WHO城市衛(wèi)生能力：評估和應(yīng)對入門

Urbanhealthcapacities

assessmentandresponse

primer

Urbanhealthcapacities

assessmentandresponse

vcc?i、vworldHealth

irganization

primer

Urbanhealthcapacities:assessmentandresponseprimer

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Contents

Acknowledgements vi

Glossary i

x

ExecutiveSummary xi

Introduction 1

I.Capacitiesforurbanhealth

3

II.Thecriticalroleofconnectivecapacities

9

III.Assessingcapacitiesasakeycomponentof

realizingurbanhealthgoals 1

3

IV.Theframeworkforassessingconnectivecapacities

forurbanhealth

19

V.Outcomesfromapplyingconnectivecapacities 2

5

VI.Ongoingcapacitystrengtheningforurbanhealth 3

1

References 35

Annexes 37

Annex1:Additionalcapacityassessmentguidancematerials 37

Annex2:Examplesofonlinecapacitystrengtheningresources 38

Annex3:Approachtodevelopment 42

vi

Acknowledgements:

ThisPrimerwaswrittenbyFranciscoObando(WHO)undertheguidanceofNathalieRoebbel(WHO)andTamitzaToroyan(WHO).

WHOextendsitsgratitudetothefollowingexternalexpertswhoreviewedthePrimer:

JoBoufford(NewYorkUniversity),JasonCorburn

(UniversityofCalifornia,Berkeley),BillieGillesCorti

(RMITUniversity),MichaelDavies(UCL),Paramita

Dey(NationalInstituteofUrbanAffairs),CarlosDora(InternationalSocietyforUrbanHealth),HelenElsey(UniversityofYork),AlexEzeh(DrexelUniversity),

NickFreudenberg(CityUniversityofNewYorkSchoolofPublicHealth),MarcusGrant(CitiesandHealth

Journal),RobertoMaderaArends(Consultantfor

theInteramericanDevelopmentBank),Johanna

Masic(WorldBank),TolibMirzoev(LondonSchool

ofHygieneandTropicalMedicine),ReneLoewenson(TrainingandResearchSupportCentre),Susan

Parnell(UniversityofCapeTown),HelenPineo

(UniversityofWashington),DavidH.Peters(York

University),OlgaLuciaSarmiento(UniversidaddeLosAndes),RaphaelleVignol(UN-Habitat).

WHOisalsogratefultothenumerousexternal

expertsandpractitionerswholedandparticipatedinthepilotsofthisPrimerandaccompanying

ActionGuide,providingcriticalreviewfeedback,informingthecontentandprocessinvolved:

AfricanRegion:

?KwekweZimbabwe:SheunesuNgwenya

(KwekweCityCouncil,Harare,Zimbabwe)andTserayiMachinda(UrbanCouncilsAssociationofZimbabwe,Harare,Zimbabwe)

?Lira,Uganda:WaiswaKakaireandJunior

AlvesSsebbanja(ACTogether,Kampala,

Uganda),AlfredOgwang(UrbanAuthoritiesAssociationofUganda,Kampala,Uganda)

?Lusaka,Zambia:VictorKagoli(Lusaka

DistrictHealthAuthority,Lusaka,Zambia),

FastoneGomaandMuwasaMukupa(CentreforPrimaryCareResearch,Lusaka,Zambia)

?Turkana,Kenya:PascalMukangaandAllanOuko(KonkueyDesignInitiative,Nairobi,

Kenya)

?Technicalsupporttopilots:Rene

Loewenson(TrainingandResearchSupportCentre,Harare,Zimbabwe)

EuropeanRegion:

?London,UnitedKingdomofGreatBritainandNorthernIreland:BiancaD’Souza,ClaraLovett,AliceWalker,andClaraGiraoud(GreaterLondonAuthority,London,UnitedKingdomofGreatBritainandNorthernIreland)

?Utrecht,Netherlands(Kingdomofthe):

SybritvandenBerg,MiriamWeber,RenskeVerstege(UtrechtLocalAuthority,Utrecht,Netherlands(Kingdomofthe))

WesternPacificRegion:

?Suva,Fiji:WallyAtalifo,MaramaDimudre,RoselynDanford,AshlynLal,TomasiBati,PeteroSanele,NickyPrasad(SuvaCity

Council,Suva,Fiji)

?Donggu-GwangjuMetropolitanCity:

EunjeongKang(SoonchunhyangUniversity,Asan,RepublicofKorea),HyranKim(GwangjuDong-gu,Gwangju,RepublicofKorea)

RegionoftheAmericas:

?Bogota,Colombia:AdrianaArdilaSierra,

WilliamRoblesFonnegra,KimberlyPi?eros

Chia,AngieCasta?edaCasallas,Diana

CuaspaSanabria,SofiaRiosOliveros

(SecretaríaDistritaldeSaluddeBogotá,

Bogotá,Colombia)inthecontextofapartiallyimplementedassessmentprocess

EasternMediterraneanRegion:Qatar:HatounSaeb(MinistryofPublicHealth,Doha,Qatar)inthecontextofapilottrainingsession

vii

ThefollowingWHOStaffcontributedimportanttechnicalfeedback:

?Headquarters:StephanieBurrows,Hyung-TaeKim,Monika

Kosinska,SusannahRobinson,Jose?Siri(DepartmentofSocial

DeterminantsofHealth);YasmineAnwar,FatenBenAbdelaziz,

TrinetteLee,(DepartmentofHealthPromotion);AbrahamMwaura(DepartmentofEnvironment,ClimateChangeandHealth)

?RegionalOfficeforAfricaDorisGatwiriKirigiaandPeterMalekelePhori(HealthPromotionandSocialDeterminantsofHealth),

AntonioPalazuelosPrieto(SocialDeterminantsofHealth)

?RegionalOfficefortheAmericasFranciscoArmada(Consultant),DiegoBejarano(Consultant),MariaPilarCamposEsteban

(DepartmentofHealthPromotion)

?RegionalOfficeforEurope:MatthiasBraubach(Environment

&HealthImpactAssessment)KiraFortune(HealthyCities,HealthPromotion&Well-being),PierpaoloMudu(EnvironmentandHealth)

?RegionalOfficefortheEasternMediterranean:SamarElfeky(HealthPromotion)

?RegionalOfficeforSouth-EastAsia:SuvajeeGood(FamilyHealth,GenderandLifeCourse)

?RegionalOfficefortheWesternPacific:IsabelEspinosa,

(Gender,EquityandHumanRights),RatuSaulaGoleaVolavola

(PacificIslandCountries),JoanaMadureiraLima(Health-enablingSociety),JosaiaTiko(HealthierPopulations)

WHOacknowledgesthefinancialsupportofBloombergPhilanthropies.

viii

ix

Glossary

ActionPlan–Aplanbasedonananaylsisof

capacityassetsandgaps,andanexistingworkprogramme,whichdetailsactivitiesintendedtoachieveaselectedurbanhealthgoal.

Component–Aspecificaspectofcapacitywithinaconnectivecapacityarea,e.g.,thecapacity

to“measuretherightthings,attherightscale,usinganappropriatedefinition”isacomponentofcapacityarea1:“Informeddecision-making,monitoringandevaluation”.

Capacitylevel–Thescaleatwhichaconnective

capacitycanbefound,i.e.,withinindividuals(individuallevel);withinanorganization

(organizationallevel),oracrossanetworkoforganizations(systemiclevel).

Connectivecapacities–Thecapacitiesrequired

fortheintegrated,coordinatedmultisector

practiceandpolicy-makingthatcreatesurban

health.Thesecapacitiesbringtogethersector-

specifictechnicalandpolicyknowledge,skillsandabilitiesacrosssectorsandlevelsofgovernance,

enablingmultilevel,multidisciplinaryurbanpolicy-makingandpractice.Theyliewithinfourkeyareas:

1.Informeddecision-making,monitoringandevaluation

2.Policies,programmes,innovationandchange

3.Resource(human,financialandinfrastructure)management

4.Partnerships,participationandknowledgesharing

Issue-specificcapacity–Theknowledge,skillsandabilitiesrelatedtoaspecificissue(e.g.,air

pollution)andtheirapplicationinurbancontexts.

Iterativecapacityassessment–Theprocessofongoingroundsofcapacityassessment,eachbuildingontheprevious,tomeasureprogressinstrengtheningandleveragingcapacities.

Levelofgovernance–Theextentofan

authority’smandatedgovernance,e.g.,local

(acrossacityoradistrictofacity),regionalor

provincial(acrossalargeadministrativeareaofacountry)andnational(country-wide).

RighttotheCity–Therightofallurbandwellers,presentandfuture,toinhabitinclusive,safeand

sustainablecitiesthatensuredecentwork,health,education,leisureandcultureforall–including

womenandmarginalizedgroups.

Sector-specificcapacity–Theknowledge,skillsandabilitiesrelatedtoaspecificsector(e.g.,

mobility,landuseanddevelopment,education)andtheirapplicationinurbancontexts.

Technicalinnovation–Thecreationand

applicationofneworimprovedtechnologies,tools,systemsandprocessesthatarenotablydifferentfrombeforeandleadtosignificant

advancementsorprogress.Thisentails

recognizingnewtechnologicalpossibilitiesand

relatedknowledgeorexperience,andsupplyingthehuman,organizationalandfinancialresourcesneededtotransformthemintousefulproducts

andprocesses.

Urbanhealth–Theartandscienceofimprovinghealthandhealthequityincities,includingby

securingtheresilienceandsustainabilityofhealth-supportingnaturalandhumansystems;more

thanthesumofitsparts,itensuresthatpeople,institutions,andenvironmentsinteracttocreatehealthysituationsandthateverypersonhasthechancetothrive,nowandintothefuture.

x

It’sameasureofthehealthofurbandwellersascontinuallycreatedbytheircomplexinteractionswithurbanphysicalandsocialenvironments,andbythedecisionsandinstitutionsatallscalesthatshapetheseinteractions.

Urbanhealthgoal–Thespecificobjectofan

ambitionoreffortwithinanareaofurbanpolicyorpracticethatultimatelyalsoimproveshealth,e.g.,theeffectiveintegrationofmigrantstocontributetotheeconomyultimatelyalsoimprovesmental

health;oraccesstoandqualityofdrinkingwaterultimatelyalsoreducescommunicabledisease.

Urbansector–Thetraditionalcompetenciesor

domainsofactionrelatedtourbangovernance,

suchaswaterandsanitationprovision,solidwastemanagement,energy,landmanagement,housing

andothers.Theseareissuesaroundwhich

municipaladministrationstendtobestructured,bothinstitutionallyandfiscally.

Whole-of-society–Awhole-of-society

approachincludesformalandinformalinstitutionsinseekingbroadagreementacrosssocietyaboutpolicygoalsandhowtoachievethem.

ExecutiveSummary

xii

ExecutiveSummary

URBANHEALTHCAPACITIES-ASSESSMENTANDRESPONSEPRIMER

Policy-makersandpractitionerscandeliversignificantbenefitsto

thehealthofcitypopulationsbyachievingurbangoalsandsolvingchallengesinanysector,includinghealth,mobility,landuse,food

production,economicdevelopment,educationandbeyond.The

keytomaximizingurbanhealthisthroughstrengtheningand

leveragingspecificsetsofcapacitiesthatconnectdiverseurban

workacrosssectorsandlevelsofgovernance.ThisPrimerprofiles

these“connectivecapacities”atindividual,organizationalandcross-

organizational(systemic)levels,andtheirvitalroleinachievingurbangoalsacrossallsectors,tosupportcity-dwellers’healthandwell-

being.Byinformingacapacityself-assessment,thisPrimerhelpsteamsaimingtounderstandtowhatextenttheyhaveconnectivecapacities,whatthismeansforachievingtheirurbanhealthgoalsandhowtorespond.

Theseconnectivecapacitiesspanfourkeyareas(seeSectionI):

1.Informed

decision-making,monitoringandevaluation

2.Policies,

programmes,

innovationandchange

3.Resource(human,

financialand

infrastructure)management

4.Partnerships,

participation

andknowledgesharing

Relevanttoboththeseniordecision-makerswhoinitiateorauthorizeanassessment,andtotheteamtheyassembletocarryitout,the

Primerenablesdiverseurbanactorstoharnessthepotentialof

theseoften-overlookedcapacities,tounderpinholistic,effectiveurbanhealthsolutions.Itcontainstheframeworkforatargeted

capacityassessment(seeSectionIV)–criticaltounlockinghealth-positivepolicy-makingandpracticewithinanyareaofurbanwork

atcommunity,localornationallevels.Theframeworkactsasachecklist,fromwhichuserscanselectandassesstheexistingcapacitiesofrelevancetotheircontext.

EXECUTIVESUMMARYxiii

Carriedoutviaaprocessofcollaborationbetweenthosewitharoletoplayindeliveringahealthgoal,anassessmentrevealstheexistingcapacitiesthatcanbeleveragedtopromotehealth,thosethat

mustbestrengthened,andcapacitygapswhichmustbemitigated.Conversely,overlookingconnectivecapacitiesofstaff,organizationsandcross-organizationalsystems,isoftenthecauseofineffective

policiesandpractice,whichcanhaveunintendedconsequencesandwhichfailtooptimizeuseoflimitedresources.

ThePrimeralsoprovidesarangeofpossibleoutcomesthatindicatestrongconnectivecapacities(seeSectionV),illustratingthepositivedifferencethesecapacitiescanmake.Strongcapacitiesleadto

outcomeswithineachareaessentialtoachievingurbanhealth

goals.Forexample,knowledgesharingbetweentransportplanners,pollutionexpertsandhealthspecialistscontributestoreducing

congestionandimprovingairquality,todeliverbetterhealth.Orprovidinginnovativeacculturationprogrammesformigrantsto

thecitycontributestomentalhealthimprovements,whichinturnsupportemploymentandeducation

(1)

.

Ultimately,theabilitytoaddressurbanchallenges,andachieve

goalsinanysectorwhichalsobenefitthehealthofpeopleandthe

planet,dependsonurbanactors’abilitytooptimizeconnective

capacities.Assessingandimprovingcapacitiesiscontext-dependent,andrequiresflexibilityandinnovationincontentandprocess.To

carryoutacapacityself-assessmentandresponseexercise,we

recommendthatusersreadthisPrimerandtheaccompanying

ActionGuideinfull,beforeembarkingontheiruseinpractice,asabasisforoptimizingdeliveryofurbanhealthgoals.

xivURBANHEALTHCAPACITIES-ASSESSMENTANDRESPONSEPRIMER

Lookoutforall4componentsofUrbanhealthcapacitiesassessmentandresponseresourcekit:

1.Primer–aimstofosterself-assessmentandunderstandingofthecapacities

neededtoperformkeyfunctionsforholistic,coordinatedpolicy-makingandpracticethatimprovethehealthandwell-beingofcitydwellers.

2.Actionguide–providesstep-by-stepguidanceenablinglocalauthoritiesand

otherurbanactorstoassessthecapacitiesvitalforprovidingholistic,joined-upurbaninitiatives,andgenerateaplantoachieveanurbanhealthgoalthatleveragesand

strengthensthesecapacities.

3.Trainingvideo–showshowtofacilitateacapacityself-assessmentprocess,guidingassessmentfacilitatorsthroughtheconceptsandmethodsofthecapacityassessment.

4.Cityexamples–tellstoriesofinstancescapacityself-assessmentandresponseexerciseswerecarriedoutindifferentlocalitiesgloballytoassesscapacitiesforurbanhealth,ultimatelyimprovinghealth.

Introduction

2URBANHEALTHCAPACITIES-ASSESSMENTANDRESPONSEPRIMER

Introduction

Urbanhealthisameasureofcitydwellers’

healthasdeterminedbytheirinteractionwith

urbanfeaturesandsystems.Itinvolvesthrivingcitypopulations,livinginsustainable,equitableenvironmentsthatpromotehumanphysical,

mentalandsocialhealthandwell-being,and

planetarysustainability.Continuallycreatedby

thecomplexinterplayofpeopleandinstitutionswiththeirphysicalandsocialenvironments,

urbanhealthextendsfarbeyondtheremitofthehealthsector.Fromairqualitytosocialservices,itencompassesallfactorsaffectingthehealthofcityinhabitantsandthesustainabilityofurban

contexts.Itreliesonfunctionalecosystems,whilealsoplayingacentralroleindeliveringenvironmentalsustainability.

Morethanthesumofitsparts,urbanhealth

involvesensuringthatpeople,institutionsand

environmentsinteracttocreatehealthysituationsandopportunitiesforeveryone,inallpartsof

thecity.Itisanessentialcomponentof“the

RighttotheCity”–therightofallurbandwellers,presentandfuture,toinhabitinclusive,safeandsustainablecitiesthatensuredecentwork,health,education,leisureandcultureforall–including

womenandmarginalizedgroups.1Simultaneously,itassistsandrequirestheexerciseofindividual

andcollectiveresponsibilitiestowardhealthwithinandbeyondthecity.

Yetdespitethenumberofsectorsthatdetermineit,urbanhealthisrarelycentraltodecision-makingbeyondthehealthsector.Asaresult,stakeholdersmissvitalopportunitiestoprotect,promote

andbenefitfromcitydwellers’health.Failurestoaddressinadequatehousing,forexample

–throughmeasuressuchasnewresidential

construction,adequatesolidwastemanagementandsewagesystems,andaffordablecleanenergysupplies–resultinmultiplelosthealthand

economicbenefitsandunsustainableburdensonurbanhealthcareprovision.

Deliveringurbanhealthandwell-beingrequiresteamworkthatcutshorizontallyacrosssectors

andhealthissues,aswellasvertically,across

local,regional,nationalandinternationallevelsofgovernance.Itispossiblethrougheffectivepolicydevelopment,servicedeliveryandmanagementpractices.Yetcurrentsector-specificwaysof

workingdonotallowtheintegrated,evidence-based

approachesneededtomanagetheenvironmentalandsocialdeterminantsofurbanhealth.New,

overarchingmechanismsareneededtoensurethatdiversestakeholdersacrosssectorsandlevelsof

governanceconsiderthehealthconsequencesoftheirdecisions,includinginthelongtermandfrom

anequityperspective

(2,

3)

.ThisPrimerconstitutessuchamechanism.Itenablestheassessmentof

thecapacitygapsandassetsavailabletoachieve

achosenurbanhealthgoal.Relevanttoboththe

seniordecision-makerswhoinitiateorauthorizea

capacityassessment,andtotheteamtheyassembletocarryitout,thePrimersupportsintegratedpolicyandactiontodeliverhealth-positivechangein

complexurbanenvironments.

1TheconceptoftheRighttotheCitywasfirstintroducedbyFrenchsociologistHenriLefebvreinthe1968book“LeDroitàlaville”.Socialmovements,localgovernmentsandinternationalbodiesfurtherdevelopedtheidea,includingatkeyglobaldialoguessuchasEco-92inRiodeJaneiroandHabitatIIinInstanbul,influencingkeydocumentssuchastheNewUrban

Agenda(NUA).

PARTI

Capacitiesforurbanhealth

4URBANHEALTHCAPACITIES-ASSESSMENTANDRESPONSEPRIMER

I.Capacitiesforurbanhealth

Capacitystrengtheningistheprocessbywhichindividuals,groups,organizationsandsocietiesincreasetheirabilitytoperform,solveproblems,defineobjectives,andunderstandandaddressdevelopmentneeds,toachieveobjectivesin

asustainablemanner

(4)

.Understandingthecapacitiesrequiredforcreatingtheconditionsforthriving,healthyurbandwellersisacriticalstartingpoint.

Improvingurbanhealthbroadlyrequirestwotypesofcapacity:

?Sector-andissue-specificcapacities–knowledge,skillsandabilitiesrelatedtoaspecificsector(e.g.,mobility,landuseanddevelopment,education)orissue(e.g.,

migrationorclimatechange)andtheirapplicationinurbancontexts.

