Is evidence-informed urban health planning a myth or reality? Lessons from a qualitative assessment in three Asian cities

Abstract

City governments are well-positioned to effectively address urban health challenges in the context of rapid urbanization in Asia. They require good quality and timely evidence to inform their planning decisions. In this article, we report our analyses of degree of data-informed urban health planning from three Asian cities: Dhaka, Hanoi and Pokhara. Our theoretical framework stems from conceptualizations of evidence-informed policymaking, health planning and policy analysis, and includes: (1) key actors, (2) approaches to developing and implementing urban health plans, (3) characteristics of the data itself. We collected qualitative data between August 2017 and October 2018 using: in-depth interviews with key actors, document review and observations of planning events. Framework approach guided the data analysis. Health is one of competing priorities with multiple plans being produced within each city, using combinations of top-down, bottom-up and fragmented planning approaches. Mostly data from government information systems are used, which were perceived as good quality though often omits the urban poor and migrants. Key common influences on data use include constrained resources and limitations of current planning approaches, alongside data duplication and limited co-ordination within Dhaka’s pluralistic system, limited opportunities for data use in Hanoi and inadequate and incomplete data in Pokhara. City governments have the potential to act as a hub for multi-sectoral planning. Our results highlight the tensions this brings, with health receiving less attention than other sector priorities. A key emerging issue is that data on the most marginalized urban poor and migrants are largely unavailable. Feasible improvements to evidence-informed urban health planning include increasing availability and quality of data particularly on the urban poor, aligning different planning processes, introducing clearer mechanisms for data use, working within the current systemic opportunities and enhancing participation of local communities in urban health planning.

Integrating Health Into the Urban Master Plan of Vic, Barcelona: A Comprehensive Approach

“…Therefore, facilitating the implementation of a health-oriented urban master plan is fundamental to address the existing gap between what is known in public health research and what gets implemented in urban planning practice (Milat et al, 2015). To our knowledge, research on urban health has focused on developing national urban indicators to describe what constitutes a healthy and liveable city (Alderton et al, 2019;Giles-Corti et al, 2014), exploring the capacity of urban policies to create healthy and liveable cities (Giles-Corti et al, 2020), providing quality criteria and validated instruments for evaluating municipal environmental planning in metropolitan areas (Poza-Vilches et al, 2020), understanding the influence of key actors, planning approaches and health-data characteristics to inform urban health planning (Mirzoev et al, 2019), and carrying out health impact assessments to estimate the health gains of city planning interventions like active transportation (Rojas-Rueda et al, 2012). Studies on urban health are predominantly cross-sectional and reviews (Mueller et al, 2015); therefore this study provides a systematic and practical approach to the design of health-enhancing cities (Sallis et al, 2016) with a special focus on medium-sized cities.…”

Ethical Evidence and Policymaking

“…Also, policymaking works on a tight schedule. Problems need swift solutions, so evidence that is good for policymaking must be available immediately or soon (Donnelly et al, 2018;Mirzoev et al, 2019).…”

Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents

“…Contentious relationships between city authorities and slums-dwellers, 27 and scant public health services whose the access needs to be negotiated through a 'middlemen' 28 have been reported in several slums. High out of pocket expenditure of urban residents, limited coverage of health insurance and access to subsidised government schemes, particularly among migrants who frequently lack the required registration documents [29][30][31] are also common. In addition, important differences in costs of accessing healthcare for chronic conditions were found among and within slums in Bangladesh.…”