By LaTina Emerson
Measuring a problem is often the first step to solving a problem. Of course, developing measurement tools for complex problems, like health disparities in urban communities, isn’t easy.
A team of researchers at Georgia State University’s School of Public Health has been focused on the task of developing an Urban Health Index, with the support of funds from the World Health Organization’s Kobe Centre in Japan.
The World Health Organization has released an online handbook about the index to teach researchers, public health professionals and policy makers around the world how to use this innovative tool.
In this Q&A, Dr. Richard Rothenberg, a Regents Professor of epidemiology and biostatistics in the School of Public Health and the leader of this effort, explains why this tool is important and the impact that researchers hope it will have on reducing health disparities around the world.
Q.What is the idea behind the Urban Health Index?
A.There are many metrics that are used to measure health and health disparities. Groups of people get together and decide what indicators to include in an index. Our impression was that these indicators and indices are of tremendous use for things like comparing areas or countries, and they require similar data from all of the sites. They’re somewhat limited in their applicability to small areas where people have to understand what the health levels and disparities are, in order to make specific decisions about resource allocation and other things like that.
The urban health index was generated by the idea that people need a more flexible tool, some way of combining information where they’re using their own information. It may not be relevant to other areas or provide means of comparison, but within an area itself, it gives people a sense of what the distribution and determinants are of some of these health factors.
This is both a local and international endeavor. This looks inside countries, cities and neighborhoods. It’s a way of connecting the macro and micro kinds of information that we get.
Q.What exactly does it measure?
A. It depends. If, for example, you’re interested in measuring mortality, you may want to look at some combination of infant and maternal mortality and young adult mortality and death at a later age. This is a way of combining information about mortality at different levels to be able to come up with an index for a particular small area and use some sort of geographic designation for highs and lows so that you can show where the disparities are within a given neighborhood or within a given area within a city.
You can also combine that with a whole variety of other information that involves actual health indicators or health determinants. Determinants are things like the built environment, features of the built environment that are present in a particular neighborhood and the availability of water in a neighborhood. We’re talking about many areas of the world where housing and sewage water availability are minimal and nonexistent. So we can then look at the levels that are available.
Q. How will the Urban Health Index be used?
A. We would like to do several things with it. One is that it’s a tool for analysis of urban questions. We can use it within the Atlanta area, as well as other areas as a tool for examining certain questions. For example, a paper has been published that looks at the improvement in health disparities in the favelas of Rio de Janeiro over the past 10 years.
Our work has been funded by the Kobe Institute, which is the World Health Organization Institute for Health Development in Kobe, Japan. They have a global agenda, and they’re interested in providing tools to urban health workers, public health workers, and decision makers to try to determine the extent of health inequities in many areas. People can use it to examine their own data in a flexible way.
I think it would be best applied in areas of environmental health and chronic disease, particularly looking at the prevalence of certain diseases. I think it could also be applied in areas that are hyper endemic for things like HIV and tuberculosis, for example. There are lots of different areas that it can be applied to. The bottleneck in all of this is data availability, and developing data that can be used for this purpose is probably something that areas are going to have to do themselves, particularly in low and middle-income countries where there isn’t much of this kind of information available in general.
Q. Income data often correlates closely to things like pollution patterns, access to healthcare and other measures that are part of the index. Why not just use income data?
A. Everyone is aware of the enormous income gaps. That’s sort of a given, but the detail of how these play out with regard to health and environmental safety, environmental threats and other things of that sort is really what we’re focused on. This is an opportunity to look in great detail at what exactly is iniquitous and what kinds of things need to be done to change environments.
Q. Where have you tested this tool?
A. Most of the work that we’ve done has been in Atlanta and Japan, looking at all of Japan, specifically in Tokyo. In Brazil, the tool has been used to study the favelas in Rio de Janeiro, and in China, where we’ve been working with people at Fudan University and in the large districts around Fudan in Shanghai.
We’re still in the stage of trying to see what this tool does, how it works out. The major effort that we’ve put in over the last several months has been to develop a handbook which will be an online resource on how to use the tool and what it does.
Q. How close is the index to being “done?” Or will it need ongoing refinements as a tool?
A. We view it as something that’s a work in progress. It will be for some time. I think it’s in pretty good shape right now. This handbook that we developed will probably go online in the next several months, so that’s a fairly finished item. In its current form, it’s something that can be used and can be applied in a wide variety of settings. Hopefully, we’ll begin to see people use it. But it’s not something that we want to fix and submit to at this point because we’re still thinking about how to develop it and what to do with it.