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.
Cohen21 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, 2012Available online at:
http://bit.ly/RWpBFS
“…..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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