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Publications

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Climate Trends and Consumption of Foods and Beverages by Processing Level in Mexican Cities

SALURBAL researchers analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service.


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Is the built-environment at origin, on route, and at destination associated with bicycle commuting? A gender-informed approach

SALURBAL researchers examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults.


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Urban social determinants of non-communicable diseases risk factors in Argentina

SALURBAL researchers examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults.


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From Causal Loop Diagrams to Future Scenarios: Using the Cross-Impact Balance Method to Augment Understanding of Urban Health in Latin America

SALURBAL recruited 16 food and transportation system experts spanning private, academic, non-government, and policy sectors from six Latin American countries to complete an interviewer-assisted questionnaire to elicit participants’ perceptions about the bivariate relationships between 11 factors in the food and transportation system. Using cross-impact balance analysis, researchers identified 21 plausible future scenarios for the system.


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Educational Inequalities in Obesity: A Multilevel Analysis of Survey Data From Cities in Latin America

SALURBAL assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development. This cross-sectional study used survey data collected between 2002 and 2017. The data included 53,186 adults over 18 years of age in one hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru). Among women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.


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COVID-19 AND Urban Health in Latin American and the Caribbean: A Challenge for Urban Health and Health Equity

COVID-19 and Urban Health in Latin America and the Caribbean

The Latin America and Caribbean (LAC) region is one of the world regions hardest hit by the pandemic. This brief the current state of the COVID-19 pandemic using data compiled by the Salud Urbana en América Latina ("Urban Health in Latin America") project (SALURBAL). The brief includes information on the number of cases, deaths, and vaccinations reported, as well as socioeconomic inequities in these outcomes in Latin American cities. Policy approaches and actions that some cities and countries have implemented to improve data quality and reduce inequities are highlighted.


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Áreas verdes y seguridad hídrica

Áreas verdes y seguridad hídrica

Greenspace and water security: This brief highlights three examples of coordinated, city-level action from the public and private sectors designed to promote greenspace, increase water security, and safeguard human health. These actions were declared through CDP’s global disclosure system, which helps investors, companies, cities, states and regions identify and manage their environmental impacts.


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Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018

Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018.


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Urban income segregation and homicides: An analysis using Brazilian cities selected by the SALURBAL project

Using data compiled by the SALURBAL project, this study investigates the associations of income segregation with homicide mortality across 152 cities in Brazil. This article also includes data on segregation, income inequality, and homicide rates for the top 20 most segregated cities in Brazil and concludes with a discussion of policy implications of the study's findings.


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Urban social environment and low birth weight in 360 Latin American cities

Using data compiled by the SALURBAL project the study quantifies variability in low birth weight (LBW) across cities in Latin America, and evaluates the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW.


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Women’s empowerment and infant mortality in Latin America: evidence from 286 cities

This study examines associations of Women Empowerment with Infant Mortality Rates (IMR) across 286 cities in seven Latin American countries. It estimates IMRs for 2014–2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision.


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The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing

The RUCAS project performed a longitudinal study where inhabitants exposed and unexposed to the intervention were compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms.


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Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil

This study seeks to explore the perceived influence of CBSD workshops and the understanding of the stakeholders from research, policy-making, and other backgrounds working in food and transportation systems that attended, and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health.


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Support for market-based and command-and-control congestion relief policies in Latin American cities: Effects of mobility, environmental health, and city-level factors

This publication studies a 2016 survey of 8178 residents from 11 cities across 10 Latin American countries collected by the Development Bank of Latin America (Corporaci´on Andina de Fomento or CAF). IT examines support for two demand-side approaches to managing the traffic congestion externality: congestion pricing – a market-based approach, and driving restrictions or bans – a command-and-control approach.


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COVID-19 and the worsening of health inequities in Santiago, Chile

This article used mortality, population and census data to show a worsening of pre-existing inequities in mortality in the municipalities that make up the metropolitan region of Santiago (Chile) during the COVID-19 pandemic.


