title: Linking evidence to action on social determinants of health using Urban HEART in the Americas.
abstract: OBJECTIVE
  To evaluate the experience of select cities in the Americas using the Urban Health Equity Assessment and Response Tool (Urban HEART) launched by the World Health Organization in 2010 and to determine its utility in supporting government efforts to improve health equity using the social determinants of health (SDH) approach.
  
  
  METHODS
  The Urban HEART experience was evaluated in four cities from 2010-2013: Guarulhos (Brazil), Toronto (Canada), and Bogotá and Medellín (Colombia). Reports were submitted by Urban HEART teams in each city and supplemented by first-hand accounts of key informants. The analysis considered each city's networks and the resources it used to implement Urban HEART; the process by which each city identified equity gaps and prioritized interventions; and finally, the facilitators and barriers encountered, along with next steps.
  
  
  RESULTS
  In three cities, local governments spearheaded the process, while in the fourth (Toronto), academia initiated and led the process. All cities used Urban HEART as a platform to engage multiple stakeholders. Urban HEART's Matrix and Monitor were used to identify equity gaps within cities. While Bogotá and Medellín prioritized among existing interventions, Guarulhos adopted new interventions focused on deprived districts. Actions were taken on intermediate determinants, e.g., health systems access, and structural SDH, e.g., unemployment and human rights.
  
  
  CONCLUSIONS
  Urban HEART provides local governments with a simple and systematic method for assessing and responding to health inequity. Through the SDH approach, the tool has provided a platform for intersectoral action and community involvement. While some areas of guidance could be strengthened, Urban HEART is a useful tool for directing local action on health inequities, and should be scaled up within the Region of the Americas, building upon current experience.
authors.affiliation: World Health Organization, Kobe, Hyogo, Japan, prasada@who.int.
authors.forename: Amit
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Rutgers University, New Brunswick, New Jersey, United States of America.
authors.forename: Ana Maria Mahecha
authors.initials: AM
authors.lastname: Groot
authors.affiliation: Pan American Health Organization, WHO, Bogotá, Colombia.
authors.forename: Teofilo
authors.initials: T
authors.lastname: Monteiro
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.affiliation: Department of Health, Guarulhos Municipality, Sao Paulo, Brazil.
authors.forename: Emilia Estivalet
authors.initials: EE
authors.lastname: Broide
authors.affiliation: World Health Organization, Kobe, Hyogo, Japan, prasada@who.int.
authors.forename: Megumi
authors.initials: M
authors.lastname: Kano
mesh_terms: D000569:Americas; D003625:Data Collection; D003661:Decision Support Techniques; D006077:Government Agencies; D006285:Health Planning; D006291:Health Policy; D006292:Health Priorities; D054624:Health Status Disparities; D006305:Health Status Indicators; D054625:Healthcare Disparities; D006801:Humans; D015397:Program Evaluation; D011640:Public Policy; D064890:Social Determinants of Health; D014944:World Health Organization