Roundtable on Urban Living Environment Research (RULER)

Abstract

For 18 months in 2009-2010, the Rockefeller Foundation provided support to establish the Roundtable on Urban Living Environment Research (RULER). Composed of leading experts in population health measurement from a variety of disciplines, sectors, and continents, RULER met for the purpose of reviewing existing methods of measurement for urban health in the context of recent reports from UN agencies on health inequities in urban settings. The audience for this report was identified as international, national, and local governing bodies; civil society; and donor agencies. The goal of the report was to identify gaps in measurement that must be filled in order to assess and evaluate population health in urban settings, especially in informal settlements (or slums) in low- and middle-income countries. Care must be taken to integrate recommendations with existing platforms (e.g., Health Metrics Network, the Institute for Health Metrics and Evaluation) that could incorporate, mature, and sustain efforts to address these gaps and promote effective data for healthy urban management. RULER noted that these existing platforms focus primarily on health outcomes and systems, mainly at the national level. Although substantial reviews of health outcomes and health service measures had been conducted elsewhere, such reviews covered these in an aggregate and perhaps misleading way. For example, some spatial aspects of health inequities, such as those pointed to in the 2008 report from the WHO's Commission on the Social Determinants of Health, received limited attention. If RULER were to focus on health inequities in the urban environment, access to disaggregated data was a priority. RULER observed that some urban health metrics were already available, if not always appreciated and utilized in ongoing efforts (e.g., census data with granular data on households, water, and sanitation but with little attention paid to the spatial dimensions of these data). Other less obvious elements had not exploited the gains realized in spatial measurement technology and techniques (e.g., defining geographic and social urban informal settlement boundaries, classification of population-based amenities and hazards, and innovative spatial measurement of local governance for health). In summary, the RULER team identified three major areas for enhancing measurement to motivate action for urban health-namely, disaggregation of geographic areas for intra-urban risk assessment and action, measures for both social environment and governance, and measures for a better understanding of the implications of the physical (e.g., climate) and built environment for health. The challenge of addressing these elements in resource-poor settings was acknowledged, as was the intensely political nature of urban health metrics. The RULER team went further to identify existing global health metrics structures that could serve as platforms for more granular metrics specific for urban settings.

Metrics in Urban Health: Current Developments and Future Prospects

“…Increased research on the social and built environments has the potential to impact decision making on key topics of public interest, such as air quality, public spaces, transport, and housing. Improved science and methods as well as greater availability and affordability of new data collection technologies are important enabling factors for enhancing the quality of research (110). The research has occasionally been linked to decision making (4), and new models and frameworks are being considered to improve the quality of metrics in the future (13,19).…”

“…However, generating high-quality evidence requires resources that are not always available, especially in LMICs. Over the past decade, international organizations have been emphasizing the relevance of the urban setting in public health, the need to uncover and address health inequities requiring the disaggregation of data at the intraurban level; and the imperative to develop entire domains of measurement to accomplish this goal (6,68,100,106,110,114). Local authorities, academia, and civil society have all emphasized the role of cities in improving public health as well as the imperative to make evidence-based decisions.…”

“…Work with policy makers to link research to decision making by generating credible evidence, a few compelling messages, and demonstrative visual tools for communicating those messages (110). This process will be facilitated by bringing in a diverse group of stakeholders to support the messages, as well as by crafting locally efficient interventions to tackle the issues at hand (118).…”

Complexity and Dynamism from an Urban Health Perspective: a Rationale for a System Dynamics Approach

“…[6][7][8][9] Across several leading urban health conceptual frameworks, complexity is implicit. 6 This is congruent with the perspectives of urban planners and other urban scholars.…”

“…8 External trends may include B… demographic shifts, globalization, climate change, proximal inequities, and decentralization [of national governments].^8 Within cities, dynamic changes occur as well. For example, the movement of different populations in and out the city can result in concentration of poor in some areas and gentrification in others.…”