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Ambient fine particulate matter in Latin American cities: Levels, population exposure, and associated urban factors

This article published in the Journal of Science of the Total Environment characterizes PM2.5 levels, describes patterns of population exposure, and investigates urban factors as predictors of PM2.5 levels in Latin American cities.


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Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment

This article published in the Journal of Epidemiology and Community Health investigated educational differences in diabetes prevalence by gender, whether these inequities vary across countries and cities, and the extent to which they are modified by city social environment.


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Life expectancy and mortality in 363 cities of Latin America

This article published in Nature Medicine describes variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. The results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.


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COVID-19, Ambient Air Pollution, and Environmental Health Inequities in Latin American Cities

This commentary aimed to characterize COVID-19-related reductions in ambient PM2.5 in four major cities in Latin America and to estimate the magnitude of reductions in adult mortality if long-term exposure to PM2.5 was lower proportional to levels observed during the COVID-19 shutdowns.


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Social Inclusion and Physical Activity in Ciclovía Recreativa Programs in Latin America

This study aims to compare spatial trajectories in four Ciclovía Recreativa programs in Latin America (Bogotá, Mexico City, Santiago de Cali, and Santiago de Chile) according to socioeconomic characteristics and urban segregation of these cities; and to assess the relationship between participants’ physical activity (PA) levels and sociodemographic characteristics.


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Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach

This publication aims to to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities.


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Web Data Mining: Validity of Data from Google Earth for Food Retail Evaluation

This publication aims to test the validity of web sources data for the assessment of community food retail environment by comparison to ground-truth observations (gold standard), as well as to test whether validity differs by type of food outlet and socioeconomic status (SES).


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Transformaciones Urbanas y Salud: Resultados de la Evaluación del TransMiCable

El resumen de resultados muestra la evaluación de las transformaciones observadas en múltiples dimensiones en el área de influencia del TransMiCable en Ciudad Bolívar, Bogotá. El estudio, realizado por miembros de SALURBAL, se llevó a cabo entre 2018 y 2020 con habitantes de Ciudad Bolívar y San Cristóbal con un equipo multidisciplinar y a través de metodologías mixtas.


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El Transporte Público Colectivo y el Transporte Activo en Tiempos de Pandemia

El transporte público colectivo y el transporte activo en tiempos de pandemia outlines key recommendations for adapting and supporting public mass transit and active transportation systems to promote safe, healthy, and equitable mobility in the context of the COVID-19 pandemic. This is the first brief in SALURBAL’s new mini-series, COVID-19 and Urban Health in Latin America.


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Oferta y Publicidad de Alimentos y Bebidas en Instituciones Educativas y Entornos Escolares de Lima Metropolitana. Un Estudio Exploratorio

La publicación describe la oferta y la publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de 15 colegios públicos y privados de Lima en 2019.


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Infant Mortality in Latin American Cities

This data brief describes how the Salud Urbana en América Latina ("Urban Health in Latin America") project (SALURBAL) is using data to describe patterns of infant mortality across Latin American cities and understand what characteristics of urban environments may be contributing to inequities in infant mortality.


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Characterising variability and predictors of infant mortality in urban settings: findings from 286 Latin American cities

This publication quantifies variability in infant mortality rates (IMR) across 286 Latin American cities and examined associations between urban characteristics and IMR in a cross-sectional design.


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Longitudinal changes in the retail food environment in Mexico and their association with diabetes

This publication describes changes in the composition of the retail food environment in Mexican neighborhoods from 2010 to 2016 and examines the association between these changes and diabetes cases diagnosed over the same period. 


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Adolescent Tobacco Exposure in 31 Latin American Cities before and after the Framework Convention for Tobacco Control

This publication describes describe the prevalence and changes in tobacco use and tobacco control policies in Latin American countries and cities before and after ratification of the 2003 Framework Convention on Tobacco Control (FCTC).


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Could severe mobility and park use restrictions during the COVID-19 pandemic aggravate health inequalities? Insights and challenges from Latin America

This opinion article discusses how parks and "green spaces" offer psychological restoration and ease mental health challenges as well as provide opportunities for physical activity practices in social distance, but how they can also provide hubs for community transmissions.


