Measuring environmental determinants of health: a review of complexity in benchmarking systems

Introduction: Many urban health benchmarking systems are produced with the aim of informing policy, thereby acting as a form of evidence. There is wide recognition that the urban environment’s impact on health is a complex... [ view full abstract ]

Introduction: Many urban health benchmarking systems are produced with the aim of informing policy, thereby acting as a form of evidence. There is wide recognition that the urban environment’s impact on health is a complex system, with a noted lack of frameworks addressing this challenge. With previous reviews of benchmarking systems focusing on population health or systems of national relevance, it remains unclear how they account for complexity or help practitioners deal with real-world complexity. This literature review aimed to identify and analyse benchmarking systems, particularly with regard to their representation of the complex range of factors influencing health in urban areas.
Methods: We identified systems by reviewing bibliographic databases, grey literature and scanning references. For inclusion, systems needed to have a purpose beyond academic research and be defined as an index, assessment process, standard or framework that uses summary measures to understand, compare, or predict the urban environment’s impact on health. We extracted and analysed launch date, presentation of results, scale, geography, scope, indicators, origin, purpose, methodology, evidence, weighting, complexity, and uncertainty.
Results: Thus far we have analysed 24 urban health benchmarking systems meeting the inclusion criteria, comprising 667 indicators. These indicators related to the environment and four other domains: health, 15 (63%); health care, 8 (33%); behaviours, 19 (79%); and demographics and social environment 16 (67%). Complexity was mentioned by 7 systems, with 3 addressing it by methods including: many indicators; socioeconomic and ‘ethno-racial’ stratification; and diverse metrics.
Conclusion: Very few systems attempted to measure or represent the complexity of urban health. Of the three systems which attempted to address complexity, it is unclear whether their methods would be sufficient to represent this complex system. Further research is needed to identify whether indicator systems can accurately reflect the complexity of urban health systems to support policy.