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Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project

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Abstract

Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city—the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed to mitigate negative impacts and enhance positive impacts. Within the scope of the EU-funded project EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY), the City of Lisbon was selected as a case study to apply a multidimensional and participatory assessment approach of urban health whose purpose was to inform the evaluation of policies and interventions with potential to address local health gaps. In this paper, we present the set of indicators identified as drivers of urban health inequities within the City of Lisbon, exploring the added value of using a spatial indicator framework together with a participation process to orient a place-based assessment and to inform policies aimed at reducing health inequities. Two workshops with a panel of local stakeholders from health and social care services, municipal departments (e.g. urban planning, environment, social rights and education) and non-governmental and community-based organizations were organized. The aim was to engage local stakeholders to identify locally critical situations and select indicators of health determinants from a spatial equity perspective. To support the analysis, a matrix of 46 indicators of health determinants, with data disaggregated at the city neighbourhood scale, was constructed and was complemented with maps. The panel identified critical situations for urban health equity in 28 indicators across eight intervention axes: economic conditions, social protection and security; education; demographic change; lifestyles and behaviours; physical environment; built environment; road safety and healthcare resources and performance. The geographical distribution of identified critical situations showed that all 24 city neighbourhoods presented one or more problems. A group of neighbourhoods systematically perform worse in most indicators from different intervention axes, requiring not only priority action but mainly a multi- and intersectoral policy response. The indicator matrices and maps have provided a snapshot of urban inequities across different intervention axes, making a compelling argument for boosting intersectoral work across municipal departments and local stakeholders in the City of Lisbon. This study, by integrating local evidence in combination with social elements, pinpoints the importance of a place-based approach for assessing urban health equity.

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Acknowledgements

The authors would like both to acknowledge the support received from the Municipality of Lisbon (CML) and to express gratitude for the opportunity to work with the City of Lisbon in a case study. Namely, the authors sincerely thank João Afonso (City Councillor for Social Rights between 2013 and 2017—CML/PDS), Teresa Craveiro and her team (Municipal Health and Wellbeing Plan of Lisbon—CML/EP-PLHDS) for the active involvement and support provided throughout the case study, namely in the preparation of workshops and support given on data collection. The authors are also grateful to the investigators involved in the preparation of the consultation materials that informed the workshops (indicator’s identity card, tables and maps), namely Adriana Loureiro, Claudia Costa, Ricardo Almendra and Joaquim Patriarca from the University of Coimbra and investigators involved in the design of the overall methodological approach of the EURO-HEALHY project, namely Paulo Correia, Carlos Bana e Costa and Mónica Oliveira from the Instituto Superior Técnico, University of Lisbon.

Then, we would like to gratefully acknowledge the participation of all local stakeholders involved in the participatory process (see list of institutions/participants below).

City of Lisbon (CML): Ana Cristina Correia, Ana Gouveia, Ana Sofia Rocha, Célia Campos, Gonçalo Belo, Graça Silva, Isabel Castanho, Luísa Araújo, Maria Alexandra Costa, Maria João Frias, Marta Santos, Pedro Homem Gouveia and Teresa Craveiro; Civil Parish Council: Maria Capitolina Marques; Regional Coordination and Development Commission (CCDR-LVT): Cristiano Amaro; Santa Casa da Misericórdia de Lisboa (SCML): Filomena Gerardo, Maria Luís Calinas and Noémia Silveiro; Médicos do Mundo (Doctors of the World): Fernando Vasco Marques; Diabetes Portugal (Portuguese Diabetes Association—APDP): Rogério Ribeiro; Alzheimer Portugal (Portuguese Alzheimer’s Association): Ana Sofia Gomes and Filipa Gomes; Observatório - Luta Contra a Pobreza na cidade de Lisboa (Lisbon Observatory for the European Anti-Poverty Network—EAPN): Catarina Cruz; The Directorate-General of Health (DGS/National Health Plan): Rui Portugal; Regional Health Administration of Lisbon (ARS LVT): Joaquim Fonseca and Manuel Cruz; Faculty of Medicine of the University of Lisbon (FMUL): Paulo Nicola; Primary Health Care Center Group of Northern Lisbon (ACES Lisboa Norte): Guilherme Quinaz Romana and Rita Azevedo; Primary Health Care Center Group of Central Lisbon (ACES Lisboa Central): Fátima Quitério; Primary Health Care Center Group of Western Lisbon and Oeiras (ACES Lisboa Ocidental e Oeiras): Fátima Nogueira and Rafic Nordin.

Finally, we would like to thank our English language reviewer, Scott Pulp (University of Coimbra) for the English editing work.

Funding

This research was conducted under the EURO-HEALTHY project, which was funded by the European Union’s Horizon 2020 research and innovation programme, Grant Agreement No 643398, and received support from the Centre of Studies in Geography and Spatial Planning (CEGOT), funded by national funds through the Foundation for Science and Technology (FCT) under the reference UID/GEO/04084/2019. Angela Freitas is a recipient of an Individual Doctoral Fellowship funded by national funds through the Foundation for Science and Technology (FCT), under the reference SFRH/BD/123091/2016.

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  1. CEGOT-UC, Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal

    Ângela Freitas

  2. CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal

    Teresa C. Rodrigues

  3. CEGOT-UC, Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal

    Paula Santana

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  1. Ângela Freitas
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Freitas, Â., Rodrigues, T.C. & Santana, P. Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project. J Urban Health 97, 857–875 (2020). https://doi.org/10.1007/s11524-020-00471-5

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