How the scoring system works
The Healthy Cities Toolkit is based on the findings from nearly 300 systematic reviews. It provides evidence-based summaries of what is likely to benefit or negatively impact health.
Each summary is assessed in terms of: impact, resources, and the quality of the evidence supporting the approach.
What do we mean by ‘impact’?
The impact is the effect that an urban intervention or exposure has on individual health or the broader wellbeing of society.
(+4) Strong positive impact: significant positive consequences, with a sustained enhancement of individual and societal health.
(+3) Moderate positive impact: positive consequences for health or wellbeing, with the potential to enhance individual and societal health.
(+2) Mild positive impact: short-term and reversible, or no long-lasting effect.
(+1) Low positive impact: negligible effect on individuals or wider society.
(0) No impact: exposure/intervention makes no difference or there is still considerable uncertainty about the overall net effect
(-1) Low negative impact: negligible effect on individuals or wider society.
(-2) Mild negative impact: adverse consequences for health or wellbeing, but without serious harm, or loss of life.
(-3) Moderate negative impact: adverse consequences for health or wellbeing, but without serious harm, or loss of life.
(-4) Strong negative impact: serious adverse consequences, with possible long-term harm, or loss of life.
What do we mean by ‘resources’?
Resources are the collective requirement for funding, materials, labour, time or other assets required to deliver an urban intervention or the financial impact of the urban exposure on the individual, community, city or organisation.
High resources: >75% of included reviews reported resource requirements, and >50% were ranked as high
Moderate resources: >50% of included reviews reported resource requirements, and >50% were ranked as moderate
Low resources: 50-25% of included reviews reported resource requirements, and 50-25% were ranked as low
Very low resources: 25% of included reviews reported resource requirements, and >50% were ranked as very low
Uncertain: no clear resource requirements on the basis of evidence, >75% of included reviews did not report information regarding the cost
How do we judge the quality of the ‘evidence’?
The quality of the evidence reflects the rigour of research and helps attribute confidence in the results. We use an adapted version of AMSTAR 2, a popular instrument for critically appraising reviews of healthcare interventions, and the reported findings from the risk of bias or quality assessments in reviews.
High quality: full confidence that the effect is as reported
Moderate quality: satisfactory confidence that the effect is likely to be close to that reported
Low quality: limited confidence in the reported effect, which may increase if higher quality evidence becomes available
Very low quality: very limited confidence in the reported effect
Uncertain: no clear reported confidence in the effect, on the basis of evidence.
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