Conceptual Framework of Social Determinants of Health of City Development Project

Research Article

Austin J Public Health Epidemiol. 2017; 4(2): 1060.

Conceptual Framework of Social Determinants of Health of City Development Project

Shojaei P¹* and Karimlou M²

¹Social Determinants of Health Research Center, Tehran Medical Science Branch, Islamic Azad University, Iran

²Social Determinant of Health Research Center, University of Social Welfare & Rehabilitation Sciences, Iran

*Corresponding author: Shojaei P, Social Determinants of Health Research Center, Tehran Medical Science Branch, Islamic Azad University, Iran

Received: July 11, 2017; Accepted: August 23, 2017; Published: August 30, 2017


Potential health advantages of green spaces exposure include the opportunity for activities within the space and psychological advantages of viewing and interacting with nature. We conducted interviews and focus groups with discussion and 35 individual interviews. Interviews and focus groups were conducted to determine the effect of urban man- made lakes on intermediary determinants of health. 28 social determinants of health including “structural” and “intermediary” determinants were extracted out. Thus, two “structural” and “intermediary” groups were formed, and 14 sub-groups were determined in each category. Data analysis matrix was the conceptual frame work of social determinants of health commission; its sub-groups and thus mediating determinant categories as well as their sub-sets were created accordingly. In addition, some extra sub-sets including environment, air quality, weather changes, noise pollution, pathogenesis, quality of life, social and physical development of children, unintentional injuries and aesthetic were extracted beyond the matrix factors, which were placed in intermediary determinant categories based on their thematic content. Quality and type of the urban man-made lake could have a significant and sustained impact on community’s health and well-being. Therefore, in order to boost the efficiency of any ongoing projects in the community, their impacts on social health and welfare should be taken into the consideration.

Keywords: Man-made lakes; Intermediary determinants of health; Content analysis; Qualitative study


In 2001 the United Nations estimated an increase of 75% in the level of urbanization in Europe compared to 2000, and also an increase of almost 80% by 2015. Urban growth by changing cities and the surrounding countryside creates many problems for the preservation of urban green spaces, and consequently for human health and well-being [1]. The relation between environmental conditions and human health both have been approved by public health practitioners and urban planners. Today, the impact of the built environment on health and well-being is taken into the consideration both in health professional researches and the public. Recent challenges about levels of physical activity, obesity, asthma, mental illness and increasing environmental inequality have increased the importance of the health than before. Now it is time that the authorities of urban planning take action by interlinking both fields to begin a more health-oriented approaches [2]. The concept of a public health observatory in urban settings has been developed to address the barriers imposed by the complex network of health determinants on urban settings [3]. Health is associated with social determinants especially in cities, for more than 150 years a large and continually expanding body of research has shown that the way in which cities are planned and managed can cause a significant difference in the health of residents [4]. There is a lack of evidence and methods for quantifying the beneficial role of the environment to support and improve human health and well-being. Essential knowledge gaps stay in assessing and indicating the multiple functions of green space infrastructure [5]. Urban green space is emphasized in policy documents worldwide and is considered the main aspect of the sustainable city [6]. According to definition of green space Scotland (2008), the term green space can be applied to any vegetated land or surface water body within or adjoining the urban areas, including natural and semi-natural habitats; countryside immediately adjoining a town which people can access green corridors paths, rivers and canals, amenity grassland, parks and gardens, outdoor sports facilities and playing fields [7]. Therefore, the man-made lakes are green space and also have the effects of green space on heath. There are many advantages available to individuals, organizations, and communities from a green environment. Most recorded benefits of living, working, or playing in a green environment have been obtained by individuals. Prospects of vegetation and water (e.g., rivers or lakes) have been shown to reduce stress, enhance healing, and reduce driving failure [8-9]. Despite a wide range of studies on health effects of urban development projects, a few studies have been carried out on urban man-made lakes and its surrounding green spaces. Based on what Santa found out in the study namely “assessment of health effects of walk able urban green spaces,” these spaces affect public health both directly and indirectly and are going to have a correlation with health status of local residence as well as environmental quality improvement [10]. According to the results of Irvine and et al (2013), the personal benefits of contact with urban nature comprise the increase of cognitive performance, social interactions, stress relief and also reduction of mental fatigue [11]. Indeed, access to the greenery has been considered important in urban planning, historically, indicated by examples such as widespread creation of public parks in the UK during the Victorian era [12]. Therefore, placing health issues in urban projects and plans are essential. Designing and building manmade lake in developing counties usually follow many dangers. Stakeholders need to sit around a table and have active participations in order to utilize the full potential of the lake and water sources projects, improve and maintain them. Therefore, it necessitates the collaboration of not only engineers but also other health sector experts such as biologists, sociologists, and economists due to the important role of each in planning and implementing developmental projects [13]. One of these under-construction projects in Iran was constructing the biggest man-made lake by volume l0 Million Cubic Meter (MCM), by the average depth of 10 meters (m.) and by the area 225 hectares (ha) in North West of Tehran in district 22. Kan River supplied approximately 80% of lake water and the remainder comes from the run-off of intermediate and surface area of the region [14]. History of construction of the lake project dated back to the development of the first comprehensive plan of Tehran city in 1986 which was predicted to build a lake in west Tehran but due to technical and budget restrictions its construction has been remained dormant for years. Finally, in the underlying studies, since 1382-1389, detailed studies were done at different times by the consultant and ambiguities survey was completed. Catchment area of operations on October 2010, and coastal zones operations on July 2012 by the supervision of Sabir Company according to study and design of Tunnel Pars engineering company (Eshtuky Pars Company) were began. On May 15th 2013, the first phase of the project named Persian Gulf Martyrs was inaugurated [15]. This lake has three islands along with entertainment, sports, games, and green spaces that are created with the aim of providing places for tourist absorption, increasing recreational aspects of area, and escalating happiness spirit among population. Although lack of proper consideration for environmental and health issues in the design, implementation and operation of these places could cause severe health problems. According to what mentioned above, a study namely “Health impact assessment of man-made lake in city development strategy on health and social determinants of health” was implemented, and this article has been extracted from it with the intention of characterizing intermediary determinants of health in the current study.

