Top

Published in:

01-10-2018

The Experience of Implementing Urban HEART Barcelona: a Tool for Action

Authors: Ana M. Novoa, Glòria Pérez, Albert Espelt, Cynthia Echave, Patricia G. de Olalla, M. Jesús Calvo, Maribel Pasarín, Èlia Diez, Carme Borrell, 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, Urban HEART Barcelona Working Group

Published in: Journal of Urban Health | Issue 5/2018

Abstract

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.

Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–45.CrossRefPubMed

Starfield B. State of the art in research on equity in health. J Health Polit Policy Law. 2006;31(1):11–32. doi:10.1215/03616878-31-1-11.CrossRefPubMed

Espelt A, Continente X, Domingo-Salvany A, et al. La vigilancia de los determinantes sociales de la salud. Gac Sanit. 2016;30:38–44. doi:10.1016/j.gaceta.2016.05.011.CrossRefPubMed

World Health Organization. Urban HEART: urban health equity assessment and response tool: user manual. Kobe: World Health Organization; 2010.

World Health Organization. Urban HEART: urban health equity assessment and response tool. Kobe: World Health Organization; 2010.

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.

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.

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.CrossRefPubMedPubMedCentral

Prasad A, Groot AM, et al. Linking evidence to action on social determinants of health using Urban Heart in the Americas. Rev Panam Salud Publica. 2013;34(6):407–15.PubMed

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.

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.

12.

Borrell C, Bartoll X, García-Altés A, Pasarín MI, Piñeiro M, Villalbí JR. Veinticinco años de informes de salud en Barcelona: una apuesta por la transparencia y un instrumento para la acción. Rev Esp Salud Publica. 2011;85(5):449–58. doi:10.1590/S1135-57272011000500004.CrossRefPubMed

13.

Borrell C, Plasència A, Pañella H. Excés de Mortalltat en Una Área Urbana Cèntrica: El Cas de Ciutat Vella a Barcelona. Gac Sanit. 1991;5(27):243–53. doi:10.1016/S0213-9111(91)71076-5.CrossRef

14.

Alonso J, Antó J. Desigualdades de Salud en Barcelona. Gac Sanit. 1988;2:4–12.CrossRef

15.

Arias A, Rebagliato M, Palumbo MA, et al. Health inequalities in Barcelona and Valencia. Med Clin (Barc). 1993;100(8):281–7.

16.

Borrell C, Arias A. Desigualtats de mortalitat en els barris de barcelona, 1983–89. Gac Sanit. 1993;7(38):205–20. doi:10.1016/S0213-9111(93)71153-X.CrossRef

17.

Borrell C, Arias A. Socioeconomic factors and mortality in urban settings: the case of Barcelona, Spain. J Epidemiol Community Health. 1995;49(5):460–5.CrossRefPubMedPubMedCentral

18.

Nebot M, Borrell C, Villalbí JR. Adolescent motherhood and socioeconomic factors. Eur J Pub Health. 1997;7(2):144–8.CrossRef

19.

Pasarín MI, Borrell C, Plasència A. ¿Dos patrones de desigualdades sociales en mortalidad en Barcelona? Gac Sanit. 1999;13(6):431–40. doi:10.1016/S0213-9111(99)71403-2.CrossRefPubMed

20.

Brugal MT, Domingo-Salvany A, Maguire A, Caylà JA, Villalbí JR, Hartnoll R. A small area analysis estimating the prevalence of addiction to opioids in Barcelona, 1993. J Epidemiol Community Health. 1999;53(8):488–94.CrossRefPubMedPubMedCentral

21.

Brugal MT, Borrell C, Díaz-Quijano E, Pasarín MI, García-Olalla P, Villalbí JR. Deprivation and AIDS in a southern European city: different patterns across transmission group. Eur J Pub Health. 2003;13(3):259–61.CrossRef

22.

Pasarin MI, Borrell C, Brugal MT, Díaz-Quijano E. Weighing social and economic determinants related to inequalities in mortality. J Urban Heal Bull New York Acad Med. 2004;81(3):349–62. doi:10.1093/jurban/jth123.CrossRef

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.CrossRefPubMedPubMedCentral

24.

Garcia-Subirats I, Pérez G, Rodríguez-Sanz M, Muñoz DR, Salvador J, Salvador J. Neighborhood inequalities in adverse pregnancy outcomes in an urban setting in Spain: a multilevel approach. J Urban Health. 2012;89(3):447–63. doi:10.1007/s11524-011-9648-4.CrossRefPubMedPubMedCentral

25.

Gotsens M, Marí-Dell’Olmo M, Pérez K, et al. Socioeconomic inequalities in injury mortality in small areas of 15 European cities. Health Place. 2013;24:165–72. doi:10.1016/j.healthplace.2013.09.003.CrossRefPubMed

26.

Borrell C, Mari-Dell’olmo M, Palencia L, et al. Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health. 2014;42(3):245–54. doi:10.1177/1403494814522556.CrossRefPubMed

27.

Marí-Dell’olmo M, Gotsens M, Borrell C, et al. Trends in socioeconomic inequalities in ischemic heart disease mortality in small areas of nine Spanish cities from 1996 to 2007 using smoothed ANOVA. J Urban Health. 2014;91(1):46–61. doi:10.1007/s11524-013-9799-6.CrossRefPubMed

28.

Marí-Dell’Olmo M, Gotsens M, Palència L, et al. Socioeconomic inequalities in cause-specific mortality in 15 European cities. J Epidemiol Community Health. 2015;69(5):432–41. doi:10.1136/jech-2014-204312.CrossRefPubMed

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.

