Urban Health Equity Research Articles

Unequal Effects of the Lockdown on Mental Health in Shanghai: The Moderating and Mediating Role of Neighborhood Environment and Online Social Connections.

The COVID-19 pandemic profoundly impacted population mental health worldwide. Few studies examined how the neighborhood environment and online social connections might influence the social gradient in mental health during the pandemic lockdown. We aim to examine the moderating and mediating role of neighborhood environment and online social connections in the association between socioeconomic status (SES) and mental health outcomes. We conducted a cross-sectional online survey of 3763 Shanghai residents during the COVID-19 lockdown between April 29 and June 1, 2022. Employing OLS linear regression analyses, our findings reveal that SES was negatively associated with depressive symptoms (B = 0.173, p < 0.001) and anxiety (B = 0.147, p < 0.001). The findings supported our hypotheses that this disparity in mental health was partially mediated by neighborhood social capital, community management, and the extent of online social connections measured by the frequency of social connection through the social media WeChat (all p < 0.05). Additionally, neighborhood social capital, community management, and online social connections also mitigated SES-driven mental health inequalities (all p < 0.05). The study underscores the significance of the neighborhood environment and online social interactions in amplifying SES-related mental health effects, offering valuable insights for urban planning and health equity strategies.

Examining spatial equity in emergency facilities during the later stage of COVID-19 in China: insights from nucleic acid testing sites

Community-level emergency facilities are essential for disaster prevention and response, contributing significantly to urban health equity. This study aims to explore the multi-scale spatial pattern, multi-dimensional availability evaluation, and multi-scenario simulation optimization of nucleic acid testing sites during the later stage of COVID-19. At a macro scale, these sites demonstrated a "multi-core clustering" pattern, while at a micro-scale, they were community-centered, often located in areas with low traffic and better ventilation. Spatial accessibility analysis showed high accessibility in urban centers when only facility capacity was considered, though accessibility dropped relative to suburban areas when community population and time costs were included. Temporally, site availability followed an M-shaped distribution. This study optimized testing site locations, providing insights into equitable distribution and supply–demand balance for emergency facilities.

The Promises and Potential Pitfalls of Highway Reclamation for Population Health: A Research Framework.

Highway reclamation (i.e., the removal of highways or placing existing highways underground to create mixed-use urban areas) is being implemented around the United States, often touting co-benefits for population health. As part of the Bipartisan Infrastructure Law and the Inflation Reduction Act, the Reconnecting Communities and Neighborhoods grant program is a first-of-its-kind investment in launching even more highway reclamation projects. Depending on how the projects are implemented, these projects may create gentrification (i.e., the displacement of poor long-time residents by wealthier new people), thereby displacing the populations these projects are designed to protect. However, little work has systematically examined the extent to which highway reclamation projects provide the promised benefits for neighborhood environments (e.g., reduced air pollution), minimize gentrification, and improve health outcomes. This commentary proposes a framework by which the multidimensional impacts of highway reclamation can be evaluated, unlocking potential new structural pathways toward urban health equity.

The gentrification of health: an analysis of its convergence

The article explores how gentrification impacts public health, with a particular focus on urban transformations and their repercussions on communities. Using a desk review methodology in the Scopus database, this study analyses the literature between 2018 and 2023 to identify how changes in urban structure influence the accessibility and quality of health services. It highlights that while gentrification can improve infrastructure and services, it can also exacerbate health inequalities and lead to the displacement of vulnerable populations. The analysis reveals the need to adapt medical education to these new urban challenges and suggests future lines of research to develop more equitable interventions. This multidisciplinary approach offers valuable insights for more inclusive policies that consider both urban development and health equity

도시건강 연구의 동향 분석

While more than half of the world’s population lives in urban areas, health disparities across cities remain serious issues. Urban settings are a relatively new phenomenon in human history, and so is urban health. This study aims to figure out the concept of urban health and analyze research trends on urban health through systematic review. Studies published since 2010 either in English or Korean were screened; 31 eligible studies were selected for the review. The contents of the studies were categorized by urban environment, urban planning, urban policy, urban health index and health equity. Taking together urban health and healthy city, there were no significant differences in the concepts; rather, they complement each other to achieve sustainable cities and communities. While there are diverse related studies, urban health remains rare in the field. Therefore, future studies need to focus on urban health topics to resolve health disparities in the urban areas.