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Promoting urban health equity in a post-COVID world: A view from Latin America

This briefing paper looks at the links between COVID-19 and urban health inequities, rooted in the Latin American context, and priorities for promoting urban health equity, climate resilience and sustainability following the pandemic.


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Urban health and health equity in Latin American cities: What COVID-19 is teaching us

This commentary highlights a few key lessons with major implications not only for COVID-19 but for urban health and health inequities, that are beginning to emerge during the pandemic.


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Park use, perceived park proximity, and neighborhood characteristics: Evidence from 11 cities in Latin America

SALURBAL researchers examine how park use may be associated with perceived park proximity, neighborhood-built environment and perceived social disorder in Latin American cities.


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Increases In Women’s Political Representation Associated With Reductions In Child Mortality In Brazil

SALURBAL researchers assessed the effects of female political representation on mortality among children younger than age five in Brazil and the extent to which this effect operates through coverage with conditional cash transfers and primary care services.


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Pandemics, cities and Public Health

Published in the Revista Ambiente & Sociedade, SALURBAL researchers examined changes in air pollution in São Paulo, Brazil during the COVID-19 pandemic. The team found that in São Paulo, reduced economic activity and a reduction in vehicle circulation contributed to a reduction by over 10% in environmental PM2.5 (fine particulate matter) in April 2020 compared to previous years.


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Bicycle safety in Bogotá: A seven-year analysis of bicyclists’ collisions and fatalities

Road safety research in low- and middle-income countries is limited, even though ninety percent of global road traffic fatalities are concentrated in these locations. In Colombia, road traffic injuries are the second leading source of mortality by external causes and constitute a significant public health concern in the city of Bogotá. Bogotá is among the top 10 most bike-friendly cities in the world. However, bicyclists are one of the most vulnerable road-users in the city. This study aims to determine the spatiotemporal trends in fatal and nonfatal collision rates and to identify the individual and contextual factors associated with fatal outcomes.


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Building a Methodological Foundation for Impactful Urban Planetary Health Science

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities.This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research.


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Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018)

Rapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018.


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Level of traffic stress-based classification: A clustering approach for Bogotá, Colombia

The Level of Traffic Stress (LTS) is an indicator that quantifies the stress experienced by a cyclist on the segments of a road network. This publication proposes an LTS-based classification with two components: a clustering component and an interpretative component. The methodology is a useful tool for policy-making, as it identifies suitable areas for interventions; and can estimate their impact on the LTS classification, according to probable changes to the input variables.


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Health as driver for urban policy in Latin America: a scoping review of literature from international organizations

Understanding how health drives urban policies is critical for highlighting knowledge gaps and communicating evidence about health impacts to policymakers. This scoping review of grey literature examined the use of multiple health arguments and corresponding scientific evidence as justification for urban policies in Latin America. Generally, health arguments were generic, underdeveloped, healthcare-focused, and/or unfounded in scientific evidence. These findings highlight the need to more effectively communicate scientific evidence on the health impacts of urban policy.


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Revisión rápida: probabilidad de contagio por infecciones respiratorias agudas en el transporte público y medidas para mitigarlo

La publicación determina el nivel de evidencia sobre la probabilidad de transmisión de enfermedades respiratorias agudas en el transporte público, incluyendo transporte activo, identificando medidas en el uso del transporte público que pueden reducir la probabilidad de contagio por SARS-CoV-2 u otra infección respiratoria aguda de etiología viral.


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A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions

Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use.


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TransMiCable Paper Cover

Urban Transformations and Health: Methods for TrUST—a Natural Experiment Evaluating the Impacts of a Mass Transit Cable Car in Bogotá, Colombia

TrUST (In Spanish: Transformaciones Urbanas y Salud: el caso de TransMiCable en Bogotá) is a quasi-experimental study using a mixed-methods approach. 


