Journal of Urban Health

, Volume 95, Issue 5, pp 662–671 | Cite as

Urban HEART Detroit: a Tool To Better Understand and Address Health Equity Gaps in the City

  • R. MehdipanahEmail author
  • A. J. Schulz
  • B. A. Israel
  • C. Gamboa
  • Z. Rowe
  • M. Khan
  • A. Allen


The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.


Urban health Health equity Social determinants of health Health equity assessment Detroit 



We would like to thank the HEP Steering Committee: Chandler Park Conservancy, Detroit Health Department, Detroit Hispanic Development Corporation, Eastside Community Network, Friends of Parkside, Henry Ford Health System, Institute for Population Health, University of Michigan School of Public Health, and community members-at-large, for their contributions to the work described here.


Funding for the study was provided by the World Health Organization Kobe Center in Japan, National Institute on Minority Health and Health Disparities (R24MD001619), National Institute of Environmental Health Sciences (R01 ES022616 and P30ES017885), and Fred A. and Barbara M. Erb Family Foundation.


  1. 1.
    Sugrue TJ. The origins of the urban crisis: race and inequality in postwar Detroit. Princeton, NJ: Princeton University Press; 2014.Google Scholar
  2. 2.
    Schulz AJ, Mentz GB, Sampson N, et al. Race and the distribution of social and physical environmental risk. Bois Rev Soc Sci Res Race. 2016;13(2):285–304. Scholar
  3. 3.
    Farley R. The bankruptcy of Detroit: what role did race play?: the bankruptcy of Detroit. City Community. 2015;14(2):118–37. Scholar
  4. 4.
    Larsen L, Sherman LS, Cole LB, Karwat D, Badiane K, Coseo P. Social justice and sustainability in poor neighborhoods learning and living in Southwest Detroit. J Plan Educ Res. 2014;34(1):5–18. Scholar
  5. 5.
    Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95(4):660–7. Scholar
  6. 6.
    Schulz AJ, Kannan S, Dvonch JT, et al. Social and physical environments and disparities in risk for cardiovascular disease: the healthy environments partnership conceptual model. Environ Health Perspect. 2005;113(12):1817–25.CrossRefGoogle Scholar
  7. 7.
    Schulz AJ, Williams D, Israel BA, et al. Unfair treatment, neighborhood effects, and mental health in the Detroit metropolitan area. J Health Soc Behav. 2000;41(3):314. Scholar
  8. 8.
    Israel BA, Krieger J, Vlahov D, et al. Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle urban research centers. J Urban Health Bull N Y Acad Med. 2006;83(6):1022–40. Scholar
  9. 9.
    Israel BA, Coombe CM, Cheezum RR, et al. Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010;100(11):2094–102. Scholar
  10. 10.
    WHO. Urban HEART Manual. Published 2010. Accessed 18 Dec 2016.
  11. 11.
    Prasad A, Kano M, Dagg KA-M, 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. Scholar
  12. 12.
    Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173–202. Scholar
  13. 13.
    Israel BA, Eng E, Schulz AJ, Parker EA. Chapter 1: introduction to methods for cbpr for health. In: Israel BA, Eng E, Schulz AJ, Parker EA, editors. Methods for Community-Based Participatory Research For Health. 2nd ed. San Francisco: Jossey-Bass; 2013. p. 3–38.Google Scholar
  14. 14.
    Abbey-Lambertz K. 11 stereotypes Detroiters are tired of hearing | The Huffington Post. The Huffington Post. Published March 5, 2015. Accessed 18 Dec 2016.
  15. 15.
    Sahn DE, Stifel D. Exploring alternative measures of welfare in the absence of expenditure data. Rev Income Wealth. 2003;49(4):463–89. Scholar
  16. 16.
    Bureau UC. American Community Survey (ACS). Accessed 22 Dec 2016.
  17. 17.
    US EPA O. 2011 NATA: assessment results. Accessed 22 Dec 2016.
  18. 18.
    Veinot TC, Okullo D. Data Driven Detroit. Neighborhood effects: health outcomes dataset. Ann Arbor, MI: Deep Blue Data; 2016.Google Scholar
  19. 19.
    Lantz PM, House JS, Lepkowski J, Williams DR, Mero R, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. Published 1998. Accessed 19 Dec 2016.
  20. 20.
    Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9. Scholar
  21. 21.
    Asadi-Lari M, Vaez-Mahdavi M, Faghihzadeh S, et al. The application of urban health equity assessment and response tool (Urban HEART) in Tehran; concepts and frameworks. Med J Islam Repub Iran. 2010;24(3):175–85.Google Scholar
  22. 22.
    Centre for Research in Inner City Health. Urban HEART @ Toronto: Technical report/user guide. Centre for Research in Inner City Health. 2014. Accessed 22 Dec 2016.
  23. 23.
    Burgard SA, Seefeldt KS, Zelner S. Housing instability and health: findings from the Michigan recession and recovery study. Soc Sci Med. 2012;75(12):2215–24. Scholar
  24. 24.
    Office of Disease Prevention and Health Promotion. Healthy people 2020: social determinants of health. 2014. Accessed on December 8, 2016.
  25. 25.
    Robert Wood Johnson Foundation. A new way to talk about the social determinants of health. Published 2010. Accessed 22 Dec 2016.
  26. 26.
    Rohe WM, Zandt SV, McCarthy G. Home ownership and access to opportunity. Hous Stud. 2002;17(1):51–61. Scholar
  27. 27.
    Ziol-Guest KM, McKenna CC. Early childhood housing instability and school readiness. Child Dev. 2014;85(1):103–13. Scholar
  28. 28.
    Cannuscio CC, Alley DE, Pagán JA, et al. Housing strain, mortgage foreclosure, and health. Nurs Outlook. 2012;60(3):134–142.e1. Scholar
  29. 29.
    Israel BA, Lantz PM, McGranaghan RJ, Guzman RJ, Lichtenstein R, Rowe Z. Chapter 13: documentation and evaluation of CBPR partnerships: the use of in-depth interviews and closed-ended questionnaires. In: Israel BA, Eng E, Schulz AJ, Parker EA, editors. Methods for Community-Based Participatory Research For Health. 2nd ed. San Francisco: Jossey-Bass; 2013. p. 369–98.Google Scholar
  30. 30.
    Schulz AJ, Israel BA, Lantz PM. Chapter 24: Assessing and strengthening characteristics of effective groups in community based participatory research partnerships. In: Garvin CD, Gutierrez LM, Galinsky MJ, editors. Handbook of Social Work with Groups. New York City: Guilford Press; 2017. p. 433–53.Google Scholar
  31. 31.
    Lasker RD. Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. J Urban Health Bull N Y Acad Med. 2003;80(1):14–60. Scholar

Copyright information

© The New York Academy of Medicine 2017

Authors and Affiliations

  • R. Mehdipanah
    • 1
    Email author
  • A. J. Schulz
    • 1
  • B. A. Israel
    • 1
  • C. Gamboa
    • 1
  • Z. Rowe
    • 2
  • M. Khan
    • 1
  • A. Allen
    • 3
  1. 1.School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Friends of ParksideDetroitUSA
  3. 3.Chandler Park ConservancyDetroitUSA

Personalised recommendations