Research Translation to Promote Urban Health in Latin America: The SALURBAL Experience.

In highly urbanized and unequal Latin America, urban health and health equity research are essential to effective policymaking. To ensure the application of relevant and context-specific evidence to efforts to reduce urban health inequities, urban health research in Latin America must incorporate strategic research translation efforts. Beginning in 2017, the Urban Health in Latin America (SALURBAL) project implemented policy-relevant research and engaged policymakers and the public to support the translation of research findings. Over 6 years, more than 200 researchers across eight countries contributed to SALURBAL's interdisciplinary network. This network allowed SALURBAL to adapt research and engagement activities to local contexts and priorities, thereby maximizing the policy relevance of research findings and their application to promote policy action, inform urban interventions, and drive societal change. SALURBAL achieved significant visibility and credibility among academic and nonacademic urban health stakeholders, resulting in the development of evidence and tools to support urban policymakers, planners, and policy development processes across the region. These efforts and their outcomes reveal important lessons regarding maintaining flexibility and accounting for local context in research, ensuring that resources are dedicated to policy engagement and dissemination activities, and recognizing that assessing policy impact requires a nuanced understanding of complex policymaking processes. These reflections are relevant for promoting urban health and health equity research translation across the global south and worldwide. This paper presents SALURBAL's strategy for dissemination and policy translation, highlights innovative initiatives and their outcomes, discusses lessons learned, and shares recommendations for future efforts to promote effective translation of research findings.

Evaluating Urban Green Space Inequity to Promote Distributional Justice in Portland, Oregon

Access and exposure to urban green space—the combination of parks and vegetative cover in cities—are associated with various health benefits. As urban green space is often unequally distributed throughout cities, understanding how it is allocated across socio-demographic populations can help city planners and policy makers identify and address urban environmental justice and health equity issues. To our knowledge, no studies have yet combined assessments of park quality, park availability, and green cover to inform equitable urban green space planning. To this end, we developed a comprehensive methodology to identify urban green space inequities at the city scale and applied it in Portland, OR, USA. After auditing all public parks in Portland and gathering green cover data from publicly accessible repositories, we used a suite of statistical tests to evaluate distribution of parks and green cover across Census block groups, comprising race, ethnicity, income, and educational attainment characteristics. Right-of-way tree canopy cover was the most significant urban green space inequity identified in bivariate analysis (rs = −0.73). Spatial autoregressive models identified that right-of-way, private, and overall tree canopy cover (Nagelkerke pseudo-R2 = 0.66, 0.77, and 0.67, respectively) significantly decreased with the proportion of minoritized racial population and increased with median income. The results were then used to identify priority locations for specific urban green space investments. This research establishes a process to assess intra-urban green space inequities, as well as identify data-informed and spatially explicit planning priorities to promote health equity and environmental justice.

Causes, consequences and health impacts of gentrification in the Global North: a conceptual framework

We aimed to create a theoretical framework to understand how neighborhood gentrification may impact urban health and health equity, taking into account perspectives and evidence from multiple disciplines. In addition to reviewing the literature and harnessing our own experience and expertise, we elicited input from researchers, activists and professionals from multiple fields using an eDelphi process, determined the agreements and disagreements between respondents on the causes, consequences, and health impacts of gentrification. Respondents agreed that neighborhood gentrification has important implications for mental health and on many of the causes and consequences of gentrification but reached less agreement on the pathways by which gentrification may affect health and the specific health outcomes that may be affected. Finally, we generated an evidence-informed conceptual framework taking into account the input from the eDelphi process. Here we present this conceptual framework for understanding the relationship between gentrification and health and discuss a future research agenda for this emerging theme in public health research.