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Knowledge to Policy Translation for Urban Health

How can urban health research drive the development of evidence-based policies? Knowledge to Policy Translation for Urban Health: Lessons from Latin American Cities explores how knowledge about the links between urban environments and health can inform action to promote urban health and health equity and contribute to environmental sustainability. The document reviews challenges and opportunities related to knowledge to policy translation for urban health in Latin America and presents concrete actions for improving how the research community engages with policymakers and other actors. (February 2020)


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Assessing Google Street View Image Availability in Latin American Cities

This study identifies patterns of Street View image availability, image age, and image age variance across cities in Latin America and assesses relationships between these measures and measures of resident socioeconomic conditions.


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Inequalities in Life Expectancy in Six Large Latin American Cities

This study reveals important differences in life expectancy within ​six Latin American cities. The findings highlight the importance of developing urban policies focused on reducing social inequalities and improving social and environmental conditions in the poorest neighborhoods in the region.


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Commute patterns and depression: Evidence from eleven Latin American cities

Although travel behavior is expected to influence personal health, few studies have examined associations with mental health. This study examines associations between commute patterns and mental health using survey data in 11 Latin American cities. The findings provide preliminary evidence that better access to mass transit systems and less congestion may be linked to better mental health among urban residents.


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The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases

Rising obesity and increasing recognition of the food environment's role in creating and addressing this challenge has led to increased attention on this topic within scientific literature in recent years. This study reviews literature describing the food environment in Latin America and policies targeting the food environment (FEP), as well as analytic studies that investigate associations between the FEP and dietary behaviors, overweight/obesity and obesity related chronic diseases. Findings suggest that health claims on food packaging are prevalent and mostly misleading; there is widespread use of marketing strategies for unhealthy foods aimed at children; and food prices are lower for processed relative to fresh foods. More work is needed to better understand policy impacts over time and the impacts of food prices and digital marketing on diet and health.


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Using community-based system dynamics modeling to understand the complex systems that influence health in cities: The SALURBAL study

This article describes the design, implementation, and results of a collaborative process designed to elucidate the complex systems that drive food behaviors, transport, and health in Latin American cities and to build capacity for systems thinking and community-based system dynamics (CBSD) methods among diverse research team members and stakeholders. During three CBSD workshops, 62 stakeholders from 10 Latin American countries identified 98 variables and a series of feedback loops that shape food behaviors, transportation and health, along with 52 policy levers. Our findings suggest that CBSD can engage local stakeholders, help them view problems through the lens of complex systems and use their insights to prioritize research efforts and identify novel solutions that consider mechanisms of complexity.


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A Novel International Partnership for Actionable Evidence on Urban Health in Latin America: LAC-Urban Health and SALURBAL

This article describes the origins and characteristics of an interdisciplinary multinational collaboration aimed at promoting and disseminating actionable evidence on the drivers of health in cities in Latin America and the Caribbean: The Network for Urban Health in Latin America and the Caribbean and the Wellcome Trust funded SALURBAL (Salud Urbana en América Latina, or Urban Health in Latin America) Project. Both initiatives have the goals of supporting urban policies that promote health and health equity in cities of the region while at the same time generating generalizable knowledge for urban areas across the globe. The processes, challenges, as well as the lessons learned to date in launching and implementing these collaborations, are described. By leveraging the unique features of the Latin American region (one of the most urbanized areas of the world with some of the most innovative urban policies), the aim is to produce generalizable knowledge about the links between urbanization, health, and environments and to identify effective ways to organize, design, and govern cities to improve health, reduce health inequalities, and maximize environmental sustainability in cities all over the world.


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Complex Systems Approaches to Diet: A Systematic Review

Complex systems approaches can help to elucidate mechanisms that shape population-level patterns in diet and inform policy approaches. This study reports results of a structured review of key design elements and methods used by existing complex systems models of diet.


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Data in the SALURBAL Project

Data in the SALURBAL Project provides an overview of the process of selecting cities, compiling data, and the types of questions the dataset may help to answer. The document was developed to inform future SALURBAL studies and to receive feedback from stakeholder working in urban health in the region regarding how SALURBAL research can support their efforts.


