completed· Health

Surveys for Urban Equity: getting, and using, the data needed to respond to neglected non-communicable diseases in urban areas in LMICs

Non-communicable diseases (NCD) are a major public health issue in South Asia (S Asia), accounting for 60% of deaths. Urbanisation is a key driver, increasing mental stress and injuries and risk factors such as tobacco use, poor diet and inadequate physical activity. Public health decision-makers in LMICs need unbiased, precise and accessibly-presented data to inform equitable urban development. Nationally representative surveys are the main data source used to inform decision-making in LMICs, e.g. Demographic and Health Surveys (DHS) and STEPS NCD Risk Factor Surveillance are used in over 90 LMICs. This approach has many problems: it excludes unofficial poor settlements and peri-urban areas beyond administrative boundaries; definitions of a 'household' overlook multiple occupancy by poor urbanites; current methods for ranking wealth are not sensitive to urban poverty; and NCDs currently assessed in these surveys do not include injuries and mental ill-health, conditions that disproportionately affect the urban poor. These methodological constraints leave policy makers with no way of understanding or responding to the NCD burden and inequities found within urban areas in LMICs. Furthermore, the way data is currently presented - in long wordy reports - undermines decision-makers' ability to find and interpret data for planning and managing health programmes. We will capitalise on existing partnerships and develop new ones, to i) identify and test questions on mental health and injuries, ii) test cheap and efficient novel methods to reduce bias in urban surveys iii) explore alternative approaches to defining households, measuring and ranking wealth iv) develop data visualisation tools to support decision-makers' use of survey data. We will conduct this foundation work in Nepal, Bangladesh and Vietnam as their different urban characteristics increase our works applicability to other LMICs and we have existing strong partnerships. We will hold two meetings and facilitate ongoing interaction with international and national bodies to share expertise and build capabilities on the novel survey methods, measures of wealth and NCDs, data visualisation and use of data to address urban inequities. We will conduct a systematic search of questionnaires and draw on our own work assessing injuries and mental health to identify the best questions for LMIC urban areas. We will finalise the questionnaire in collaboration with government stakeholders after checking its comprehensibility in urban slums. We will pilot our novel survey sampling and mapping methods in Kathmandu, where our initial pilot of these methods was curtailed by the 2015 earthquake. Our novel methods use satellite imagery, mobile phone and census data, to identify the entire urban population including those not captured by the census. Once sampled, we will use a web-based app to accurately map communities. Smaller feasibility studies of the methods and developed questionnaire will be conducted in Hanoi and Dhaka. We will explore household types and identify wealth indicators in urban slums. Using our pilot data, we will explore associations between household consumption, assets and income to develop an appropriate measure of urban wealth. In each country, we will assess the extent to which data is used in urban planning and management through interviews with decision-makers. Through the establishment of communities of practice within municipalities, we will co-produce appropriate data visualisation tools to support planning and management. This foundation grant has the potential to i) transform survey methods used in all LMICs, enabling more accurate assessment of health inequities in urban areas ii) provide questions on mental health and injuries for use in other surveys in LMICs, and iii) ensure data informs the health-sector response to NCDs in LMICs.