Improving Accountability for Equitable Health and Well-being in Urban Informal Spaces: Moving from Dominant to Transformative Approaches

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research.

Health Equity as a Guide for Urban Planning

Urban planning has struggled to establish a consensus on what “good” planning looks like and instead grapples with balancing competing planning priorities and perspectives. This paper proposes that planners and planning scholars look to health equity as a guiding “north star.” We justify this proposal by reviewing scholarship at the intersection of planning and public health. Drawing from empirical and theoretical work linking urban planning, health, and social equity, we recommend planners adopt participatory and anti-racist practices; implement cross-sectoral strategies beyond the professional boundaries of urban planning or public health; and learn from diverse data sources, research methods, and geographic contexts.

Investigating the Relationship between Structural Features of Built Environment and Physical Activity using Geographic Information Systems (GIS).

Built environment determinants of engaging in physical activity are dependent on the properties of societies. This study investigates the relationship between structural variables of the environment using geographic information systems (GIS) and the level of physical activity in 22 districts of Tehran. This cross-sectional study was based on Urban Health Equity Assessment and Response Tool (Urban HEART-2). Physical activity level was assessed via the Global Physical Activity Questionnaire (GPAQ). The characteristics of the neighborhood environment, including land use, street pattern, population density, and traffic, were determined via ArcGIS software. Walkability index (population density, street pattern, land use) was calculated to assess the effect of the main variables of living environment on physical activity level. Among the built environmental variables, land use was associated with the total physical activity and travel-related physical activity level (r: 0.155, P value: 0.001, and r: 0.122, P value: 0.007, respectively). The walkability index indicated an association with the total physical activity level and travel-related physical activity level (r: 0.126, P value: 0.006, and r: 0.135, P value: 0.001, respectively). Higher levels of the walkability index were associated with an improved level of physical activity (OR: 2.04). Walkability index and land use positively correlate with total physical activity level, and providing action plans that improve walkability index and land use might lead to increased physical activity level.

Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative

To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.

Factors Affecting Trust in the Elderly Based on Data from the Second Phase of the Urban Health Equity and Response Tool

Introduction: Trust is among the social determinants of health in the elderly. Considering the importance of trust, this study was conducted to investigate demographic, economic, social, and health factors affecting trust in the elderly over 60 years old. Method: This cross-sectional study was based on the data of the second phase of the Urban Health Equity and Response Tool (Urban HERAT-2) on 5,760 elderly people. The economic status of the household was measured by principal component analysis and based on the variables of living supplies and facilities. Then, demographic and socio-economic variables such as the economic score of the household, ethnicity, occupation, education, and self-reported physical and mental health were presented in the linear regression of the explanatory model of trust using STATA software. Results: Based on the findings of this study, The living supplies and facilities explained 0.58 of the variances of the economic score of the household. Furthermore, it was observed that being married, having seasonal and permanent labor jobs, and being relatively poor was associated with a decrease in trust in the elderly and the ability to read and write, good self-reported physical health, and unchanged with an increase in trust in the elderly. The variables of age, gender, retirement, ethnicity, and mental health were not related to trust in the elderly. Conclusion: The variables such as labor jobs, low education, and poor economic status affected trust in the elderly. The findings of this study showed the lack of institutional and intergroup trust in the elderly, and it requires the attention of policymakers

City deals and health equity in Sydney, Australia

'City Deals' are new governance instruments for urban development. Vast evidence exists on the relationship between urban factors and health equity, but little research applies a health equity lens to urban policy-making. This paper does precisely that for the Western Sydney City Deal (WSCD) in Australia. We conducted a critical discourse analysis of publicly available documents and interviews with the WSCD's main architects, applying insights from relevant theories. We find 'pro-growth' discourse to encourage economic investment dominates any references to disadvantage. Interviewees maintained the WSCDs fundamental purpose is to rebalance urban investment toward the historically disadvantaged West. However, the WSCD makes limited reference to health and none to equity. Institutionalised governance practices that favour private investments in infrastructure remain the dominant force behind the WSCD. We document how a shift to 'place-based' infrastructure has promise for equity but struggles to overcome institutionalised approaches to urban investments.

