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Assessing the alignment between community perceptions of urban health and resilience needs in the Lagos metropolis and state, federal and global priorities
Ebele Mogo
+Thank You
Mr Durst Dr Robinson Michelle Shiver Center for Global Health Committee members: Dr Leiferman, Dr Litt, Dr
McManus, Dr Risendal Colleagues and professors in the doctoral program Parents
+Background/Why Lagos Metropolis ?
Lagos State: smallest but most populous state in Nigeria (Lagos State Government, 2015)
Lagos metropolis is the metropolitan area of Lagos State (Lagos State Government, 2015)
Made up of 16 of the 20 local government areas of Lagos State (Lagos State Government, 2015)
Houses 1/3 of the urban dwellers in Nigeria and 75% of Lagosians (Okunlola, 2015)
Economic center of Lagos State and major economic center in Nigeria (Alo et al, 2014)
Population density: 20000 people/km squared (Helsinki University of Technology, 2015) (state average is 4193 people/km squared (Lagos State Government, 2015).
Population growth rate – 6-8% (Okunlola, 2015), (national growth rate is 2.7% (World Bank, 2015))
+Background City positively impacts health and wellbeing through: opportunities
for economic advancement, information, technology, culture, and knowledge (World Health Organization et al, 2010)
City negatively impacts health and wellbeing through: intra-urban poverty, crime, slum proliferation, noise, pollution (World Health Organization et al, 2010)
Poor quality of urban environment: transportation, air quality, traffic congestion, safety, noise, power supply, flooding, poor, overcrowded and unsafe housing (Ajayi et al, 2014)
Increases cardiovascular risk (Yamamoto et al, 2014), psychosocial stress (Kondo et al, 2014), injury (WHO Hidden Cities, 2010), poor adoption of active lifestyles (Hino et al, 2014)
Inequitable spread of positive and negative impacts with poor outcomes concentrated among urban poor (World Health Organization et al, 2010)
+Background Government solutions often involve a focus on aesthetics and
aggregated outcomes without a focus on poverty or equity (Cheshmehzangi et al, 2014)
City development plans often include eviction of urban poor and informal economic sector without alternatives or remuneration (Cheshmehzangi et al, 2014)
Informal sector excluded from means for social mobility e.g. employment, mortgage, health insurance, loans and land (Lagos Home Ownership Mortgage Scheme, 2015; National Health Insurance Scheme, 2015).
Poor maintenance of infrastructure (Dele et al, 2014), often leading to decay and injury
Therefore - urgent need to integrate equity and health into development plans for the metropolis
+Aims To describe i) residents’ perceptions of the urban built
environment and their perceived priorities for a healthy and resilient urban environment
To audit the urban built environment to a) describe the quality of built environment factors such as land use integration, varieties of destinations, natural features, active transportation, street characteristics, public amenities, aesthetics and signage and b) to estimate the association between built environment factors and residents’ identified priorities and c) to estimate the association between the built environment and residents’ health
To assess the alignment between residents’ identified priorities and i) built environment factors ii) state and federal government urban development plans and iii) the resilience framework of the Rockefeller Foundation
+Conceptual model based on socio-ecological model (Golden et al, 2015) l, social determinants of health (Wilkinson et al, 2013) and City Resilience Framework (Rockefeller Foundation, 2014)
Regional level
Local level
Interpersonal level
Individual level
+Regional level
Governance: cooperation between transport, health, environment and urban planning, emergency preparedness plan, communication between government and citizens, urban development strategy, surveillance
Environment: environmental policy, integrated development plans, practices to manage the ecosystem including flood risk, aesthetics, green spaces, buses, sidewalks, pedestrian bridges, street signs and street lights
Housing: housing policy, mortgage policies, approach to slum proliferation, land use policies, building codes
Health: public health management, funding, primary health care quantity and quality, health insurance policy
+Local level Housing: price, convenience and quality of housing Health: access to health insurance, out of pocket
spending, healthcare utilization, health literacy, preventive health practice, quality of health care sought, access to emergency health
Transport: access, convenience and cost of means for active transportation
Poverty and unemployment: availability and type of employment, cost, type and quality of skills training, reliability and cost of access to energy
+Local level
Food security: availability of food, quality of food, purchasing power to ensure access to quality food, and sustainability of access
Water and sanitation: access to water, cost, spatial proximity, quality of water
Safety: trust, transparency and adequacy of policing, cooperation of local leaders with police, inclusive public spaces, civic education, fairness in use of law
+Interpersonal level
Community and civic participation: membership of local organizations
Social relationships and networks: varieties of social support, trust
Integrated communities: ethnic, religious, income diversity in neighbourhood
+Individual level
