this pdf is an assignment on urban HEART ( Urban Health Equity Assessment and Response Tool)

1. S
Urban HEART
Urban Health Equity
Assessment and Response
Tool
CASE STUDY: Gezirat El Warak Giza, Egypt
G DIVYA SRI
2170200224

2. Urban HEART (Urban Health Equity Assessment and Response Tool) 2
INEQUITY IN HEALTH:
A difference in health that is systematic, socially produced (and, therefore, modifiable) and
unfair is an inequity in health
CONCEPTS AND PRINCIPLES
Systematic differences in health are
not distributed randomly but show a
consistent pattern across the
population. One of the most striking
examples is the systematic
differences in health between
different socioeconomic groups.
This difference is, largely produced by
differential social circumstances and
is not biologically determined.
Inequity is unfair because
(a) we know how to reduce inequities with known interventions and to not take action is unjust;
(b) inequities are avoidable and preventable.
EQUITY IN HEALTH
The World Health Organization Constitution, adopted in 1946, asserted then that “the highest
standards of health should be within reach of all, without distinction of race, religion,
political belief, economic or social condition”. Echoing these sentiments more than 60 years
later, equity in health implies that ideally everyone could attain their full health potential and
that no one should be disadvantaged from achieving this potential because of their social
position or other socially determined circumstance.
THREE MAIN APPROACHES TO REDUCE HEALTH INEQUITIES
• targeting disadvantaged population groups or social classes
progress in terms of an improvement in health for the targeted group
only, for example people living in poverty. There is no reference to
improvements in health taking place among the population as a
whole. Any improvement in health of the targeted population can be
considered a success.
.
• narrowing the health gap
starting-point the health of disadvantaged groups relative to the
rest of the population. The focus of action in this category is to
reduce the gap between the worst off in society and the best off –
the inequity in health status between the extremes of the social
scale.
• reducing inequities throughout the whole population
health status tends to decrease with declining socioeconomic
status and is not just an issue of a gap in health between rich and
poor. Therefore, the whole population is taken into consideration,
including middleincome groups, and the goal is to reduce the
inequities by equalizing health opportunities across the
socioeconomic spectrum..

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INTRODUCING URBAN HEART
WHAT IS URBAN HEART?
The Urban Health Equity Assessment and Response Tool (Urban HEART) is a user-friendly
guide for policy- and decision-makers at national and local levels to:
• identify and analyse inequities in health between people living in various parts of cities, or
belonging to different socioeconomic groups within and across cities;
• facilitate decisions on viable and effective strategies, interventions and actions that should be
used to reduce inter- and intra-city health inequities.
Urban HEART has four characteristics that are desirable in such a tool:
(a) it is easy to use;
(b) it is comprehensive and inclusive;
(c) it is operationally feasible and sustainable; and
(d) it links evidence to actions.
WHY SHOULD YOU USE URBAN HEART?
The adoption and use of Urban HEART by national and local governments, community
organizations and urbanized or rapidly urbanizing communities is intended to:
• guide policy-makers and key stakeholders to achieve a better understanding of the social
determinants of health and their consequences for people living in a city;
• stimulate policy-makers, programme managers and key stakeholders to make strategic
decisions and prioritize specifi c actions and interventions that are tailored to the needs of
vulnerable and disadvantaged groups in cities;
• assist communities to identify gaps, priorities and required interventions to promote health
equity;
• support programme managers in improving intersectoral collaboration and communication
strategies relating to the social determinants of health.
WHAT IS URBAN HEART EXPECTED TO ACHIEVE?
• local and national authorities equipped with relevant evidence to inform important decisions
related to prioritization and resource allocation;
• communities mobilized and empowered to promote health equity;
• multiple sectors engaged in addressing common goals, including the promotion of health
equity;
• people living in cities with better health and social status, and reduced inequities in health
between population groups.
The tool is based on three essential elements:
•Sound evidence: reliable, representative and comparable data, disaggregated by sex, age,
socio-economic status, major geographical or administrative region, and ethnicity, as
appropriate
•Intersectoral action for health: building relationships beyond the health sector in order to
influence a broad range of health determinants – in particular, working with other government
sectors (e.g., education, transport and public works), community groups and nongovernmental
organizations
•Community participation: involving community members in all aspects of the process, from
planning, designing and implementing interventions to helping ensure that these efforts are
learned from and sustained beyond the initial phase.
Urban HEART (Urban Health Equity Assessment and Response Tool)