Socioeconomic Determinants of Social Capital Inequality among Older Adults of Tehran: A Population-Based Study (Urban HEART-2).

Background: Social capital (SC) is an essential concept of communities, and there is more SC inequality. In the current study, we studied SC Inequality concerning the explanatory socioeconomic factors. Methods: In a cross-sectional observational study, the household data were retrieved from an Urban Health Equity Assessment and Response Tool survey in 2011. Over 5000 elderlies in Tehran (> 60 years old) consented toparticipate in the study and filled out 2 SC questionnaires (SCQ) and a household properties questionnaire (HPQ). Subsequently, the collected HPQ data were then statistically analyzed and used to measure the economic status of households. Besides, the statistical concentration index of the SC was applied to measure socioeconomic inequality and decomposed into its determinants using both SCQ and HPQ data collections. The concentration index and the decomposition analysis were used to analyze the study data. Results: The overall concentration index of the SC in Tehran senior citizens was 0.059 (95%CI,0.044-0.076). Among the SC dimensions, collective activity, social coherence, voluntary help, and social network were more concentrated in the poor older adults. Simultaneously, reciprocity was more focused onthe wealthy class, and there was no inequality in trust. The decomposition of the concentration index showed that economic status made the most considerable contribution to the SC inequality among citizens (69.11%), followed by the level of education (12.695) and the elderlies'job type (9.58%). Conclusion: Given that the economic status and level of education are the 2 main determinants of SC inequality, a holistic policy approach should be adopted to address the socioeconomic inequalities that are taken root in Tehran's senior communities.

The World Health Organization’s approach to equity

The World Health Organization (WHO), as the most prominent global health institution as a specialized agency of the United Nations, has expressed concern for health equity as part of its mandate, “the attainment by all peoples of the highest possible level of health”. However, there is a lack of clarity around the WHO’s fundamental definition and conceptualization of equity. Through drawing on the WHO’s Urban Health Equity Assessment and Response Tool (Urban HEART) as an illustrative case, the aim is to determine how the WHO operationalizes equity in practice. Preliminary findings suggest there is no consistent understanding of what the goal of Urban HEART is. This research has direct implications for practice: not only can the findings be applied to other global health work that seeks to improve equity, but the WHO is planning to reinstate Urban HEART. As such, this research may be beneficial in guiding these plans. Further, the findings yield an important consideration for global and public health policy and practice more broadly: the need to clarify objectives around equity (e.g. because how equity is defined determines the work undertaken and the populations served).

A health political science for health promotion.

If health promotion as a field of change for human and ecological health is to maintain its urgency, it needs to continue building its policy credentials. This paper charts the development of policy as a concern for IUHE/IUHPE (International Union for Health Education/International Union for Health Promotion and Education) from the mid-1970s when 'health education policies' were prominent issues, to the launch of Healthy Public Policy (in the 1980s) and Health in All Policy (in the 2000s). We argue that solid conceptual and theoretical foundations exist to frame and develop the relevance and connectedness of health promotion more prominently. We start off with a brief introduction into (health) political science, and then illustrate the urgency of the argument with three case studies. The first takes a critical realist perspective on 'closing the gap' in Australian Indigenous populations. With recent evidence it demonstrates that the core of the policymaking process needs to re-align itself with an Indigenous narrative. The second case study reviews the politics of healthy urban planning and health equity in cities. Taking a critical theory institutionalist view, the case describes how the political and narrative parallels between urban theory and health equity have gone underexplored. With an explicit gaze to connect the two, the field could become a large and influential driver of enhanced health promotion and public health policy. The third case describes the languages, policy frames, and distinctions, in four urban/health paradigms. It shows that unconscious policy and practice bias exists in policy priorities and processes. We conclude with observations and recommendations on the role of health promotion as a conceptual realm and field of activity. We show that all health promoters should be aware of the political nature of their enterprise. Tools and analyses exist to help further action.

