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.

Structural Funds & Health Gains - 3 workshops - registration open

Entry free - expenses for travel and accommodation can be provided



A post for those of you working in the European Union - but of interest to all

EU Structural Funds (SF) represent almost € 50 billion a year to support the development of poorer regions across Europe. This investment source is made available to improve the infrastructure and socio-economic profile of a region. There are opportunities to use these funds innovatively and to tackle inequalities, target pockets of poverty and assist vulnerable groups. The key challenge is how to make the most of these funding opportunities, ensuring that each Euro contributes towards better health and wellbeing.

A site is being developed that presents a range of resources (case studies, causal pathways etc) to assist this process.

There are three workshops in June. Entry is free and there is assitance with travel and expenses

Register now for the workshops on Structural Funds & Health Gains http://bit.ly/lLthw8 

Climate Change Health Risk Assessment

I'm at a workshop on climate change risk assessment and environmental interventions at the NSW Ministry of Health this morning. It's particularly focused on a climate change health risk assessment that was conducted in the UK and lessons for Australia.

I'll update this post throughout the morning.
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UK Climate Change Risk Assessment
Dr Sotiris Vardoulakis gave an overview of the UK's climate change risk assessment. Some of this headline issues include:

• Increases in flooding, difficulties with water supply, heat effects and heatwaves, and biodiversity impacts and changes to ecosystem services.


• Significant increase in deaths due to heat, particularly by 2080s.


• The main opportunity in the UK is a reduction in cold-related deaths and potentially some scope to increase outdoor physical activity.


• There's quiet a bit of variation in the level of confidence we can have in predicting impacts.


• The risks are not homogenous even within a setting with more limited climatic range like the UK. Different regions face different challenges.


• The public health repsonse to the CCRA included a heat wave response plan and health advice for flooding.


• Air pollution and extreme weather events are well characterised risks. Many other impacts, especially financial and social ones are poorly understood, as are climate tipping points.


• Uncertainty is a critical issue not only in predicting impacts but also in trying to understand the the effectiveness of adaptation methods.

So what does this mean for health and health services?

• What major risks are we failing to take into account? What presumptions are being made? For example work in Hong Kong has found that rates of MI increased during cold periods, which wasn't anticipated.


• In Australia we lack national policy coordination on climate change, unlike the UK.


• There's a genuine risk in linking everything to climate change, e.g. extreme weather events, as these can be misleading.

Health Impact Assessment in the ASEAN Community

Some really interesting presentations and information from the first ASEAN Meeting on Health Impact Assessment held in Thailand in February.