Evaluating healthy cities: A scoping review protocol

Healthy city evaluation based on factor analysis-Taking cities in the Guangxi Zhuang Autonomous Region as an example

As urbanization speeds up, the concept of healthy cities is receiving more focus. This article compares Chongzuo and Nanning in Guangxi with Beijing to assess the development gaps in cities in Guangxi. An indicator system for healthy cities was designed from six dimensions-healthy economy, healthy population, healthy healthcare, healthy environment, healthy facilities, and healthy transportation-and 26 secondary indicators, which were selected from 2005 to 2022, and an improved factor analysis was used to synthesize a healthy city index (HCI). The number of factors was determined by combining characteristic roots and the variance contribution rate, and the HCI was weighted using the entropy-weighted Topsis method. A comprehensive evaluation of the urban health status of these cities was conducted. The results showed that extracting six common factors had the greatest effect, with a cumulative variance contribution rate of 93.83%. Chongzuo city scored higher in the field of healthcare. The healthy environment score of Nanning was relatively high, which may be related to continuous increases in green measures. In terms of the healthy economy dimension, Beijing was far ahead. However, in recent years, the healthy economy level in Chongzuo has increased, and the GDP growth rate has ranked among the highest in Guangxi. In addition, the growth rate of healthy facilities in Nanning was relatively fast and has been greater than that in Chongzuo in recent years, which indicates that the Nanning Municipal Government believes urban construction and municipal supporting facilities are highly important. In terms of healthy transportation, Chongzuo and Nanning scored higher than Beijing. This may be because the transportation in these two cities is convenient and the traffic density is more balanced than that in Beijing, thereby reducing traffic congestion. Chongzuo had the highest score for a healthy population, and a steadily growing population provides the city with stable human resources, which helps promote urban economic and social development. Finally, relevant policy recommendations were put forwards to enhance the health level of the cities.

Equity and gender mainstreaming in public policy: A scoping review protocol

BACKGROUND

Despite growing attention paid to health equity and efforts to promote gender mainstreaming-a global strategy to promote gender equality-how policymakers have 'institutionalized' this in their work is less clear. Therefore, this planned scoping review seeks to search the peer-reviewed and grey literature to compile evidence on the ways in which policymakers have routinely or systematically considered equity and/or gender in their work.

METHODS

A scoping review will be undertaken by drawing on the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). With the expert guidance of a research librarian, Ovid MEDLINE, Ovid EMBASE, PAIS Index, and Scopus databases will be searched, in addition to custom Google searches of government documents. The search will be conducted from 1995 and onwards, as there were no hits prior to this date that included the term "gender mainstream*" in these databases. The inclusion criterion is that: (i) texts must provide information on how equity and/or gender has been considered by government officials in the development of public policy in a routine or systematic manner (e.g., descriptive, empirical); (ii) both texts produced by government or not (e.g., commentary about government action) will be included; (iii) there are no restrictions on study design or article type (i.e., commentaries, reports, and other documents, would all be included); and (iv) texts must be published in English due to resource constraints. However, texts that discuss the work of nongovernmental or intergovernmental organizations will be excluded. Data will be charted by: bibliographic information, including the authors, year, and article title; country the text discussed; and a brief summary on the approach taken.

DISCUSSION

This protocol was developed to improve rigour in the study design and to promote transparency by sharing our methods with the broader research community. This protocol will support a scoping review of the ways in which policymakers have routinely or systematically considered equity and/or gender in their work. We will generate findings to inform government efforts to initiate, sustain, and improve gender and equity mainstreaming approaches in policymaking.

Assessing the governance environment for private sector engagement in health in Africa: Results from a multi-country survey

Background

The role of the private sector in health is clear in many countries but engagement can be improved. The World Health Organization (WHO) developed a global strategy in 2020 focused on engaging the private sector in health service delivery through governance in mixed health systems and detailed six governance behaviours to guide its Member States. To operationalise these global ideas into practice, the Regional Office for Africa conducted a multi-country study to understand perceptions around the six governance behaviours. This article examines the perceptions of respondents from 13 African countries on the governance environment for private sector engagement in health.

