Conversations on Urban Health - Dr Yonette Thomas

Dr. David Vlahov, the founding President of ISUH, provides a history of the ISUH and gives context for its future directions.

From its inception in 2002 and its first conference in Toronto, ISUH is intended to create a dialogue to define urban health. Over time the annual conferences provide an opportunity for members to connect. The first conference focused on inner city health in high-income countries. It is at the second meeting, held at the New York Academy of Medicine in New York City, where a conceptual framework was developed that focused on the social determinants of health that affect individual behavior. Subsequent conferences in Baltimore, Amsterdam, Nairobi, Boston, Vancouver, Manchester, and Dhaka expanded ISUH’s global perspective and reach. It was the work of ISUH that influenced WHO’s Year of Urban Health.

ISUH was seen as the only NGO that brought together researchers in urban health from around the world. The idea was for ISUH to become a mobilizing force for disseminating evidence for improving urban health. This is what lead to ISUH’s value proposition as the only global organization focused on urban health.

The future of ISUH should include a focus now on providing trans-disciplinary education, the development of a shared vocabulary for team collaboration, and the leveraging of this expertise by turning research into education. Another part of our future should include taking research into the policy arena and being advocates for populations that live in urban settings, particularly for those that are more disadvantaged – making coherent recommendations. Membership engagement through virtual regional activities and panels should be part of ISUH’s future as well.

Dr. Tsouros is a leading international expert with 30 years of experience in the fields of health policy, urban health and healthy cities, inter-sectoral governance and health in all policies, social determinants of health and equity and health promotion. His Global Healthy Cities initiative is focused on providing leadership and engagement for municipal leaders who want to promote health and sustainability at the local level. Agis points out that it has taken almost four decades to realize that many of the public health challenges of our time can be dealt with effectively at a local level. National policies are always helpful and important. However, it is mayors and local governors who the power to mobilize various constituencies to work together for the health and wellbeing of the urban population.

Agis stresses that when we talk about health we are talking about health in its widest sense – not only the absence of disease. We need to make it understood that health is not just the health sector. Health is basically every sector in our society. He underlines and is keen to make it understood that if we really want to mobilize local government and different sectors to focus on urban health and health equity, we need legitimacy and leadership which can come only from the top. You need a champion to embrace the thinking of making health a priority and a value for the city’s development. Every sector should be engaged in the mobilization to work for health. This is where he is making a difference with his Global Healthy Cities initiative.

Professor Nguendo-Yongsi is the President-Elect of ISUH. Professor Nguendo-Yongsi is an Urban Health Influencer. He has been involved in the ISUH for several years and will be working with us to lead the organization into a sustainable future. He is a strong advocate for engaging African scholars in the ISUH global network of urban health thinkers and doers. His work in Africa has made strong theoretical and methodological contributions, addressing environmental hazards and deficiencies in health service provision. He sees this experience as being critical to creating opportunities for trans-disciplinary research in urban health through the ISUH network.

Professor Nguendo-Yongsi believes that ISUH is well placed to influence decisions in urban health and to help improve the wellbeing of urban populations through education and research. His vision is to engage members and foster partnerships worldwide because improving urban health requires the engagement of multiple sectors. Expanding, connecting, and engaging are three key activities. He sees local engagement as being particularly important as well as the focused engagement of partners. He sees two important priorities: (1) education and (2) research. For people to be in good health they need first to be educated and without reliable research we cannot have information about how best to influence social determinants. We must encourage health governance and provide training in urban health as ways to engage many stakeholders in the organization.

Dr. Blessing MBeru is an ISUH Board member and a lead for the Africa Workgroup. In this podcast, Dr. MBeru believes that his role on the board is to help deepen ISUH’s role and work in Africa where urbanization is a major demographic event that creates many challenging issues related to health. The growth of urban informal settlements has created a number of population health challenges. Blessing sees ISUH’s focus on urban health as an important organizing hub for reaching the African continent and can bring greater relevance and value to what is happening in urban health.

Dr. MBeru is anxious to help engage African thinkers and doers in urban health as members of ISUH. Africa has a lot of complexities as a continent of 54 independent countries. He is particularly interested in engaging existing observatories such as the Nairobi Urban Health Demographic Observation platform, including the one in Burkina Faso, in the development of an ISUH-Africa Urban Health Observatory. He sees researchers as the link to the local communities. His organization, APHRC, is a pan-African research center that has regional reach and can work with ISUH to connect with practitioners and policymakers.

