services. The present study aimed to assess changes regarding the management of food allergens in school food services in Barcelona after an intervention conducted by the public health services of the city. METHODS School meal operators of a random sample of 117 schools were assessed before and after the intervention using a structured questionnaire. The questionnaire collected general information on the students and their demand for special menus, and included 17 closed questions regarding the implementation of specific preventive measures for the management of allergens. Based on these 17 questions, a food safety score was calculated for each school. The improvement in these scores was evaluated. RESULTS The results showed positive increments in the percentage of implementation of 12 of the 17 preventive measures assessed. The percentage of school food services with an implemented ACP increased by 49%. Schools with external and internal food supplies increased their scores by 16.5% and 19.6%, respectively. The greatest improvements were observed in smaller food services and in schools located in districts with low gross household incomes. CONCLUSIONS The intervention was effective in improving school food services' management of allergens and in reducing the differences found among food services in the pre-intervention survey. We must also focus efforts on reducing socio-economic inequalities linked to the management of allergens.
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