Methods

Data were collected through an online survey that was distributed to individuals from ministries of health and their partner organisations, private sector institutions and initiatives in countries and development organisations (n = 81) across 13 countries. The survey was based on the following six governance behaviours: build understanding, enable stakeholders, nurture trust, foster relations, align structures and deliver strategy.

Results

Results showed that respondents had mixed perceptions of the governance environment for private sector engagement in health in their respective countries. Although 88% of respondents (n = 63/72) were familiar with the general inclusion of the private sector in national health sector plans, 63% of respondents (n = 45/71) noted there was limited or no integration of the private sector in the health system, and further, 28% of respondents noted there was no private sector reporting in health information systems (n = 19/69). Key opportunities presented in more than one governance behaviour include: (i) increasing private sector engagement in public sector activities, (ii) establishing clear roles and responsibilities through formal partnership agreements, (iii) improving data sharing through shared health information systems, (iv) incentives and subsidies, (v) capacity building, (vi) creating norms, guidelines, and regulations and (vii) conducting joint monitoring and evaluation. Many of these outlined overlapping concepts are not exclusive to one behaviour, thus, it is evident that when targeted, there is the potential to improve numerous governance behaviours. This further reiterates the view that the governance behaviours should be understood as connected and not unrelated areas.

Conclusions

The study provides insight into the perceptions of respondents from select African countries on the governance environment for private sector engagement in health. These findings can inform the development of strategies and interventions to support and enhance private sector engagement in health in the region.

Health Equity Cannot Be Sought Without the Consideration of Racism In Equity-Focused Urban Health Initiatives

Given that racism is present worldwide, we believe it is imperative to address racism in the pursuit of health equity in cities. Despite the strengths of global urban health efforts in improving health equity, these initiatives can be furthered by explicitly considering systemic racism. Because racism is a major contributor to health issues, utilizing critical race theory (CRT) and taking an anti-racist perspective can help key players understand how racial health differences are initiated and sustained, which will subsequently inform solutions in seeking to address urban health inequities. Applying CRT within policymaking can happen in a variety of ways that are explored in this article. Ultimately, by acknowledging and responding to the effect of racism on groups within cities and the increased difficulties racialized minorities face, international players may use their power to transfer data and resources to cities that could benefit from specialized support.

Conceptual approaches in combating health inequity: A scoping review protocol

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.

An umbrella review of intersectoral and multisectoral approaches to health policy

Despite the widespread acceptance of the need for intersectoral and multisectoral approaches, knowledge around how to support, achieve, and sustain multisectoral action is limited. While there have been studies that seek to collate evidence on multisectoral action with a specific focus (e.g., Health in All Policies [HiAP]), we postulated that successes of working cross-sectorally to achieve health goals with one approach can glean insights and perhaps translate to other approaches which work across sectors (i.e., shared insights across HiAP, Healthy Cities, One Health, and other approaches). Thus, the goal of this study is to assemble evidence from systematic approaches to reviewing the literature (e.g., scoping review, systematic review) that collate findings on facilitators/enablers of and barriers to implementing various intersectoral and multisectoral approaches to health, to strengthen understanding of how to best implement health policies that work across sectors, whichever they may be. This umbrella review (i.e., review of reviews) was informed by the PRISMA guidelines for scoping reviews, yielding 10 studies included in this review. Enablers detailed are: (1) systems for liaising and engaged communication; (2) political leadership; (3) shared vision or common goals (win-win strategies); (4) education and access to information; and (5) funding. Barriers detailed were: (1) lack of shared vision across sectors; (2) lack of funding; (3) lack of political leadership; (4) lack of ownership and accountability; and (5) insufficient and unavailable indicators and data. These findings provide a rigorous evidence base for policymakers to inform intersectoral and multisectoral approaches to not only aid in the achievement of goals, such as the Sustainable Development Goals, but to work towards health equity.