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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit’s health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.

This paper is based on qualitative interviews (n=20) conducted with individuals working or residing within a heavily depopulated section of the city of Detroit. This area is the projected site of an urban agriculture (UA) project, which proposes to utilise vacant land and economically marginalised residents to produce marketable products and services. With a few exceptions, neighbourhood respondents had little hope of improvement occurring in the neighbourhood anytime soon, and few expectations for UA to alter the daily life or social dynamic of the area. These findings are framed and interpreted using Wacquant’s (1999) concept of advanced marginality and Sampson’s (2012) arguments concerning neighbourhood effects. While some neighbourhood improvement efforts were viewed positively, others were regarded with intense suspicion, indicating that idealistic UA efforts may have some work to do in terms of engaging residents and offsetting legacies of displacement as well as on-going marginalisation.

The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.

Community development tends to focus on large-scale, government-funded transformations or on small-scale, grassroot initiatives. In the US, the financial resources, available infrastructure, and broad-based civic support to implement large-scale community transformations are frequently lacking. In contrast, niche interventions, while often locally successful, tend to be unscalable. Accordingly, many community development programs either do not go beyond an ideational stage, or they are unscalable or unsustainable in the long run. In this qualitative case study, we analyze the Eastern Market in Detroit, Michigan, a local institution that contributes considerably and in several ways to the sustainability of multiple communities. Using Content Configuration Analysis (CCA), we conduct a bottom-up exploratory analysis of fieldwork notes, nonparticipant observations, as well as audio, visual, and written materials including policy and strategy documents from the City of Detroit, Wayne County, and the State of Michigan, academic publications, strategy and annual reports, websites, blogs, vlogs, social media outlets, newspapers, podcasts, and interviews along two lines of inquiry: first, to examine how the market contributes to sustainable community development and, second, to explore the systemic underpinnings that facilitate such development. Specifically, we focus on the Eastern Market to identify system-relevant actors, interests, relations, interventions, and outcomes that illustrate an institution which operates well beyond the ideational confines of a conventional farmers market. In the process of exploring the adaptive nature of the Eastern Market within its financial and infrastructural constraints, we also exemplify with this case that a well-established institution, a farmers market, can reinvent itself to serve multiple needs of larger, heterogeneous communities, and that the successful adaptations associated with this reinvention reimagine the community in which it is embedded.

Objective. This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. Methods. We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships’ development. Results. Activities critical in partnership development include sharing decisionmaking, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. Conclusions. The URC experiences suggest that CBPR can be successfully implemented in diverse settings.

This study uses industrial pollution data from the Environmental Protection Agency's Toxics Release Inventory (TRI) and tract-level demographic data from the 2000 U.S. census to determine whether environmental racial inequality existed in the Detroit metropolitan area in the year 2000. This study differs from prior environmental inequality research in two important ways. First, it offers a positive rationale for using hazard proximity indicators. Second, it uses a distance decay modeling technique to estimate hazard proximity. This technique weights each hazard's estimated negative effect by distance such that the estimated negative effect declines continuously as distance from the hazard increases, thus providing more accurate estimates of proximity-based environmental risk than can be obtained using other variable construction techniques currently found in the literature. Using this technique, I find that Detroit's black neighborhoods were disproportionately burdened by TRI facility activity in 2000 and that neighborhood racial composition had a strong independent effect on neighborhood proximity to TRI activity.

Despite ongoing debate regarding the effectiveness of tax abatements, Michigan's Industrial Facilities Tax (IFT) abatement program has been widely and extensively used to boost local economic development. In this article, we estimate the effects of industrial property tax abatements on industrial, residential, and commercial property value growth in the context of regional competition for a panel of 152 communities in the five counties surrounding Detroit from 1983 through 2002. We find that: (1) offering tax abatements yields statistically significant positive impacts on industrial property value growth; (2) the impacts are larger in high tax than in low tax communities; (3) there are positive spillover effects of industrial tax abatements on residential and commercial property value growth; (4) tax abatements offered in competitor communities do not appear to influence own industrial property value growth; and (5) changes in the own as well as competitor property tax rates are important determinants of industrial property value growth. However, the fiscal benefits of tax abatements are quite small as compared with the costs of offering abatements even when spillover benefits to residential and commercial properties are considered.