What gets measured does not always get done – Authors' reply

In their Correspondence, Jennifer Kent and colleagues have concerns about the sentiment “what gets measured, gets done” expressed through the title of the lead Comment in the Lancet Global Health Series on urban design, transport, and health1Giles-Corti B Moudon AV Lowe M et al.Creating healthy and sustainable cities: what gets measured, gets done.Lancet Glob Health. 2022; 10: e782-e785Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar “promotes measurement alone as a legitimate pathway to decision making”. We agree that measurement alone is insufficient to bring about change. However, creating surveillance systems to guide and evaluate evidence-informed goal setting, action, advocacy, and accountability is an essential public health function. The primary aim of this Series was to develop a set of health-related policy and spatial indicators that could be used in a global surveillance system to benchmark and monitor progress towards creating healthy and sustainable cities. We have helped to enable this goal by creating open-source tools facilitating indicators to be replicated. The importance of incorporating public health concerns into city planning policies is clear. Hence, all our indicators are policy-relevant and associated with health outcomes. The indicators also align with the UN Sustainable Development Goal indicator framework2UN General AssemblyResolution adopted by the General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development A/RES/70/1. United Nations, New York, NY2015Google Scholar and WHO's3WHOUN HabitatHidden cities: unmasking and overcoming health inequities in urban settings. World Health Organization, Geneva2010Google Scholar call to unmask the hidden city by identifying inequities and integrating health in all policies. On our collective watch, unhealthy and unsustainable cities continue to be built. Given rapid urbanisation, global health challenges, and climate change, the time to act is now. The Series found that despite urban policies expressing an ambition to be healthy, sustainable, and liveable, most cities did not have measurable standards and targets to achieve this vision.4Lowe M Adlakha D Sallis JF et al.City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities.Lancet Glob Health. 2022; 10: e882-e894Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar Consequently, there is inequitable access to health-supportive environments,5Boeing G Higgs C Liu S et al.Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities.Lancet Glob Health. 2022; 10: e907-e918Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar which is crucial to address in all cities. We agree with Kent and colleagues that academic evidence alone is insufficient to stimulate policy improvements. Hence, we developed local scorecards and reports distributed online, encouraged collaborators to discuss local findings with policy makers, and are currently working with local advocates championing policy reform (eg, Bicycle Mayors in Chennai and Mexico City). The Series also called on civil society to advocate for evidence-informed city planning. Although measurement alone will not change urban policies, as Sharon Friel argues: “no evidence, no problem, no action” (Friel S, Australian National University, personal communication). Our cities are causing harm to human, ecosystem, and planetary health. All tools available—science, advocacy, politics, policies, standards, and regulations—must be used to reduce these harms. Our indicators are designed to benchmark and monitor progress, to support evidence-informed decision making, and to help advocates hold governments accountable for achieving healthy and sustainable cities for all. We believe they are worth measuring. BG-C is currently supported by a National Health and Medical Research Council Partnership Grant (GNT9100003) and an Royal Melbourne Institute of Technology Vice Chancellor's Professorial Fellowship. JFS has received travel support from the Rails to Trails Conservancy; and has participated in an Advisory Board for a National Institute of Health Grant for InSPACE and American Association of Retired Persons Liveability Index. DP is on the Steering Committee of the Low-and-Middle Income Country Council of the International Society for Physical Activity and Health. All other authors declare. Creating healthy and sustainable cities: what gets measured, gets doneSince the first Lancet Series on urban design, transport, and health (Series 1) was published in 2016, the urgency to make the transition to healthy and sustainable cities worldwide has intensified. That year, the UN's Sustainable Development Goals1 for promoting prosperity while protecting the planet and ensuring equity came into force. WHO also released its Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. At WHO Global Conference on non-communicable diseases (NCDs) in 2017, heads of states reiterated their commitment to reduce premature mortality from NCDs by a third by 2030. Full-Text PDF Open AccessCity planning policies to support health and sustainability: an international comparison of policy indicators for 25 citiesCity planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Full-Text PDF Open AccessWhat gets measured does not always get doneWe commend the authors of the Lancet Global Health Series on urban design, transport, and health on the delivery of a comprehensive set of recommendations, which are relevant and useful. We have the greatest respect for their work in measuring the health impacts of urban form in various international contexts. Full-Text PDF Open Access