Dr. MBeru thinks it is important to create a mapping and measurement tool for community indicators on urban health. It will be a very important opportunity for greater collaboration and engagement of practitioners in the region as well as global engagement. The APHRC has a consortium for engaging African researchers that can be used to support this effort. There are many opportunities for partnering with APRRC that will enable ISUH to extend its reach in Africa. Particularly, the opportunity to engage emerging urban health researchers in the region and can create a broader link to universities across the continent.

Dr. Olga Lucia Sarmiento Dueñas is a member of the ISUH Board. She is a member of the Latin American Urban Health Network and is a member of the executive committee in that network. The LAC Network consists of people and researchers who live in Latin America as well as researchers in the U.S. who work on Latin American issues. She is a physician epidemiologist and analyses community interventions in Latin American that can have influence on the prevention of chronic diseases. Her work as an urban-health-influencer presents many opportunities for collaboration within ISUH. For example, her work with the Open-Streets Project. The Open-Streets Project focuses on social inclusion, social capital, inequalities, and community interventions and health.

Dr. Sarmiento Duenas sees ISUH as truly multidisciplinary and truly global and works from a perspective that shows that health is more than the health care system. To have healthy cities we need to see how other sectors can teach us how to improve the health in our cities. She is anxious to learn from other continents – e.g. the relationship between South America and other continents. Her vision for ISUH is a focus on capacity building for the new generation of academics who want to be part urban health work. Some of the ways that can help this new generation could be done through mentorship, connecting with other early career urban health thinkers, webinars, exchange opportunities, and helping build new programs in countries that have less capacity. Webinars blended within existing programs can generate interests – e.g., an ISUH webinar in one of her public health courses blended within an existing program to optimize resources.

Professor Giles-Corti is a public health academic and has been working in the built environment and health space for two decades. Most of her research is with sectors outside of health – urban planners, landscape architects, etc. She is really pleased to see that the health sector is getting into the built environment and health area. Her work has been focused on creating evidence for thinkers and actors outside of health to influence policy and practice. She describes her efforts as a very interesting journey. The evidence-base has been important for sustaining multi-sector partnerships.

When Professor Giles-Corti refers to the health sector, she is focused on the use of the health budgets less on the health care system and more on health promotion, disease prevention, and the environment. She feels that the health sector’s role in asking the other sectors to create conditions for doing health has been late coming. That is partly because we haven’t had the quantitative evidence. It has taken a long time to get the evidence. There has been a lot of sophisticated conversations going on over the last year and when we need to change cities we need to use natural experiments. That is increasingly valued. We are creating this wonderful multidisciplinary database on interventions and associations in focusing on the role of cities in diseases in general.

Professor Giles-Corti sees ISUH playing a major role in getting researchers to think differently about how we do research. If you want to change cities and influence health, you really have to influence the policy environment. She sees the ISUH conferences as opportunities for engaging policy makers and practitioners with researchers in innovative ways for generating policy-relevant research. Such research should be co-designed and resonate with the people you are trying to influence. This can be very exciting applied scientific work – applying innovative techniques focused on a particular problem that a city is trying to solve. ISUH can be a space for discussing how to do research that makes a difference and influences policy makers.

Professor Birch is trained as a city planner focused on building cities of lasting value. She points out that health is a very important aspect of that value. A community of lasting value is a community in which its inhabitants lead healthy productive lives. Mental health and physical health are equally important for lasting healthy cities. The field of city planning has its origins in public health. The focus on sanitation, water, and housing are among the key issues in neighborhood and city planning.

Professor Birch sees ISUH as having three functions: (1) Convener – bringing together people across disciplines. The population of the people attending the ISUH conferences crosses disciplinary boundaries and dialogue is based on good scientific research and different points of view; (2) A voice for all of the principles that we work out and promote together for good health and good healthy places; and (3) A lab – supporting projects that bring together people to solve problems affecting people in urban environments.

SDG alignment is a definite area around which ISUH can create transdisciplinary dialogue and action by bringing groups together. ISUH can serve a bridge function for engagement at the national level with the agencies that are working on the SDGs and at the local level where projects are modeling and piloting solutions for challenges such as gender health and food and cities.