30.

Díez E, Villalbí JR, Benaque A, Nebot M. Inequalities in maternal-child health: impact of an intervention. Gac Sanit. 1995;9(49):224–31.CrossRefPubMed

31.

Díez E, Clavería J, Serra T, et al. Evaluation of a social health intervention among homeless tuberculosis patients. Tuber Lung Dis. 1996;77(5):420–4.CrossRefPubMed

32.

Ospina JE, Orcau À, Millet J-P, Sánchez F, Casals M, Caylà JA. Community health workers improve contact tracing among immigrants with tuberculosis in Barcelona. BMC Public Health. 2012;12(1):158. doi:10.1186/1471-2458-12-158.CrossRefPubMedPubMedCentral

33.

Manzanera R, Torralba L, Brugal M, Armengol R, Solanes P, Villalbí JR. Coping with the toll of heroin: 10 years of the Barcelona Action Plan on Drugs, Spain. Gac Sanit. 2000;14(1):58–66.CrossRefPubMed

34.

Villalbí JR, Guarga A, Pasarín MI, Gil M, Borrell C. Correction of social inequalities in health: reform of primary health care as a strategy. Aten Primaria. 1998;21(1):47–54.PubMed

35.

Mehdipanah R, Rodríguez-Sanz M, Malmusi D, et al. The effects of an urban renewal project on health and health inequalities: a quasi-experimental study in Barcelona. J Epidemiol Community Health. 2014;68(9):811–7. doi:10.1136/jech-2013-203434.CrossRefPubMed

36.

Fuertes C, Pasarín MI, Borrell C, Artazcoz L, Díez E, Group of Health in the Neighbourhoods. Feasibility of a community action model oriented to reduce inequalities in health. Health Policy. 2012;107(2–3):289–95. doi:10.1016/j.healthpol.2012.06.001.CrossRefPubMed

37.

Ajuntament de Barcelona. Mesura de Govern d’Acció Conjunta per La Reducció de Les Desigualtats Socials En Salut. Barcelona: Ajuntament de Barcelona; 2015.

38.

Hanlon J, Pickett G. Public health administration and practice. 8th ed. St. Louis: Mirror/Moshy College Publishing; 1984.

39.

Agència de Salut Pública de Barcelona. La Salut a Barcelona 2014. Barcelona: Agència de Salut Pública de Barcelona; 2015.

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.

41.

Borrell C, Pons-Vigués M, Morrison J, Díez È. Factors and processes influencing health inequalities in urban areas. J Epidemiol Community Health. 2013;67(5):389–91. doi:10.1136/jech-2012-202014.CrossRefPubMed

42.

Morrison J, Pons-Vigués M, Bécares L, et al. Health inequalities in European cities: perceptions and beliefs among local policymakers. BMJ Open. 2014;4(5):e004454. doi:10.1136/bmjopen-2013-004454.CrossRefPubMedPubMedCentral

43.

Morrison J, Pons-Vigués M, Díez E, Pasarin MI, Salas-Nicás S, Borrell C. Perceptions and beliefs of public policymakers in a southern European city. Int J Equity Health. 2015;14(1):18. doi:10.1186/s12939-015-0143-5.CrossRefPubMedPubMedCentral

44.

Pan American Health Organization. Road Map for the Plan of Action on Health in All Policies. Washington DC: Pan American Health Organization; 2016.

45.

Institute for State and Local Governance. Equality indicators. http://equalityindicators.org/ (2015). Accessed 9 Nov 2016.

46.

Besag J, York J, Mollié A. Bayesian image restoration, with two applications in spatial statistics. Ann Inst Stat Math. 1991;43(1):1–20. doi:10.1007/BF00116466.CrossRef

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.CrossRefPubMedPubMedCentral

48.

World Health Organization. Handbook on health inequality monitoring: with a special focus on low- and middle-income countries. Geneva: World Health Organization; 2013.

49.

Hosseinpoor AR, Bergen N, Schlotheuber A, Victora C, Boerma T, Barros AJD. Data resource profile: WHO Health Equity Monitor (HEM). Int J Epidemiol. 2016;45(5):1404–1405e. doi:10.1093/ije/dyw176.CrossRefPubMedPubMedCentral

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.

Title: The Experience of Implementing Urban HEART Barcelona: a Tool for Action
Authors: Ana M. Novoa
Glòria Pérez
Albert Espelt
Cynthia Echave
Patricia G. de Olalla
M. Jesús Calvo
Maribel Pasarín
Èlia Diez
Carme Borrell
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
Urban HEART Barcelona Working Group
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of Urban Health / Issue 5/2018
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI: https://doi.org/10.1007/s11524-017-0194-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Experience of Implementing Urban HEART Barcelona: a Tool for Action

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2018

Avenues of Influence: the Relationship between Health Impact Assessment and Determinants of Health and Health Equity

Tackling Health Inequalities Using Urban HEART in the Sustainable Development Goals Era

Correction to: Avenues of Influence: the Relationship between Health Impact Assessment and Determinants of Health and Health Equity

How Do Racial/Ethnic Groups Differ in Their Use of Neighborhood Parks? Findings from the National Study of Neighborhood Parks

Correction to: Participatory Budgeting: Could It Diminish Health Disparities in the United States?

The Urban Health Equity Assessment and Response Tool (HEART)—a Decade of Development and Implementation