WHO Urban HEART Consultation Day 1

I've been invited to participate in a WHO Consultation on Urban HEART in Kobe. This is a post on some of the issues discussed on Day 1, with some of my thoughts and reflections scattered throughout. There are also posts on Day 2 and Day 3.

Urban HEART grew out of the Commission on the Social Determinants of Health's work and dates back to 2007. Early activity on piloting and developing a tool were led by a few countries, notably Iran. The final report from the CSDOH gave further impetus and led to more piloting of Urban HEART in more cities. After piloting Urban HEART was extensively reviewed and Version 1 was published in 2010.

Urban HEART is conceptualised by WHO as a tool for assessment and response to health equity issues at the city level. Urban HEART was designed to meet four criteria:

• ease of use
• comprehensive and inclusive
• feasible and sustainable
• links evidence to action

It's a stepwise process with a lot of similarities to HIA. In contrast to HIA it doesn't need a proposal (even a general one or options) to assess. Rather it allows municipalities to identify issues for action and responses at the city level, and in that way it's more like a needs assessment or planning activity. It's useful where some willingness to act on health already exists, so Healthy Cities is a useful basis for action. Higher-order support is always required (which may be less true for HIA?).

Data that informs Urban HEART is almost always spread across agencies - no single one holds or reports on even the core indicators. This means multiple permissions and interagency liaison is often required, which reiterates the need for higher-order permission and negotiation at the earliest stages. Whilst this is undoubtedly desirable for HIAs as well it hasn't always been possible in my experience and HIAs often fly under the radar, at least in the early stages. I'm not sure that would be possible for Urban HEART but I'm not sure that's a bad thing. The under-the-radar HIAs I've been involved in have often encountered resistance when their recommendations are presented. A clear, unambiguous mandate and imprimatur as a basis for proceeding isn't a bad thing.

A survey of Consultation participants that was conducted in advance found that most participants thought Urban HEART works well overall, is easy to use and successfully links evidence to action, but is less successful at being comprehensive and organisationally sustainable.

Case studies from the City of Paranaque in the Philippines, Tehran in Iran and Indore in India provided a range of useful, practical lessons on the use of Urban HEART (and they were quite inspirational). The Inore case in particular modified the indicators in a way to suit the local context, in their case by ensuring that the indicators were all meaningful and comprehensible to anyone, from residents to national bureaucrats. The case studies also highlighted the need for Urban HEART to not be a one-off activity but as an activity that needs to be revisited/undertaken semi-regularly.

Labour Migration: opportunities and challenges for mountain livelihoods

“While working in Hong Kong I experienced many things – the way people treat a dependent or independent woman. I have gained much experience and my confidence has grown. Now, I have a say in decision-making at home. My husband does not shout at me. I have bought a piece of land and four rickshaws and I am creating a means of livelihood for four other families...”.
Sushila Rai, a Nepalese migrant domestic worker, (Jolly and Reeves 2005, in ICIMOD Summer 2011 periodical)

The latest edition of the International Centre for Integrated Mountain Development Periodical Summer 2011 focuses on:

• labour migration in the Himalayas and Nepal a very interesting topic evidencing the positive and negative economic, social and environmental impacts of labour migration in mountain communities;
• impact of environmental change on human migration;
• internal and international migration in the Peruvian Andes;
• feminisation, ageing of agriculture and farmer's changing livlihoods in South Western China; and
• the use of remittances in natural or political crises in Pakistan.

My highlights are the many quotes of people that ICIMOD have talked to.

“We are dependent on agriculture, which is totally dependent on good weather conditions. The biggest problem we face is food insecurity. If the weather was good, with timely rain and better food security, we would never opt to migrate. Why would we want to leave our families and travel to another place and work like animals?”
Village Development Committee (VDC) Secretary, Dailekh district, Nepal (ICIMOD, unpublished)

Click here to download the periodical.

Hat tip: Loreley Fortuny via IAIA Connect.