STEP 2 & 3

Objectives -To review how health, social, and economic indicators can reveal health inequities -To understand the necessity of adopting all 12 Urban HEART core indicators and using existing, available datasets for a city Objectives for Session

Indicators Indicator: A key measure that can represent what is happening in a complex environment You should adopt ALL 12 Urban HEART core indicators Consider using additional indicators to address special issues in your city

12 Urban HEART Core Indicators Health outcomes Infant mortality DiabetesTuberculosis Road traffic injuries Physical environment & infrastructure Access to safe water Access to improved sanitation Social and human development Completion of primary education Skilled birth attendance Fully immunized children Prevalence of tobacco smoking Economics Unemployment Governance Government spending on health

Define Your Local Indicators Set Review how health, social and economic indicators can reveal health inequities Consult broadly to identify local health equity concerns in your city Choose indicators to represent stakeholders’ health equity concerns Identify appropriate disaggregation variables for the indicators Identify available data sources for these indicators Global, national, and local definitions for indicators and type of data collected may differ in many cases

Benchmarking External benchmarking: Assesses performance based on normative international or national standards e.g. MDGs or national health objectives Internal benchmarking: Assesses performance of a city or urban area based on its previous performance by plotting progress within a time period

California (U.S.A.) city health report: Example 1 Worse than 54 cities avg Between cities and national avg Better than national avg

California (U.S.A.) city health report: Example 2 Worse than national avg Between national avg & 2010 goal Achieved 2010 goal

California (U.S.A.) city health report: Example 3 Has not achieved 2010 goal Achieved 2010 goal

Assembling Data Urban HEART should rely as much as possible on use of existing, available datasets for your city from diverse policy sectors Extensive new data collection is often time consuming, financially burdensome and not sustainable – Teams that emphasize new surveys may lose momentum – In contrast, data sharing can foster intersectoral responsibility for health and promote cooperative action later on

Assemble Relevant and Valid Data Assess the quality and validity of data sources Negotiate formal data-sharing agreements Set up a data-sharing repository Conduct general database management Conduct or commission new surveys, if necessary

Activity: Selecting an Indicator Set

Selecting Indicators In your country group, review the list of indicators in Annex III of the Urban HEART User Manual Construct an indicator list that is relevant to the context of your country/city Complete the table on the next slide

Indicator Suggested benchmarks and targets Data sources Possible disaggregating variables

Addressing Potential Problems arising from Indicator Set Select 3 statements from the next slide and elaborate on the specific challenges described in each scenario as it relates to your city. Propose solutions for dealing with the identified problems by filling in the scenario tables.

Identifying challenges & problems With regard to your chosen indicator set, you should circle the appropriate response for the following statements (1 – strongly disagree, 2 – disagree, 3 – unsure, 4 – agree and 5 – strongly agree).

Statement: “The indicator set will need to be approved by multiple agencies.” Group response: Strongly agree How does this relate to the challenges found in your city? The Urban HEART team needs to meet with multiple agencies (city council, law enforcement, ministry of health, ministry of finance) to negotiate the indicator set. This process is time-consuming and may potentially derail the whole indicator selection if approval by any one agency is not obtained. What are some possible solutions for the problems outlined above? Cultivate Urban HEART champions from these agencies and use their influence to obtain support for the project. Create a common platform where representatives from these agencies can meet and discuss the indicator set together so that approval process can be quickened. The Urban HEART team should consult the agencies concurrently for their inputs on the indicator set to expedite the process. Identifying challenges & problems

Scenario 1 Statement: Group response: How does this relate to the challenges found in your city? What are some possible solutions for the problems outlined above?

Scenario 2 Statement: Group response: How does this relate to the challenges found in your city? What are some possible solutions for the problems outlined above?

Scenario 3 Statement: Group response: How does this relate to the challenges found in your city? What are some possible solutions for the problems outlined above?