Generating political priority for urban health and nutrition : Application of a policy framework

Background: Over the past 2 decades there has been much dis- cussion of the challenges posed by rapid urbanization in the devel- oping world, yet the health of the urban poor continues to receive little political priority at the global level. Despite wide recognition that the world is rapidly urbanizing, little research has specifically exam- ined why little action has been taken globally. Drawing on social science scholarship concerning how issues come to attract attention, this study examines factors that have shaped political priority for ur- ban health. We draw on the Shiffman and Smith (2007) policy framework, which consists of four categories: 1) actor power, 2) issue framing, 3) the political contexts within which actors operate, and 4) characteristics of the issue itself. Structure/Method/Design: The paper triangulates among several sources of data, including 18 semi-structured interviews with experts involved with agencies that shape opinions and manage resources in global health, published scholarly literature, and reports from orga- nizations involved in urban health provision and advocacy. Results (Scientific Abstract)/Collaborative Partners (Program- matic Abstract): Several key factors currently hinder urban health’s advancement globally. First, with respect to actor power, there is no policy community cohesion or unifying political entrepreneur, and limited mobilization of civil society to champion the cause. While there has been demonstrated uptake in momentum for “urban” among development organizations, funders, state governments, and academics, this area has yet to be recognized as its own discipline and be attached to uniform, formal strategic policies. Second, with respect to framing, there is a lack of consensus in defining “urban,” which has lead to longstanding conceptual and measurement difficulties. Third, concerning political contexts, the MDGs, rapid climate change, and the recent demographic shift to more than half of the world’s population living in urban settings have been largely un- tapped as policy windows. Finally, with respect to issue characteristics, there is limited disaggregated data and a lack of accepted metrics available to capture the burden of disease and poverty within disad- vantaged urban communities, which is needed to quantify the magnitude of the problem, develop effective interventions, and ulti- mately present it as a critical, unmet need. Summary/Conclusion: The study concludes with insight around what can be done to secure attention and resources for this over- looked area of development. This includes focusing on health equity by framing urban health problems through an “urbanerural con- tinuum” model, rather than reinforcing a strict urbanerural di- chotomy; seeking more urban-specific data that enables disaggregation to highlight the most vulnerable urban communities; supporting systematic knowledge-sharing of effective urban interventions; and capitalizing on policy windows like the post-MDG discussions.