Self reported physical functioning: days spent in poor physical health
Self-report mental health: days spent in poor mental health
+Sample
Focus groups of 8 participants per each of the three strata of society: high income, middle income and low income
Focus groups will be administered till saturation Estimate: 2-3 focus groups per income category Key informant interviews will be conducted with decision
makers in ministries of health, environment, transport, and urban planning
2-3 directors will be interviewed per ministry Will recruit 12 participants per focus group and 4 key
informants per ministry to offset no shows
+Audit administration Analytic audit tool by Brownson et al (2004) Site visits to residential streets of each focus group
participant Audit administration should take approximately one hour
per street. Land use integration, variety of destinations, natural
features, active transportation, street characteristics (connectivity, lighting, signs), public amenities, aesthetics (comfort, noise, air pollution, physical disorder,) and signage (Brownson et al, 2004)
+Audit administration
Tested in St Louis, Missouri for 147 street segments that comprised high and low income neighborhoods (Brownson et al, 2004)
Accurately found physical disorder for 67 of the low income segments and found no disorder in the high-income segments.
Most of the 8 questions from each aspect of the audit had poor to moderate agreement
The aspects of transportation and land use had high agreement and the aesthetic and social aspects of the environment were moderately to fairly reliable
Will test reliability in the new context of Lagos
+Analysis of the audit
Microscale Audit of Pedestrian Streetscapes (MAPS) data collection and scoring manual will be used to quantify the audit (Cain et al, 2012).
Face validity to remove scales that are not meaningful in that setting
Present descriptive statistics such as frequency, mode, mean, range, standard deviation for each subscale and correlation between subscales
+Analysis of audit
Internal consistency and reliability will be tested using Cronbach’s alpha for each subscale
Will investigate association between income in the local government area where the street is located and the audit score and use this to test construct validity
We will also use an exploratory factor analysis to investigate the structure of the variables and the underlying relationships between the measured aspects of the built environment in the context of Lagos.
+Analysis of archival information Archival information for federal and state government
sources will be assessed to gain contextual information and understand government priorities
Political manifestos: Jimi Agbaje, Ambode Akinwunmi, President Muhammadu Buhari
Lagos State Development Plan, Lagos State Research and Development Council Research Brief,
The Lagos Policy Review, Lagos Water Supply Master Plan, the Lagos Metropolitan Development and Governance Project Procurement Plan, the Lagos Strategic Transport Master Plan, the 1st, 2nd , 3rd and 4th National Development Plans, The Structural Adjustment Policy, Lagos State Ministry of Housing 2013-2015 medium term sector strategy
+Analysis of archival information
Urban health: Political Commitment to Urban Health, Lagos: Confronting challenges of rapid urbanization in a megacity, The Changing Face of Lagos: From Vision to Reform, The National Strategic Health Development Plan
2013 Ministerial Press Briefing, Nigeria’s intended nationally determined contribution to the UNFCC, The Lagos State Government Digest of Statistics, City Resilience Framework
+Triangulation To be triangulated: scored audit, focus group information,
key informant interview, archival information Interviews with experts – themes, frequencies, mode Archival documents – themes, frequencies, mode Map themes captured by focus groups to subscales in the
audit Low scoring items on the audit compared to identified
priorities by residents, government priorities from interviews, priorities from archival documents
Assess utility of audit: compare concordance and discordance of audit and and focus groups
+Timeline & 1st Lesson: Be Resilient January – February 2016: Meeting community member,
going to Nigerian IRB, testing the audit and correcting it, starting to read through archival documents, getting feedback from colleagues at the University of Lagos
March 2016 January 2016: Receipt of IRB approval; content analyses of archival documents; scheduling of interviews and focus groups
April 2016 February 2016: Focus groups and key informant interviews, Archival document analysis
+Timeline
May 2016: Analysis of audit June 2016: Administration and analysis of
focus groups and interviews (by phone?) July-August 2016: Write up of the final project Dissemination
+Experience
Grew up in Lagos, visited in the past ten years 4 month stints in 2007, 2011, 2013 and this year Seeing Lagos from a researcher’s perspective and
new parts Networking and exploring pathways for
dissemination Learning from local researchers Experimenting with social media to engage my
network – twitter, instagram, blog
+Experience Being immersed in my work versus talking
about it Positive feedback on the importance of public
health- panel, everyday people, non-health/science/academic people - increased my passion
Learning about the IRB and research process in Lagos
Built my own resilience to deal with challenges
Spending time with family and friends Great – professionally, academically,
personally
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+Thank you very much
Questions?
