Response-oriented measuring inequalities in Tehran: second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2), concepts and framework

Authors

  • Ali Asghar Farshad Department of Occupational Medicine, Iran University of Medical Sciences, Tehran, Iran.
  • Ali Montazeri Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
  • Alireza Esteghamati Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Bahman Cherghian Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Hossein Hesari Department of Oral Public Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
  • Hossein Malek-Afzali Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
  • Maziar Moradi-Lakeh Department of Community Medicine, Medical School, Iran University of Medical Sciences, Tehran, Iran.
  • Mohammad Kamali Rehabilitation Research Centre, Iran University of Medical Sciences, Tehran, Iran.
  • Mohsen Asadi-Lari Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran.
  • Naser Kalantari Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
  • Ramin Kordi Sports Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:

 Background: Current evidence consistently confirm inequalities in health status among socioeconomic groups, gender, ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health of the population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural, educational, political or environmental problems. Measuring inequalities, improving daily living conditions, and tackling inequitable distribution of resources are highly recommended by international SDH commissioners in recent years to ‘close the gaps within a generation’. To measure inequalities in socio-economic determinants and core health indicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2) was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). Method: For ‘assessment’ part of the project, 65 indicators in six policy domains namely ‘physical and infrastructure’, ‘human and social’, ‘economic’, ‘governance’, ‘health and nutrition’, and also ‘cultural’ domain were targeted either through a population based survey or using routine system. Survey was conducted in a multistage random sampling, disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households (118000 individuals) were collected. For ‘response’ part of the project, widespread community based development (CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. Conclusion: Following the first round of Urban HEART project in 2008, the second round was conducted to track changes over time, to institutionalize inequality assessment within the local government, to build up community participation in ‘assessment’ and ‘response’ parts of the project, and to implement appropriate and evidence-based actions to reduce health inequalities within all neighborhoods of Tehran. 

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Journal title

volume 27  issue 4

pages  236- 248

publication date 2013-11

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