Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018).
Rosie Mae Henson, Ana Ortigoza, Kevin Martinez-Folgar, Fernando Baeza, Waleska Caiaffa, Alejandra Vives Vergara, Ana V Diez Roux, Gina Lovasi
Author Information
Rosie Mae Henson: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104. Electronic address: rosie.mae.henson@drexel.edu.
Ana Ortigoza: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104.
Kevin Martinez-Folgar: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala.
Fernando Baeza: Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
Waleska Caiaffa: Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Brazil.
Alejandra Vives Vergara: Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Desarrollo Urbano Sustentable (CEDEUS), Pontificia Universidad Católica de Chile, Chile.
Ana V Diez Roux: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104.
Gina Lovasi: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street, 7th Floor, Philadelphia, PA, USA, 19104.
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. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a longitudinal study design ("primary evaluations"). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.