?Connectivecapacities–requiredforthe

integratedandcoordinatedmultisector

practiceandpolicy-makingthatcreatesurbanhealth,andbringstogethersector-specific

technicalandpolicyknowledge,skillsandabilities.Thesecapacitiesliewithinfourkeyareas,outlinedbelow

(5)

.

ThisPrimerfocusesontheconnectivecapacitiesthatlinktheworkofindividualsandorganizationsacrosssectorsandlevelsofgovernance,fosteringanintegratedapproachtourbanpracticeand

policy-makingforhealthandwell-being.Thesecapacitiesenablemultilevel,multidisciplinary

modelsofgovernance.Theyareinclusiveandconsultative,drawingonmultipleformsof

evidencetodeliverurbanhealth.

Thefourareasofconnectivecapacityforurbanhealth

1.Informeddecision-making,monitoringandevaluation

Effective,interconnectedinterventionsinanysectortopromote

urbanhealthdependonreliableevidenceandanalysis.Dataand

informationfromthehealthsystemandsectorssuchassanitation,transport,education,employment,food,housingorurbandesignallowstakeholderstomapthedistributionofdiseaseandhealth

atdifferentscales,andthesocialandenvironmentalfactorsthatdeterminethem.Thisenablesurbanactorstounderstandhealth

dynamics,informingbetterpracticeandmonitoring

(6)

.

Thecapacitytogeneratethenecessaryinformationrequiresgeospatializeddatasystemsthataredisaggregatedand

interoperablebetweensectorsandlevels.Therelevantqualitativeandquantitativedataenablesactorstomapandtrackthe

I.CAPACITIESFORURBANHEALTH5

relationshipsbetweenhealth,theurbanenvironmentand

governance.Actorsalsoneedcapacitytomonitorandevaluate

interventionsusingindicatorsthatreflecttheperspectivesofall

urbanhealthactors,particularlylocalcommunities,ensuringequityandinclusion.

2.Policies,programmes,innovationandchange

Thiscapacityareaprioritizestheleadershipandexpertisetoaddressurbanhealthproblems,emphasizingthevalueofstrategic,evidence-basedthought,analysisandaction.Itincludesthecapacitiesto

shape,implementandevaluateplansandprogrammesintheshortandlongterms,byidentifyingwhatworksordoesnot,andwhy,aswellaswhattoscaleuporcutback.Italsoincludesthecapacityto

allowchangeandengageininnovation–forexample,adaptingbestpracticeorasuccessfulexampletoanewcontext,orusingevidence

todevelopsolutionstoanewchallenge.

Capacitiesinthisareaarealsoneededtodrivereform,bynurturingpoliticalwillasthebasisforintegratedurbanhealthpolicyand

practice.Theyincludeadvocacyforpoliticalleaderstosupporta

holisticvisionofurbanhealth,andanenablingenvironmentwhichgivespeopletheauthorityandresourcestoimplementintegratedsolutionsacrossscalesandsectors.

3.Resource(human,financial,infrastructural)management

Integratedurbanhealthdeliveryrequiresactorswiththeskillsand

knowledgetoallocatehuman,financial,andinfrastructuralresourceseffectively,tobuildandmaintainthenecessarysystems,institutionsandcompetencies.Capacitiesinthisareaensurethatsufficient

resourcesareallocatedtothemostpressingissues,atappropriatescales,andthatwell-trainedpeopleworkininstitutionsthatarefit-for-purposetodeliverurbanhealthgoals.

Cross-sectoralbudgeting,planningandimplementationrequire

financialfoundationsthatencouragepeoplefromdifferentsectorstoworktogether–forexample,allowingthecapitalallocatedto

confrontairpollutiontodrawonbothhealthandtransportbudgets.Thecapacitytoimplementsuchprogrammesrestsonadequate

humanresources,whichdeliverexpertisefromallrelevantsectors–suchassanitation,foodsystemsorpublichealth.

Infrastructuralresourcessuchasthecivilservice,certifyingbodies

andprofessionalorganizationsarevitaltopromotemultidimensional

6