The Experience of Implementing Urban HEART Barcelona: a Tool for Action
- 124 Downloads
Urban Health Equity Assessment and Response Tool (HEART) is a tool developed by the World Health Organization whose objective is to provide evidence on urban health inequalities so as to help to decide the best interventions aimed to promote urban health equity. The aim of this paper is to describe the experience of implementing Urban HEART in Barcelona city, both the adaptation of Urban HEART to the city of Barcelona, its use as a means of identifying and monitoring health inequalities among city neighbourhoods, and the difficulties and barriers encountered throughout the process. Although ASPB public health technicians participated in the Urban HEART Advisory Group, had large experience in health inequalities analysis and research and showed interest in implementing the tool, it was not until 2015, when the city council was governed by a new left-wing party for which reducing health inequalities was a priority that Urban HEART could be used. A provisional matrix was developed, including both health and health determinant indicators, which allowed to show how some neighbourhoods in the city systematically fare worse for most of the indicators while others systematically fare better. It also allowed to identify 18 neighbourhoods—those which fared worse in most indicators—which were considered a priority for intervention, which entered the Health in the Barcelona Neighbourhoods programme and the Neighbourhoods Plan. This provisional version was reviewed and improved by the Urban HEART Barcelona Working Group. Technicians with experience in public health and/or in indicator and database management were asked to indicate suitability and relevance from a list of potential indicators. The definitive Urban HEART Barcelona version included 15 indicators from the five Urban HEART domains and improved the previous version in several requirements. Several barriers were encountered, such as having to estimate indicators in scarcely populated areas or finding adequate indicators for the physical context domain. In conclusion, the Urban HEART tool allowed to identify urban inequalities in the city of Barcelona and to include health inequalities in the public debate. It also allowed to reinforce the community health programme Health in the Barcelona Neighbourhoods as well as other city programmes aimed at reducing health inequalities. A strong political will is essential to place health inequalities in the political agenda and implement policies to tackle them.
KeywordsUrban health Social determinants of health Public health surveillance Health status indicators Health policy Health inequalities Small-area analysis
Urban HEART Barcelona Working Group (in alphabetical order): M. Jesús Calvo, Berta Cormenzana, Imma Cortés, Èlia Diez, Cynthia Echave, Albert Espelt, Patrícia G. de Olalla, Josep Gòmez, Ana M. Novoa, Montserrat Pallarès, Glòria Pérez, Maica Rodríguez-Sanz
- 4.World Health Organization. Urban HEART: urban health equity assessment and response tool: user manual. Kobe: World Health Organization; 2010.Google Scholar
- 5.World Health Organization. Urban HEART: urban health equity assessment and response tool. Kobe: World Health Organization; 2010.Google Scholar
- 6.Basweti Nyasani I. Kenya’s experience on urban health issues. Final report on the Urban HEART pilot-testing project. http://www.who.int/kobe_centre/measuring/urbanheart/nakuru_urbanheart_city_report.pdf. Published 2009. Accessed 2 Dec 2016.
- 7.Socorro De Los Santos M. Report on documentation and evaluation of Urban HEART pilot in the Philippines. 2013. http://www.who.int/kobe_centre/publications/Philippines.pdf. Accessed 13 Oct 2017.
- 8.Prasad A, Kano M, Dagg KAM, et al. Prioritizing action on health inequities in cities: an evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa. Soc Sci Med. 2015;145:237–42. doi: 10.1016/j.socscimed.2015.09.031.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Asadi-lari M, Vaez-mahdavi MR, Faghihzadeh S, et al. The application of urban health equity assessment and response tool (Urban HEART) in Tehran; concepts and framework. Med J Islam Repub Iran. 2010;24(3):175–85.Google Scholar
- 11.Centre for Research in Inner City Health Toronto. Urban HEART @Toronto: technical report/user guide. Toronto; Centre for Research in Inner City Health Toronto; 2014.Google Scholar
- 15.Arias A, Rebagliato M, Palumbo MA, et al. Health inequalities in Barcelona and Valencia. Med Clin (Barc). 1993;100(8):281–7.Google Scholar
- 23.Marí-Dell’Olmo M, Rodríguez-Sanz M, Garcia-Olalla P, et al. Individual and community-level effects in the socioeconomic inequalities of AIDS-related mortality in an urban area of southern Europe. J Epidemiol Community Health. 2007;61(3):232–40. doi: 10.1136/jech.2006.048017.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Borrell C, Villalbí J, Díez E, Brugal M, Benach J. Municipal policies. The example of Barcelona. In: e, Bakker M, eds. Reducing inequalities in health: a European perspective. Ed. Outledge; 2002.Google Scholar
- 37.Ajuntament de Barcelona. Mesura de Govern d’Acció Conjunta per La Reducció de Les Desigualtats Socials En Salut. Barcelona: Ajuntament de Barcelona; 2015.Google Scholar
- 38.Hanlon J, Pickett G. Public health administration and practice. 8th ed. St. Louis: Mirror/Moshy College Publishing; 1984.Google Scholar
- 39.Agència de Salut Pública de Barcelona. La Salut a Barcelona 2014. Barcelona: Agència de Salut Pública de Barcelona; 2015.Google Scholar
- 40.Agència de Salut Pública de Barcelona. Barcelona Salut Als Barris. Programa d’intervencions comunitàries per reduir les desigualtats en Salut. memòria d’Activitat 2016. Barcelona: Agència de Salut Pública de Barcelona; 2017.Google Scholar
- 44.Pan American Health Organization. Road Map for the Plan of Action on Health in All Policies. Washington DC: Pan American Health Organization; 2016.Google Scholar
- 45.Institute for State and Local Governance. Equality indicators. http://equalityindicators.org/ (2015). Accessed 9 Nov 2016.
- 47.Martí-Pastor M, García de Olalla P, Barberá M-J, et al. Epidemiology of infections by HIV, syphilis, gonorrhea and lymphogranuloma venereum in Barcelona City: a population-based incidence study. BMC Public Health. 2015;15(1):1015. doi: 10.1186/s12889-015-2344-7.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.World Health Organization. Handbook on health inequality monitoring: with a special focus on low- and middle-income countries. Geneva: World Health Organization; 2013.Google Scholar
- 50.Canadian Institute for Health Information. Health inequalities interactive tool. 1996–2016. https://www.cihi.ca/en/factors-influencing-health/socio-economic/health-inequalities-interactive-tool. Accessed 9 Nov 2016.
- 51.Public Health England. Health profiles. http://fingertips.phe.org.uk/profile/health-profiles. Accessed 9 Nov 2016.
- 52.Agència de Salut Pública de Barcelona. InfoBarris BCN. www.aspb.cat/infobarris. Accessed 9 Nov 2016.
- 53.Communities Count. Social and health indicators across King County. 2012. http://www.communitiescount.org/. Accessed 9 Nov 2016.