A spatiotemporal analysis of inequalities in life expectancy and 20 causes of mortality in sub-neighbourhoods of Metro Vancouver, Canada, 1990-2016

BACKGROUND AND AIM: There is limited evidence on the magnitude and contributing causes of intra-urban inequalities. Spatially varying baseline data are needed to better understand geographical health inequalities as a first step in identifying and acting upon determinants. METHODS: Mortality data (1990-2016) in British Columbia (BC), Canada were linked to three national and provincial demographic data sources and assigned to 20 Global Burden of Disease Study cause categories with further cause differentiation for neoplasms and cardiovascular diseases. All data were restricted, aggregated and merged to 368 Census Tracts (CTs) in Metro Vancouver. Bayesian small area, mixed-effects estimation models were used to estimate life expectancy (LE) at birth and 20 cause-specific and age-standardized mortality rates by sex and year. RESULTS:Over the 27-year period, the gap in LE for CTs in the 90th percentile (P90) and 10th percentile (P10) for both males and females ranged from 6.9 years to 9.5 years. The two largest increases in percentage of total deaths from 1990-2016 were neurological diseases (10.0%) and other non-communicable diseases (3.7%). Relative inequality increased for almost all causes, especially for HIV and sexually transmitted infections, maternal and neonatal disorders, and neoplasms (especially pancreatic cancer in females and prostate cancer in males), whereby CTs in the P90 were 17.4 (P90: 1.2/100,000; P10: 0.2/100,000), 10.0 (16.4; 1.3), and 3.8 (367.7; 95.9) times higher, respectively, compared to CTs in the P10. CONCLUSIONS:Spatial heterogeneity and clusters of cause-specific deaths were observed in one of the healthiest cities in Canada, with widening inequality in more recent years. These results and application of similar methodology to other locations can be used to support more in-depth analysis and prioritisation of policies and programs to advance urban sustainability and health equity. KEYWORDS: Health equity, small area analysis, life expectancy, cause-specific mortality, urban health, spatial analysis

Loops and Building Blocks: a Knowledge co-Production Framework for Equitable Urban Health

This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: co-designing, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interaction-based methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-production loops and building blocks are deployed flexibly.

Breaking Down and Building Up: Gentrification, Its drivers, and Urban Health Inequality.

Purpose of ReviewMany neighborhoods which have been unjustly impacted by histories of uneven urban development, resulting in socioeconomic and racial segregation, are now at risk for gentrification. As urban renewal projects lead to improvements in the long-neglected built environments of such neighborhoods, accompanying gentrification processes may lead to the displacement of or exclusion of underprivileged residents from benefiting from new amenities and improvements. In addition, gentrification processes may be instigated by various drivers. We aimed to discuss the implications of specific types of gentrification, by driver, for health equity.Recent FindingsSeveral recent articles find differential effects of gentrification on the health of underprivileged residents of gentrifying neighborhoods compared to those with greater privilege (where sociodemographic dimensions such as race or socioeconomic status are used as a proxy for privilege). Generally, studies show that gentrification may be beneficial for the health of more privileged residents while harming or not benefiting the health of underprivileged residents. Very recent articles have begun to test hypothesized pathways by which urban renewal indicators, gentrification, and health equity are linked. Few public health articles to date are designed to detect distinct impacts of specific drivers of gentrification.SummaryUsing a case example, we hypothesize how distinct drivers of gentrification—specifically, retail gentrification, environmental gentrification, climate gentrification, studentification, tourism gentrification, and health care gentrification—may imply specific pathways toward reduced health equity. Finally, we discuss the challenges faced by researchers in assessing the health impacts of gentrification.