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Urban HEART Detroit: the Application of a Health Equity Assessment Tool.

ABSTRACT: The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit's health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.

SUBMITTER: Mehdipanah R

PROVIDER: S-EPMC7781400 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The equity of rural-to-urban migrants' health care utilization is already on China's agenda. The Chinese government has been embarking on efforts to improve the financial and geographical accessibility of health care for migrants by strengthening primary care services and providing universal coverage. Patient experiences are equally vital to migrants' health care utilization. To our knowledge, no studies have focused on equity in the patient experiences between migrants and locals. Based on a patient survey from Guangdong, China, which has a large number of rural-to-urban migrants, our study assessed the equity in the primary care patient experiences between rural-to-urban migrants and urban locals in the same health insurance context, since different forms of insurance can affect the patient experiences of primary care. METHODS:We stratified our samples by different insurance types into three layers. We assessed primary care patient experiences using a validated Chinese version of the Primary Care Assessment Tool (PCAT), including eight primary care attributes. A 'PCAT total score' was calculated. Data were collected through face-to-face and one-on-one surveys in 2014. Propensity score matching (PSM) was used for each layer to generate comparable samples between rural-to-urban migrants and urban locals. Based on the matched dataset, a t-test was employed to compare the primary care patient experiences of the two groups. RESULTS:Using PSM, 220 patients in the rural-to-urban migrants group were matched to 220 patients in the urban locals group. After the matching, the observed confounding variables were balanced, and the PCAT scores were almost equal between the two groups. The only slight differences existed in the Urban Employee Basic Medical Insurance layer and in the without basic medical insurance coverage layer. CONCLUSIONS:Equity in the primary care patient experiences between rural-to-urban migrants and urban locals seems to have been achieved to some extent. However, there is room for improvement in the equity of coordination of care and comprehensiveness. Policy makers should consider strengthening these two dimensions by integrating the health care system. More attention should be focused on helping migrants break down language and cultural barriers and improving the patient-physician communication process.

Project description:Nigeria experiences wide heterogeneity in vaccination rates by vaccine and region. However, inequities in vaccination status extend beyond just geographic covariates. Traditionally, inequity is represented by a single metric pertaining to socioeconomic status. A growing body of literature suggests that this view is limiting, and a multi-factor approach is necessary to comprehensively evaluate relative disadvantage between individuals. The Vaccine Economics Research for Sustainability and Equity (VERSE) tool produces a composite equity metric, which accounts for multiple factors influencing inequity in vaccination coverage. We apply the VERSE tool to Nigeria's 2018 Demographic and Health Survey (DHS) to cross-sectionally evaluate equity in vaccination status for national immunization program (NIP) vaccines over the following contributing covariates: age of child, sex of child, maternal education level, socioeconomic status, health insurance status, state of residence, and urban or rural designation. We also assess equity for zero-dose, fully immunized for age, and completion of NIP. Results show that socioeconomic status contributes substantially to variation vaccination coverage, but it is not the most substantial factor. For all vaccination statuses, except for NIP completion, maternal education level is the greatest contributor towards a child's immunization status among model variables. We highlight the outputs for zero-dose, fully immunized at infancy, MCV1 and PENTA1. The percentage point gap in vaccination status between the top and bottom quintiles of disadvantage, as ranked by the composite indicator is 31.1 (29.5-32.7) for zero-dose status, 53.1 (51.3-54.9) for full immunization status, 48.9 (46.9-50.9) for MCV1, and 67.6 (66.0-69.2) for PENTA1. Though concentration indices indicate inequity for all statuses, full immunization coverage is very low at 31.5% suggesting significant gaps in reaching children after initial doses for routine immunizations. Applying the VERSE tool to future Nigeria DHS surveys can allow decisionmakers to track changes in vaccination coverage equity, in a standardized manner, over time.

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Urban HEART Detroit: the Application of a Health Equity Assessment Tool.

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