Cities & Health

Visualising health equity for urban planning

Since the start of this century the role of urban planning for public health has increasingly been acknowledged, and important conceptual work has been carried out on the relationship between both disciplines. There is clear evidence that if we want to improve and promote health for all, we need to implement policies that tackle the root causes of health inequities, many of which have a place-based component. This will involve urban planners, educators, and policy makers working with public health practitioners.

With this special issue we want to further a conversation on the role of visualization in urban planning for health equity. When using the term health equity, we refer to those social differences in health that are avoidable, unfair and unjust. However, to identify which social inequalities in health are avoidable, unfair or unjust – and require policy intervention – we need to transfer epidemiological knowledge into spatial representation which can be applied in the rules and logic of decision-support within planning culture. Finding modes of communication which are understood by different disciplines, stakeholders and communities is one of the biggest challenges contributing to overcome the existing implementation gap in urban planning.

We think there is an important role for visualizing health inequities in, and for, urban planning. Diagrams, sketches, drawings, charts, maps, virtual or physical models, renderings, photographs or videos can all be relevant tools to help show existing health inequities and the impact urban planning may have on diminishing health inequities.

With this Call for Contributions we want hear from a range of actors who are involved in the role of visualisation in urban planning for health equity.

We identify five main reasons why this topic is important now:

1. To understand spatial connections: The pathways from built environment characteristics to health outcomes are very complex, and the health equity perspective adds to this complexity.
2. To support decision-making: There is an urgent need to make the available data fit better with what is needed in practice and support decision-making.
3. To gain momentum: Visualizations are important tools to raise awareness and health literacy in the community and among policymakers and planners.
4. To explore the potential of new techniques: There is evolving potential from new technologies such as virtual reality or generative artificial intelligence.
5. To support knowledge exchange and international collaboration: There is a widening gap across countries (both: In global North and South) in terms of their capacities, budget, knowledge, legal framework and culture for visualizing health inequity.

To support those submitting to this special issue, as guest editors, we are publishing, as an editorial for this call, a preliminary overview of different ways to visualise health equity in cities, illustrated with examples. We have observed how visualizations inform different stages of urban planning processes and can deliver key messages both within and across dimensional divides such as objective/subjective, narrative/illustrative and conceptual/interactive.

Eight Critical Questions

1. There is a range of indicators and dimensions used for visualisation. The combination of health outcomes, socio-economic and spatial data is important, but also reveals methodological challenges and ethical implications. What are suitable methods to spatially visualise social inequalities in environmental conditions relevant for health equity?
2. Structural discrimination against people of different age, religion, gender, sexual orientation, nationality, ethnicity, mental and physical ability and language has a place-based component. How do we communicate on different types of structural discrimination and their association to health inequities?
3. Visualisation tools are often heavily reliant on quantitative data. Qualitative data is essential to understand and act on health inequity. What qualitative strategies can give subjective experiences more importance?
4. A variety of methodological approaches and visualisation strategies co-exist, with little research available on the impact on planning processes and policy making. How effective is the visualisation of health equity today?
5. We need to be aware of who is making these visual images, and who is equipped to use the tools (e.g. for decision-making). While improving data literacy is essential, there might also be a role for urban planners (or not?). Who is responsible for the visualisation of health equity?
6. Most of the health equity visualization tools came from the public health sector and planners are not using them due to a lack of awareness, education or training. How can we increase the use of visualization tools within the planning process?
7. Innovations such as generative artificial intelligence and virtual reality can support better visualisation and decision-making tools, but also present a risk of overreliance on “black box” calculations, and missing more qualitative perspectives. How to steer technological innovation for visualisation?
8. However valid a visualisation technique is, the degree to which it can effect change will depend on the context and processes where it is used. More research is needed both to identify the key factors that promote success, and those that may hinder required outcomes. What kind of contexts and processes are required to support change? What role can visualisation play?