1. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 1 |1 | Urban Health Equity Assessment and Response Tool – Urban HEART Urban Health Equity Assessment and Response Tool – Urban HEART Megumi Kano, DrPH WHO Centre for Health Development

2. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 2 |2 | Overview WHO Kobe Centre and its urban health equity agenda Urban HEART –The tool and its development –Case examples from pilot study sites –Dissemination and scale-up plan for 2010-2011 WHO Campaign Year for Urbanization and Health

3. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 3 |3 | WHO Kobe Centre and Urban Health Equity WHO lead for initiatives on urban health equity 2005-07 Hub of the Knowledge Network on Urban Settings 2008 Report to the Commission on Social Determinants of Health 2010 Leading the WHO Campaign for Urban Health

4. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 4 |4 | Programme Areas Urbanization and Health Equity Health Governance Climate Change and Emergency Preparedness Health Equity Impact Assessment Urban HEART

5. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 5 |5 | What is Urban HEART? User-friendly guide to identify health inequities and develop an action plan Assessment component Response component National government Target audiences Mayors, local authorities

6. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 6 |6 | Why use Urban HEART? Urban HEART has primarily been used as a planning tool for decision-makers at national and local levels to: –Assess and monitor inequities in urban health outcomes and social determinants –Identify viable and effective actions to optimize urban health and reduce inequities –Determine priorities and plan for resource allocation

7. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 7 |7 | Six Steps of Urban HEART STEP 1 Build inter- sectoral team STEP 1 Build inter- sectoral team STEP 2 Define local indicators STEP 2 Define local indicators STEP 3 Data collection STEP 3 Data collection STEP 4 Data analysis STEP 4 Data analysis STEP 5 Identify responses STEP 5 Identify responses STEP 6 Prioritize relevant responses STEP 6 Prioritize relevant responses

8. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 8 |8 | Urban HEART Core Indicators

9. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 9 |9 | Health Equity Assessment

10. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 10 | Health Equity Monitoring

11. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 11 | Health Equity Response Example of tobacco control Prevalence of tobacco smoking & Second- hand smoke exposure Prevalence of tobacco smoking & Second- hand smoke exposure Policy domain: Social and human development Strategy A: Urban planning Strategy A: Urban planning Strategy B: Primary health care Strategy B: Primary health care Strategy C: Health equity focus Strategy C: Health equity focus Strategy D: Local agenda Strategy D: Local agenda Strategy E: National agenda Strategy E: National agenda Prioritize an issue based on Assessment Designate tobacco-free areas in the community Create a smoke-free city Put tobacco control higher on the national agenda

12. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 12 | Prioritizing Responses UnfeasibleFeasible Acceptable by affected communities Achievable within a timeframe Likely to reduce inequity Complies with national priorities Unlikely to be cost-effective Insufficient local resources

13. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 13 | Urban HEART Pilot Sites

14. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 14 | Air Quality Assessment Ulaanbaatar, Mongolia District200020012002200320042005200620072008 1+ 20%+ 1%N/A- 17%- 36%-12%- 8%- 71%- 29% 2- 7%+ 35%+ 15%+ 27%+ 70%+ 55%+ 75%+ 41%+ 58% 3- 58%- 35%N/A- 32%+ 23%+ 26%- 1%- 3%+ 123% 4- 15%- 12%+ 20%+ 27%+ 66%+ 105%+ 79%+ 62%+ 75%

15. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 15 | Safe Water and Solid Waste Removal Guarulhos, Brazil Access to Safe WaterSolid Waste Removal Services Coverage

16. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 16 | Social Gradient in Access to Sanitation Jakarta, Indonesia

17. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 17 | Dissemination and Scale-up Policy Brief, Tool Document and User Manual Pilot study reports and evaluation Training workshops in additional countries Urban HEART website Urban Health Equity Metrics development Continuous improvement …

18. 5 th International Academic Conference on Environmental and Occupational Medicine Dujiangyan, Chengdu, People’s Republic of China, 7-10 April 2010 18 | 2010 WHO Campaign Urbanization and Health 7 April - World Health Day Global Report – “Hidden Cities” 15-17 November - Global Forum