Urban Health, The Context: Literature, networks, indicators

1
Urban Health, The ContextLiterature, networks,
indicators

• Erik van Ameijden, Kaspar Bams
• Epidemiology and Information Department, Utrecht
  Municipal Health Service, The Netherlands

2
Objectives work package 4

• Concept of urban health (literature review)
• Inventory of major international collaborative
  actions
• Inventory and selection of urban health indicators

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What is urban health?

• urban health concerns itself with the
  determinants of health and diseases in urban
  areas and with the urban context itself as the
  exposure of interest Galea Vlahov, 2005
• Urban health is public health specific for cities
  (Bams Ameijden, 2007)

4
Urban health has legitimacy as a separate
discipline for policy and research

• High and increasing numbers of people living in
  cities
• Some diseases more important (e.g. AIDS, asthma,
  psychosocial problems)
• Some environmental problems more important (e.g.
  water quality, housing conditions, air pollution)
• Risk groups can be different in cities
• Problems heap up in urban areas, cities as centre
  innovation
• Monitoring in cities is more complex migration,
  diversity (socio-economic, ethnicity), hidden
  populations (e.g. drug users, homeless)
• Health policy and practice different actors and
  possibilities
• Between-city comparisons for benchmarking needed
  

5
Major international collaborative
actions

• Possibilities for collaboration on
• Source for indicators and definitions ECHI,
  Urban Audit, WHO Healthy cities
• Definition of urban area Urban Audit?
• Data collection Urban Audit
• Dissemination results EUPHIX, Urban Audit
• Communication results e.g. European Urban
  Knowledge Network (URBACT, EUROCITIES)

6
International collaborative actions, lessons
learned

• From e.g. Isare, Megapoles, Urban Audit
• Possible to gather comparative regional data on
  the European level
• Time consuming to shape and maintain
  infrastructure, choose and implement indicators
• Importance of tight and widely accepted
  definitions
• Importance of a network of local correspondents
  (not all data are accessible on national level)
• Some indicators remain not well comparable

7
Steps development UH indicator set

• Develop UH indicator model
• ECHI short-list as starting point
• Search scientific / grey literature, political
  documents identify important UH themes
• Specify specific criteria selection indicators
• Discuss resulting set with experts, adapt
• Later adaptation in other WP's feedback
  participating cities, data availability

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EC Model for study of
urban health
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Inventory of main health themes

• National level EU countries similar themes
• Specific main themes for Urban level
• Socioeconomic inequalities/ social disparities
• Risk groups migration, marginalized populations
  (homeless people, sexual minority groups)
• Lifestyle overweight, physical exercise, smoking
• Environmental issues pollution, population
  density, green space, noise annoyance
• Health insurance
• Mental health

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Selection of indicators, specific
criteria

• relevant for local policy level, easy to
  understand, intervenable
• No overlap in the aims of indicators
• Four domains of Lalonde sufficiently represented
  (demographic and socio-economic situation, health
  systems, health determinants, and health status)
• Methodological criteria (whether a valid,
  reliable and sensitive definition was available)
  Existing definitions ECHI long-list, Urban
  Audit, Megapoles, WHO, OECD
• Total number of 50

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Selection of indicators, results

• 36 from the 80 shortlist indicators selected for
  the Euro-URHIS indicator list.
• 14 extra special urban indicators
• Methodological criteria (valid, reliable and
  sensitive definition available)
• Some non-selected indicators are nevertheless
  essential, e.g. physical activity and nutrition.
  However no appropriate definitions have been
  found for these indicators

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Conclusions

• Urban health is comprehensive and as such
  difficult to define
• The concept has a legitimacy on its own
• Possible to gather comparative regional data on
  the European level, but time consuming
• Many possibilities to collaborate with existing
  international actions
• Possible to develop an indicator set, but for
  several important indicators appropriate
  definitions are lacking

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• Thank your for your attention
• presentation is open for discussion