Addressing Inequities in Urban Health : Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015

Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum. We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO’s Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities. We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. The work presented during our special session at ICUH 2015 highlighted not only the problems of existing data sources but also the great potential of new approaches such as gridded sampling techniques to improve the representation of the urban poorest within household surveys. The use of crowd-sourcing applications, such as OpenStreetMap, offers great potential to plug the gaps in traditional approaches to mapping populations for household survey samples. This can provide a verifiable dataset which local authorities, NGO and communities can easily update and utilize for action. It is easy to become focused on the ‘assessment’ component of Urban HEART and overlook the ‘response’. The participatory adaptation of Urban HEART from UHRC provides a practical working methodology to assess health inequities across neighborhoods and wards to provide information for governments and NGOs engaged in slum health programming. Importantly the participatory approach gives equal weight to the Response with the identification of immediate actions to be taken by residents and by local governments and other providers. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities