Local public health observatories serving urban populations: a hub for producing, linking and translating data to improve health and wellbeing for all

It is now common knowledge that over half the world’s population lives in urban areas, and that this urban population continues to grow. By the middle of this century, it is expected that seven out of every 10 people, globally, will be living in urban areas ¹1. World Health Organization. Urbanization and health. Bull World Health Organ 2010; 88:245-6.. The latest State of the World’s Cities report ²2. United Nations Human Settlements Programme. State of the world’s cities 2012/13: prosperity of cities. http://mirror.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3387 (accessed on 19/Mar/2015).
http://mirror.unhabitat.org/pmss/listIte... revealed that the world’s cities have often not lived up to expectations as places of opportunity and prosperity. Instead, many have become places where deprivation, inequality and exclusion are the norm. Slums have proliferated in many cities around the world where basic services are lacking not only in these informal settlements but even in formal settlements. According to United Nations Human Settlements Programme (UN-Habitat), one-third of the urban population of the developing world lives in slums. In much of Europe and in other developed countries where slums are a lesser problem, social exclusion and poverty as well as income inequalities are increasingly driving health inequity in urban areas.

When researchers and decision-makers try to understand the extent of these problems and measure the impact of action, they run into a recurrent problem throughout the world: the deficiency in data availability, accessibility, quality and system interoperability. Particularly lacking are intra-urban data linking broader determinants of health to health outcomes, broken down by socio-demographic groups and small geographic areas. Even when data are available, the technical capacity for analysis is often limited, and the relationships between the bodies producing the evidence and those that should consider them for their policy making are weak or do not exist. As a result, urban health equity problems often go unrecognized, at least officially, and urban policies are guided and resourced based on insufficient or inappropriate information.

In a pursuit of possible solutions to this structural deficiency, the World Health Organization (WHO) Centre for Health Development in Kobe, Japan, cast its attention to local public health observatories around the world, serving urban populations ³3. WHO Centre for Health Development. Urban health observatories: a possible solution to filling a gap in public health intelligence. http://www.who.int/kobe_centre/publications/uho_policybrief/en/ (accessed on 19/Mar/2015).
http://www.who.int/kobe_centre/publicati... ,⁴4. Caiaffa WT, Friche AA, Dias MA, Meireles AL, Ignacio CF, Prasad A, et al. Developing a conceptual framework of urban health observatories toward integrating research and evidence into urban policy for health and health equity. J Urban Health 2014; 91:1-16.,⁵5. WHO Centre for Health Development. Providing health intelligence to meet local needs: a practical guide to serving local and urban communities through public health observatories. http://www.who.int/iris/handle/10665/152645#sthash.7jXmDk7T.dpuf (accessed on 19/Mar/2015).
http://www.who.int/iris/handle/10665/152... . Several of them had made significant achievements in developing locally relevant public health knowledge, and influencing urban health and development policies through an approach that engaged multiple sectors of both government and society. One of the keys to their success is to be flexible and responsive to their unique local context. They are not one-size-fits-all. There are, however, valuable insights and learning opportunities to be gained from local public health observatories at all levels of development, from those in inception, to those in maturation, or even going through “retirement”.

This Forum presents the experiences and perspectives of local public health observatories in various stages of development, each from a different country. First, Carlos Castillo-Salgado introduces a recently established public health observatory at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, USA. It integrates an academic training and research programme for public health professionals with the functions of an urban-focused public health observatory. Next, Maria Angelica Salles Dias and colleagues describe the international and local influences which contributed to the establishment of the Belo Horizonte Observatory for Urban Health in Brazil. They explain how the observatory matured over the following 12 years, and what opportunities and challenges it faces today. Finally, John Wilkinson, Director of the former North East of England Public Health Observatory (now part of Public Health England’s Knowledge and Intelligence Team), retraces the development trajectory of local public health observatories in England, which included the London Health Observatory among many others. He concludes by discussing the different facets of ensuring the legacy of those observatories in a changing national environment. Together the articles in this Forum portray the different ways in which local public health observatories can be created and evolve, while being similar in their aim to generate detailed information at the local level about the causes of ill health and the systematic differences between people and places, as well as their potential remedies.

Every member of an urban community, from the local municipal government to local businesses, civil society organizations or individual citizens, can and should benefit from well-informed policy making and resource allocation. Cities must develop and strengthen structural capacities that will enable them to understand their current state, anticipate future trends, and translate them into appropriate equity-oriented strategies and policies. Cities need to be capable of accomplishing this in a timely and comprehensive manner if they are to be prosperous cities which ensure quality of life, equity and environmental sustainability in a rapidly and constantly changing world. Local public health observatories can play a pivotal role in making this a reality.

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