Engaging ISUH membership in such efforts can be done by identifying spaces within the conferences to create conversations and opportunities for dialog on synthesis across the SDGs, for example. There could be a special issue of the Journal of Urban Health that really dives into how to integrate and synthesize the SDGs – creating opportunities for problem solving and solutions generation. Professor Birch urges ISUH to collaborate and partner with the General Assembly of Partners and other large organizations to create matching opportunities for members.

Dr. Jason Corburn is a member of the ISUH Board. He is committed to engaged scholarship, by which he means using research and academic resources to promote change, particularly social justice. He sees ISUH as a critical organization because it brings together people from around the world doing specific activities related to urban health. His joining the ISUH board has been a great opportunity for him to connect globally with a whole host of practitioners.

Dr. Corburn likes the term “urban health influencer” and sees significant ways in which his work is influencing urban health. As an academic he runs the Center for Global Healthy Cities at UC Berkeley. The Center focuses on policy that facilitates changes in urban communities and neighborhoods – who benefits and how changes impact wellbeing. The second is building local collaborations and partnerships focused on reducing inequalities in urban neighborhoods and how people live. Focus on intra city work and those ways engaging the world around these issues.

Professor Corburn views ISUH’s role in the context of his work as providing opportunities for bringing people together to dialog – likes the way the conference has evolved in bringing both researches and practitioners together – transdisciplinary activities focused on problem solving. Another area is rethinking education. We need a new set of practitioners for the 21st century city. The city is vastly changing, with new technologies, and increased inequalities and so we need to train people in new ways for dealing with these new challenges – preparing people to be change agents. Dr. Corburn sees the education workshop that he co-leads as being instrumental in helping to propel this change. The idea is that we want to think cross-culturally, different learning styles, different ways in which we can teach and train folks – focused on new ways to include the urban core and community members in cities who are the ones suffering the most around inequalities in cities. Three key things are being focused on: (1) developing a web-based platform where people can access different training; (2) bringing people together for training at each conference with a specific theme; and (3) figuring out how to bring this back to universities around the world to support education and training in urban health.

Dana’s and Jose’s collaboration will be presented at the ICUH in Kampala, Uganda in November 2018. Their goal is to influence urban health dialogue between health decision makers and urban health scientists by creating datasets to map areas in slum boundaries where infrastructure is insecure, and health is tenable. They will help to provide estimates of survey data by slum and non-slum areas. However, they point out that this is a piece in a larger puzzle. It allows us to develop data for marginalized populations and informal settlements.

For both Dana and Jose, ISUH can facilitate remote activity and exchange in networks to create transdisciplinary funding for urban health research and get members to apply for this type of funding. ISUH has a role in reaching out to and collaborating with other sectors beyond urban health, developing collaborative publications and special issues with organization such as the Planetary Health Alliance, green space organizations, etc.

Dr. Sainath Banerjee has been an ISUH Board member over the past year. Being a board member is quite exciting for him because of the scope and nature of the task. He sees his participation in ISUH enabling him to have global impact. He is currently co-leading the community solutions workgroup. This workgroup proposes to share local community solutions for urban health globally and to create opportunities for community-based actions.

Dr. Banerjee started actively working in urban health back in 2002-2003 when he led a small pilot program in India with USAID assistance. His work focused on slums that were not supported by the government of India’s development agenda because they are not “listed.” He used data to show the need for including these communities in the national planning. His work inspired the government to develop a national urban health agenda.

He sees ISUH in 4 areas: (1) advocacy; (2) implementation research; (3) knowledge support; and (4) is networking. Because of its position on the global level, ISUH can be an advocate for the creation of urban health agendas. ISUH should have a field presence and implementation to add to its knowledge base. For knowledge support, ISUH can provide predictor information to support landscape or future predictor of urban health for some countries. For networking ISUH can create partnerships with various institutions to address urban health issues.

Dr. Banerjee wants to help ISUH figure out how to engage and amplify research being conducted by its members and provide a frame for supporting opportunities for members to develop advocacy platforms. He believes that membership engagement in ISUH can be supported through institutional level involvement, not just at the individual level. Members should see ISUH as the source of knowledge information and global initiatives on urban health. ISUH can create a bridge for issues and themes in urban health and provide regional opportunities for collaboration. Each member is an ambassador of ISUH. He thinks it will be a good idea to create regional chapters of ISUH.