Socio-spatial inequities beyond the big city: evaluating the World Health Organization’s Urban HEART tool in a non-metropolitan context

Abstract

ABSTRACTWhere you live matters to your health. In our rapidly urbanizing world, measuring social and health inequities within cities is of increasing importance. In 2010, the World Health Organization created the Urban Health Equity Assessment and Response Tool (Urban HEART) to measure inequities within cities. It has been applied in large metropolitan centers (populations over 1 million) in low- and middle-income countries around the world. In North America, this tool was applied to Canada’s most populated city - Toronto, Ontario (population 2,731,571). However, the feasibility and utility of applying the Urban HEART tool to smaller jurisdictions has not been tested in Canada. Applying the Urban HEART tool to the city of Kingston, Ontario (population 123,798) revealed a complex story, as distinct geographic areas were simultaneously categorized as having optimal and suboptimal conditions depending on the indicator applied. While the Urban HEART provides a less granular analysis compared to other established area-based deprivation indexes, it offers unique indicators and domains that are absent from most others. In this way, the Urban HEART can stimulate conversations about the structural factors that influence population health within smaller jurisdictions, laying the foundation for evidence-based decision-making for healthier, more equitable cities regardless of size.