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• It comprises of four phases: assessment, response, policy and programme.
• Monitoring and evaluation take place during each phase.
assessment phase: Urban health inequities are identified in the assessment phase. Evidence
gathered at this stage forms the basis for raising awareness, determining solutions and
promoting action.
response stage: involves identifying appropriate responses, designating key actors, defining
goals and establishing targets. This is an opportunity to engage all relevant sectors and
communities in setting the agenda – determining which policies, programmes and projects
should be introduced, continued, expanded, improved, changed or stopped to achieve equity
goals.
PLANNING AND IMPLEMENTATION CYCLE
policy stage: the most relevant interventions are
prioritized and budgeted to ensure that they
become part of the local government policymaking
process. Success is measured by the laws,
programmes and interventions implemented.
Programme implementation: hinges on resources
and time frames determined by local authorities.
Health sector programmes implementing pro-
equity health policies are complemented by other
sectors’ actions to bring about health equity.
Monitoring and evaluation encompass both process
and outcomes.
Core indicators
Indicators measuring selected health outcomes and social determinants for different urban
population groups form the basis of the assessment component of Urban HEART. Indicators fall
into two main categories: health outcomes (shown in blue) and social determinants of health
(shown in grey). Twelve core indicators are used across all Urban HEART schemes, allowing
comparison across cities and countries.
Embedding Urban HEART
Urban HEART is primarily a tool to enhance current interventions as part of existing national
and local health planning and programme frameworks. The chosen health equity solutions
should be results-focused, cost-effective and timely; use available local resources where
possible; ensure broad support among affected communities; and comply with national
priorities. Intervention strategies include incorporating health in urban planning and
development, strengthening the role of urban primary health care and promoting an emphasis
on health equity.
Urban HEART (Urban Health Equity Assessment and Response Tool)

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CASE STUDY
Socioeconomic determinants and health status in Gezirat El Warak Giza, Egypt, 2012
Why Urban HEART in Gezirat El Warak?
Gezirat El Warak island is a residential slum area located in the River Nile in Giza Governorate.
It has relatively poor access to quality health care services (secondary and tertiary), water or
sanitation, and uses a trench sewage disposal system. The island is reached by ferry that stops
working after 8 p.m. On the island the main forms of transportation are tok tok or animals due
to the extremely narrow streets.
Objectives of the project
•Assess the health determinants that affect the
population’s health
•Compare the social determinants of health of Gezirat El
Warak with the national standards
•Determine the gap in health equity between Gezirat El
Warak and the national level.
Process
An orientation workshop was held on 30 June 2011 to brief
stakeholders about the Urban HEART concept and
methodology in Gezirat El Warak. During July 2011, a door-
to-door household survey was conducted and heads of
households interviewed using the survey questionnaire.
The process was conducted with government and
community support and supported technically by the
World Health Organization, Country Office for Egypt.
Urban HEART (Urban Health Equity Assessment and Response Tool)

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Results
•Red indicates a more than 20% difference in performance compared to national level (>20% diff.)
•Yellow indicates a less than 20% performance compared to national level (<20% difference)
•Green indicates good or similar performance compared to national level
Future directions
• Based on results, city planners need to pay more attention to people’s lifestyles in order to
support healthy behaviours, for ex: designation of no-smoking areas, factors to improve food
safety, and provision of infrastructure to support physical activity, among other things.
• Focus needs to be maintained on access to quality primary health care services and
maintaining current immunization coverage.
• The local authorities need to improve environmental health, including access to water,
sanitation and local transportation facilities.
• Joint efforts between different
• stakeholders are needed to increase the literacy rate among adults, this being an important
social determinant of health.
The following strategies may be considered to support these directions:
❑ •Strengthening community ownership at all stages of planning, implementation and monitoring
❑ •Partnership enhancement and resource mobilization
❑ •Effective sustainable collaboration between the various development sectors, including
health, education, municipality, social welfare, transportation and environment, among others.
Urban HEART (Urban Health Equity Assessment and Response Tool)