+References Dele, O., Ayodeji, O., & Tunji-Olayeni, P. (2014). Sustainability strategies in engineering
infrastructure maintenance in developing countries: selected south western Nigeria states case study. Civil and Environmental Research, 6(2), 80-93
Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A. L., & Lieberman, L. D. (2015). Upending the Social Ecological Model to Guide Health Promotion Efforts Toward Policy and Environmental Change. Health Education & Behavior, 42(1 suppl), 8S-14S.
Hino, A. A., Reis, R. S., Sarmiento, O. L., Parra, D. C., & Brownson, R. C. (2014). Built environment and physical activity for transportation in adults from Curitiba, Brazil. Journal of Urban Health, 91(3), 446-462.
Kondo, M. C., Gross-Davis, C. A., May, K., Davis, L. O., Johnson, T., Mallard, M., ... & Branas, C. C. (2014). Place-based stressors associated with industry and air pollution. Health & place, 28, 31-37.
Lagos Home Ownership Mortgage Scheme (2015). Retrieved from http://www.lagoshoms.gov.ng
Lagos State Government. (2015). Population. Retrieved from http://www.lagosstate.gov.ng/pagelinks.php?p=
+References Ajayi, O. O., Oviasogie, F. O., Azuh, D. E., & Duruji, M. M. (2014). Urban
Design and Sustainable Development: A Case of Makoko Area of Lagos State, Nigeria. European Scientific Journal, 10(10).
Alo, B., Olayinka, K., Oyeyiola, A., Oluseyi, T., Alani, R., & Abayomi, A. (2014). Studies and Transactions on Pollution Assessment of the Lagos Lagoon System, Nigeria. In The Land/Ocean Interactions in the Coastal Zone of West and Central Africa (pp. 65-76). Springer International Publishing.
Brownson, R. C., Hoehner, C. M., Brennan, L. K., Cook, R. A., Elliott, M. B., & McMullen, K. M. (2004). Reliability of 2 instruments for auditing the environment for physical activity. J Phys Act Health, 1, 191-208.
Cain, K. L, Millstein, R.A., Geremia, C.M. (2012).Microscale Audit ofPedestrian Streetscapes (MAPS): Data Collection & Scoring Manual. University California San Diego. Available for download at: http://sallis.ucsd.edu/measures/maps
Cheshmehzangi, A., & Bond, O. A. (2014). Rapid Urbanization and Challenges of Sustainable Development in the City of Lagos, Nigeria.
+References National Health Insurance Scheme (2015). Retrieved from
http://www.nhis.gov.ng Okunlola, P. (n.d.). UN HABITAT Globalization and Urban Culture. Retrieved
from www.unhabitat.org/documents/media_centre/sowc/lagos.pdf Rockefeller Foundation. (2014). City Resilience Framework. Retrieved
from https://assets.rockefellerfoundation.org/app/uploads/20150530121930/City-Resilience-Framework1.pdf
Wilkinson, R., & Marmot, M. (2013). Social determinants of health: the solid facts. Geneva, Switzerland: World Health Organization; 2003.
World Health Organization, & Habitat, U. N. (2010). Hidden Cities: unmasking and overcoming health inequities in urban settings. Geneva-Kobe, WHO.
Yamamoto, S. S., Phalkey, R., & Malik, A. A. (2014). A systematic review of air pollution as a risk factor for cardiovascular disease in South Asia: Limited evidence from India and Pakistan. International journal of hygiene and environmental health, 217(2), 133-144.
