Q&A: Pursuing equity in urban health

September 4, 2020 by PATH

By 2050, the United Nations projects 7 of 10 people will live in cities. What new challenges will this create? And how can health systems prepare?

A congested settlement in Mumbai, India. Photo: PATH/Ruhani Kaur.

A congested settlement in Mumbai, India. An additional 2.5 billion people are projected to live in cities by 2050, with close to 90 percent of the increase taking place in Africa and Asia. Photo: PATH/Ruhani Kaur.

PATH’s Ndack Diop, Oscar Kadenge, and Katharine Shelley offer their insights on urban health and its role in the global progress towards health equity and universal health coverage.

  • Dr. Ndack Diop, senior monitoring and evaluation advisor, Senegal Country Program
  • Oscar Kadenge, early childhood development manager, Kenya Country Program
  • Dr. Katharine Shelley, team lead, Health Systems Analytics

Q: What's unique about urban health?

It really comes down to the incredible diversity of urban settings.

There are so many different health needs, income levels, and barriers to access, there is no single “approach” that will work in every city, or even in every neighborhood in a given city.

Instead, urban health is about identifying and meeting needs in a complex and evolving landscape.

Q: What health inequities do people face in urban environments?

Health inequity takes many forms in cities. An informal settlement may sit adjacent to an affluent neighborhood, but the people living in the settlement will lack access to safe water and sanitation infrastructure. Clinics and health centers may not be distributed equitably, limiting care options for certain communities. Even the way health information is shared can be inequitable.

Plus, the urban environment can actually concentrate and multiply the challenges and risks associated with health.

For example: higher population density can increase the spread of communicable diseases; highly mobile populations can lead to gaps in care if referral services are not in place; economic and social factors can make marginalized populations hard to reach—even when health services exist nearby.

Q: How can health systems address these inequities?

First, decision makers need a much clearer picture of all the different populations living in a given city, and a better understanding of the unique challenges each population might face.

Intra-urban inequities are often masked by district-level indicators, but better data can help us understand the pockets of vulnerability that exist within and across urban environments.

Landscape assessments, mapping, surveys, and data analysis can reveal the different needs of diverse urban communities. With a more nuanced view, health system actors and decision makers can apply people-centered approaches in the design and implementation of urban health programs.

Urban environments also provide opportunities to integrate health services into wider social services. Public and private service providers can work in tandem to increase options for urban communities. And importantly, existing community structures can support health-related activities to embed health into the fabric of these communities—creating consistent, responsive, and sustainable health services.

Q: How is PATH pursuing health equity in urban environments?

PATH supports urban health efforts around the world through systems innovations and data-driven approaches. Here are just a few examples:

In Mumbai, India, PATH helped introduce the Private Provider Interface Agency (PPIA) for tuberculosis (TB) treatment. This innovative model allows patients from private sector health providers access to free public sector TB diagnosis and treatment—improving access to care and giving the government of India better insight into the TB burden. PPIA streamlines diagnosis and treatment processes, reduces financial barriers, and engages community-based partners through a technology platform that helps improve case management and treatment success.

In Kisumu, Kenya, PATH applies a differentiated care approach to HIV prevention, testing, and treatment. Working directly with affected or at-risk communities, we identify new and creative ways to deliver post-exposure prophylaxis,expand the reach of HIV testing through partner notification, and increase treatment adherence among adolescents and young women.

In Dakar, Senegal, the Better Hearts, Better Cities (BHBC) project is utilizing a multisectoral approach to address hypertension and its underlying risk factors. Funded by the Novartis Foundation, and implemented by PATH and IntraHealth, the project put in place an action plan for the Ministry of Health and the National Supply Pharmacy to improve the availability and accessibility of hypertension medications. The project is also providing prevention and care services through Bajenu Gox and Relais Communitaire community health workers. BHBC also established a coalition of private companies to raise awareness and increase health literacy around non-communicable diseases and their impact on businesses. The goal? Shift the mindset from treatment to prevention by demonstrating the gain for companies and employees alike.

In Ho Chi Minh City, Vietnam, the Community for Healthy Hearts project has established nearly 300 blood pressure checkpoints. Trained volunteers offer blood pressure monitoring at pharmacies, grocery stores, hair salons, and other non-traditional locations—opening more options for individuals and extending this service into the community.

Q: What's next for PATH in urban health?

As we enter the Decade of Action, pursuing health equity in urban environments will be essential to achieving the Sustainable Development Goals. The good news is we have a great start. Next, we can:

  • Scale-up approaches that are already working. For example, PPIA inspired the Joint Effort to Eliminate Tuberculosis, a pan-Indian program that will reach communities in more than 400 cities.
  • Promote multisectoral collaboration in the design and implementation of innovative solutions to reach the most vulnerable.
  • Build stronger, more integrated health services that give urban communities more options in how and where they access care.
  • Continue to innovate, introducing new people-centered approaches to primary health care that directly address the unique challenges faced by urban communities.
  • Engage more urban communities directly and—taking lessons from rural-focused community health worker efforts—train trusted health advisors who are members of the local community.
  • Work to meet the unique needs of adolescents and youth to improve health outcomes and foster healthy behaviors for the generations to come.

Together, through common vision and multisectoral partnership, we can shape cities into healthier, more equitable environments—for everyone.