DEVELOPMENT AND IMPLEMENTING URBAN HEALTH EQUITY INDICATORS IN TEHRAN URBAN HEART- TEHRAN. On behalf of Urban- HEART Team Tehran

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1 DEVELOPMENT AND IMPLEMENTING URBAN HEALTH EQUITY INDICATORS IN TEHRAN URBAN HEART- TEHRAN On behalf of Urban- HEART Team Tehran CAPACITY BUILDING WORKSHOP ON HEALTH SYSTEM DEVELOPMENT

2 What is Urban HEART The Urban Health Equity Assessment and Response Tool aims at directing local/ national policy-makers to Identifyy the differences between the health of people living in disadvantaged urban areas and the general population Decide what strategies, interventions/actions should be used to reduce health equity gaps

3 Content of the original tool 27 indicators in 4 policy domains Physical and infra-structure Social and human development Economic (health) Governance

4 How disparities are demonstrated in UH? 1. Urban health equity matrix Shows disparities among regions 2. City Health Equity Performance Monitor Describes the trend of an indicator over the year Compare the status of the city with national targets

5 Workshop on Urban HEALTH, Tehran- April 2008

6 Indicators Urban Health Equity Assessment and Response Tool in Tehran (Urban HEART) Urban HEART Domains: 1.Physical and infra-structure: 10 indicators 2.Human and social development: 18 indicators 3.Economic: 10 indicators 4.Governance: 8 indicators 5.Health: 10 indicators 6.Nutrition: 9 indicators

7 Indicators of UH-Tehran Physical and infra-structure 1.Safe drinking water 2.Accidents and injuries (5 indicators) 3.Air pollution 4.Noise nuisance 5.Access to public transport 6.Solid waste management 7.Health centre utilisation Economic development 1. Employment 2. Residency in normal home/ Person/ room 3. Fair Financial Contribution Index (FFCI) 4. Household costs 5. Absolute/ Partial poverty 6. Social Welfare Index 7. Human Development Index Human and social development 1. Education: NER/ GER/ primary school completion/ Higher education (5 indices) 2. Violence: domestic, street 3. Smoking/ addiction 4. Smoke-free places 5. Mental health 6. Social capital Governance (Municipality) 1. Annual reports 2. Contracts transparency 3. Satisfaction 4. Responsiveness (Hot Lines) 5. Community participation (local elections) 6. Lawfulness 7. Standard activities Health 1.Safe delivery 2.Vaccination 3.Early pregnancy 4.Breastfeeding (excl & 24m) 5.IMR/ U5MR/ MMR 6.HRQL 7.Disability Nutrition 1. Calorie poverty 2. Wasting 3. Stunting 4. LBW (IUGR/ NMR) 5. BMI: obesity 6. Food diary 7. Food costs 8. Cereal costs

8 Main survey Sample size calculation based on pilot findings: 960 households per district: Training surveyors: 390 in two 2-day sessions Assigning 15 academics for supervision Last for 55 days Data entry completed and editing/ processing is ongoing; mostly delivered to working groups

9 Home owner

10 Person per room

11 Smoking rate among families

12 Energy Intake 45% Above 110% calorie 40% 35% 30% 25% 20% 15% 10% 5% 0%

13 Traffic accidents Percentage

14 Illiteracy rate Illiteracy

15 Distribution of University Education in CDEFGH?BIJIK LMNO

16 Severe violence rate (per 1000)

17 Voluntary help to close family

18 Divorced women

19 Mean Family costs (Non-Food)

20 13+ months children with full vaccination

21 Assets Matrix District Home owners Pc Family size Piped water Landline Bath Kitchen Toilet Cell phone Freezer Car Gas supply Urban HEART- Tehran

22 Health Matrix 22 Distri ct Exclusive BF rate Under y Married Suspected to mental disorder Vaccination Over rate U- MR NMR IMR Disabilit y rate Quality of life (Physical) Life expectanc y at birth Safe delivery Early pregnancy -. / / Urban HEART- Tehran

23 Social Matrix 23 District Violence rate Severe violence rate Addiction rate Higher education Illiterate!"+ Traffic accidents Percentage Voluntary help Collective activities Trust Friendship and unity Respect to values -. / 0 Urban HEART- Tehran /

24 Mental Health and Smoking 24 District Family Smoking rate Male current smoking rate % Female current smoking rate % Female Youth current smoking rate (.-) % Male Youth current smoking rate (.-) % Suspected to mental disorder Somatisati on Anxiety Functioning Depression! & ' ( " ) * +,!-!!!&!'!(!"!)!*!+!, &- &! &&

25 Economic situation 25 District Male!-+ Unemploym ent rate Female!-+ Unemploym ent rate!--!" Employme nt rate FFCI Catastrophic costs Un-insured family head Non Food Costs Food costs Proportion of Non-Food Costs to total costs Person per room Area per capita Resident in normal home -. / / Urban HEART- Tehran

26 Urban Governance 26 District Satisfaction with Municipality services Responsiveness Hotlines Transparency Participation Lawfulness -. / / Urban HEART- Tehran

27 Nutritional Matrix 27 /! "# $ % &' Urban HEART- Tehran

28 30 : : 18/5 ن: / : 28 17/8% 32/9% 24/4% 21/0% 32/5% 24/1% 35/1% 35/3% 42/3% 28/8% 36/9% 23/3% 21/5% 31/0% 32/4% 34/7% 33/0% 25/6% 27/0% 30/0% 38/0% 21/2% 45/2% 36/5% 41/1% 42/0% 38/6% 53/2% 35/1% 29/4% 37/2% 33/8% 44/0% 39/5% 45/6% 39/1% 34/1% 47/2% 45/7% 40/2% 41/9% 45/0% 40/5% 49/4% 35/6% 28/2% 34/4% 35/8% 25/3% 21/5% 29/9% 31/8% 19/2% 35/0% 17/9% 33/7% 31/6% 29/9% 30/0% 16/7% 20/2% 34/1% 29/7% 23/8% 21/5% 25/9% RSTUH TUV WX Y@SZB [\]^ WS_`S 1/4% 2/4% 0/0% 1/2% 3/6% 1/3% 0/0% 3/5% 1/3% 2/5% 1/2% 3/5% 1/3% 0/0% 3/5% 1/4% 1/1% 0/0% 1/4% 1/3% 0/0% 3/5%! " # $ %! " # $ %

29 <70% 70-90% % >110% ن ن! RSTUH TUV WX Y@SZB [\]^ WS_`S

30 Response tool The second part in UH Response could be organised with several approaches: Evidence-based policy making (City Council, Municipality, The Higher Council for Health, The Cabinet, The Parliament) Evidence-based practice (district Mayors) Inter-Sectoral Collaboration Community Based Initiatives

31 Policy making City Council: During the endorsement of 5-year development plan of Tehran: 2 articles indicated annual assessment of inequalities, using Urban HEART The Parliament Presenting data has been scheduled for different commissions, fractions The MHME: involvement of different sections to extend the plan 40 cities in 2010 (Healthy Urbanisation by WHO) Development of a National Health Inequality Monitoring System Targeting the planning system to diminish disparities is the main intervention for inequality reduction: a major task of the Deputy Mayor for Research and Urban Planning

32 Following year (2009) district budget according to UH 1.2E+09 1E Before After UH

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