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6 Bridging Drivers and Interventions to Scale Up Successful Practices
Pages 89-104

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From page 89...
... Participants in group 1 were asked to consider integrated strategies that promote health and health equity on the national and local levels in low-income urban settings. This group was moderated by Jason Corburn, director of the Institute of Urban and Regional Development and professor of public health and of city and regional planning at the University of California, Berkeley.
From page 90...
... PROMOTING HEALTH AND HEALTH EQUITY IN LOW-INCOME URBAN SETTINGS Jason Corburn, director of the Institute of Urban and Regional Development and professor of public health and of city and regional planning at the University of California, Berkeley, reported for the group that focused on integrated strategies that promote health and health equity in lowincome urban settings. He said that individuals in the group framed their discussion along five areas related to urban health equity: 1.
From page 91...
... He noted that WHO has pushed for urban air pollution data across thousands of cities, for example, and wondered whether something similar might be achieved through local support and local capacity building around urban and slum health issues. Corburn suggested that longitudinal data could be helpful for tracking what is happening in slums.
From page 92...
... Prioritizing Slum Health in Existing Institutions The final point considered by his group, said Corburn, was potential opportunities available within existing institutions to incorporate work on urban and slum health. For example, the group discussed that academic institutions might refocus training around urban and slum health, because few global health programs offer explicit training in this field in a holistic, interdisciplinary, and organized fashion, he said.
From page 93...
... Scaling Up Public Health Programs in Local Urban Environments Scott said the group deliberated about potential components for successfully scaling up public health programs in local urban environments. Sustainability was seen as an important component to many members of the group, which could be reinforced if the intervention contributes not only to its intended purpose but also to other positive community outcomes, explained Scott.
From page 94...
... He also noted that, while there have been successful public health programs that could be scaled up, they were often driven by charismatic individuals, and when such individuals leave, the programs dissolve. To avoid this, Scott reported, the group discussed the potential value of establishing an institutional home to ensure continuity and having key champions train and counsel successors moving into these leadership roles.
From page 95...
... Distinctiveness of urban environments 5. Potential case studies and evidence base
From page 96...
... Other players involved in the business case, Dye added, may include the government; industry; nongovernmental organizations, such as faith-based organizations; and large- and small-scale funders and investors, including local entrepreneurs. The group considered that the research design and evaluation expertise of the academic community can also play a role in developing the business case, said Dye.
From page 97...
... However, he noted that the health outcomes of multisectoral actions can be hard to discern and measure. He suggested building a better evidence base around the effectiveness of different types of multisectoral actions.
From page 98...
... Dye said that building an evidence base requires characterizing the quality of the evidence, which can range from anecdotal evidence to randomized controlled trial results. He noted that people who champion randomized control trials around implementation research are probably in the minority, however, and that judgments are most commonly made by people on the ground to make sense of the underlying causes for a pro
From page 99...
... He added that the road map has identified hot spots in places like Kibera in Nairobi, Kenya, and other large slums and informal settlements where a large cholera epidemic is a potential threat. David Nabarro, advisor for health and sustainability at 4SD, described his multipart hypothesis of what he defined as a new narrative on how best to contribute to better health of poor urban residents, not only in developing countries but around the world, which is different from the way urban work has conventionally been carried out.
From page 100...
... To move toward the framework proposed by Nabarro, Corburn suggested that taking an aggressive approach would be better than a slow one because the current crisis of health and inequities in cities demands significant attention. Corburn articulated the "need to build the evidence base by doing, not by just studying," arguing that the evidence base needs to be built quickly through action, such as pilot programs, coupled with evaluating and tracking multiple effects.
From page 101...
... Scott responded that there is a balance to strike between addressing urgent needs quickly and making informed decisions based on an appropriate evidence base, even though randomized controlled trials are expensive and time consuming. Dye remarked that the discussion had been focused on top-down initiatives and noted the importance of other types of initiatives that selfpropagate within communities and spread quickly.
From page 102...
... They also used a strategy called participatory budgeting that allowed residents to prioritize certain aspects, he added, as well as the innovative use of existing technology, such as ski lifts and escalators for public transportation. Corburn said that another strategy employed with significant health impact was called the "ethics of aesthetics," placing beautiful buildings, museums, and libraries in the poorest neighborhoods.
From page 103...
... Ezeh reiterated that, in many cases, the health solutions brought to bear for poor, vulnerable populations are poor policies that end up damaging more than healing. The necessary solutions and interventions are often simple and affordable, he added, but they require working jointly with the communities.
From page 104...
... Relman concluded by emphasizing the importance of striking a balance in both considerations of more experimental studies such as those that may help better understand ecological dispersal across slum environmental circumstances and the urgency of scaling up demonstrable interventions as presented throughout the workshop.


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