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Building a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study

Studies examining urban health and the environment must ensure comparability of measures across cities and countries. We describe a data platform and process that integrates health outcomes together with physical and social environment data to examine multilevel aspects of health across cities in 11 Latin American countries. We used two complementary sources to identify cities with ≥ 100,000 inhabitants as of 2010 in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. We defined cities in three ways: administratively, quantitatively from satellite imagery, and based on country-defined metropolitan areas. In addition to "cities," we identified sub-city units and smaller neighborhoods within them using census hierarchies. Selected physical environment (e.g., urban form, air pollution and transport) and social environment (e.g., income, education, safety) data were compiled for cities, sub-city units, and neighborhoods whenever possible using a range of sources. Harmonized mortality and health survey data were linked to city and sub-city units. Finer georeferencing is underway. We identified 371 cities and 1436 sub-city units in the 11 countries. The median city population was 234,553 inhabitants (IQR 141,942; 500,398). The systematic organization of cities, the initial task of this platform, was accomplished and further ongoing developments include the harmonization of mortality and survey measures using available sources for between country comparisons. A range of physical and social environment indicators can be created using available data. The flexible multilevel data structure accommodates heterogeneity in the data available and allows for varied multilevel research questions related to the associations of physical and social environment variables with variability in health outcomes within and across cities. The creation of such data platforms holds great promise to support researching with greater granularity the field of urban health in Latin America as well as serving as a resource for the evaluation of policies oriented to improve the health and environmental sustainability of cities.


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Health in All Urban Policies

Health in All Urban Policies: Lessons from Latin American Cities outlines the core principles of a Health in All Policies (HiAP) approach to understanding how urban environments affect health, and how urban policies and interventions across sectors can impact the health of people living in cities. This policy brief was co-produced by the SALURBAL project in collaboration with the Pan American Health Organization (PAHO) and describes initiatives by each organization to advance HiAP implementation. The 12-page booklet provides an introduction to key concepts related to HiAP, research and evidence to support this approach, and recommendations for policymakers and for the academic community for leveraging action across sectors to promote health, equity, and environmental sustainability. 


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Cover page of the SALURBAL mortality and life expectancy data brief

Mortality and Life Expectancy in Latin American Cities

Life expectancy and causes of death vary greatly across urban areas in Latin America, and global and regional summaries of life expectancy and causes of death can hide significant variability across cities. Urban environments that differ across neighborhoods, cities, and countries can have a major impact on life expectancy and causes of death. Mortality and Life Expectancy in Latin American Cities presents the experiences of the SALURBAL project in harmonizing and describing mortality data across 366 cities in 10 countries.


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Planning Health Evaluations of Housing and Neighborhood Interventions

Planning Health Evaluations of Housing and Neighborhood Interventions: Lessons from Latin America​ discusses opportunities to integrate health evaluations into the design and implementation of urban policies. Housing and neighborhood interventions can be important interventions that deliver packaged benefits to improve urban health and well-being, but more evidence is needed regarding their effects under different conditions and the pathways underlying these effects to inform policy changes. The policy brief details potential health effects and evaluation designs, recommendations for intersectoral planning, and shares three case studies of current evaluations from the SALURBAL project.


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Food and Urban Health

Food and Urban Health: Lessons from Latin America presents leading challenges in urban nutrition in the context of demographic changes, poverty, and markets and regulations. The policy brief describes mechanisms that can be implemented to affect food-related behaviors and consumption, and highlights innovative policies, laws, and programs from the region. Recommendations build upon best regional practices and suggest integrated and intersectoral responses.


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Sustainable Transport and Urban Health

Sustainable Transport and Urban Health: Lessons from Latin American Cities explores strategies and interventions from throughout the region that support active transport and mobility in cities. The policy brief gives an overview of the key areas of transportation policies, regional trends, case studies of policies in major cities, and discusses the contributions of Latin America to global efforts in urban policies and health. 


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