Materials and Methods

Inclusion criteria

1. Experts that were employed in city development planning (individuals that have activity in deputy of city development strategy and planning of Municipal District 22) and area related to health determinants (such as house, education, environment, security, transport, etc).

2. The council of region 22 as people representative

3. Have at least one year of work in the field are former self

4. Having academic education in urban project and health

5. Consent to participate in individual interviews or in focus group discussion

Exclusion criteria

1. Not wanting to participate in the meetings of the study

Participant recruitment

The focus groups runs counter to critical characteristics that important for holding it such as Homogeneity of participants, An acceptable environment and Limit on the number of people.

All Experts that were employed in city development planning approached and participated in this study. Individual interviews were carried out on 35 informants in three groups: 1- people who live in the district 22 of Tehran, 2-Members who were involved in the manmade lake project from the municipal district 22 with the following characteristics: educated individuals with at least BA degree, experts in urban development, water sources, environment, urban planning, geography, civil engineering; and 3- To avoid information bias, members from outside the municipal district 22, experts in the field of health determinants and environment, members of NGOs and UNDP with at least a bachelor’s degree, were included. Individual interview lasted for 50 minutes. The target group for Focus Group Discussions (FGDs) consisted of 2 expert groups that participated in individual interviews (second and third group). First FGD was held with members who were involved in the man-made lake project from the municipal district 22 with the following characteristics: educated individuals with at least BA degree, experts in urban development, water sources, environment, urban planning, geography, civil engineering; and second FGD with members from outside the municipal district 22, experts in the field of health determinants and environment, members of NGOs and UNDP with at least a bachelor’s degree .Numbers of individuals in each focus group was 12 people and lasted for 90 minutes. Informants were selected using purposive sampling and data gathering process was continued until data saturation.

Interviews and Focus Groups

This qualitative step was conducted with a content analysis method. Data were driven from individual interviews as well as Focus Group Discussions (FGDs) from September to March 2013, respectively. In the present study, purposive sampling was taken and it has been continued till data saturation and new ideas and insights were driven. Interviews (in-person) and focus groups (inperson) with consenting participants were conducted. Discussion was semi structured and conducted with the aim of creating a relaxed and comfortable environment for participants. A first qualitative researcher managed the individual interviews and run the focus groups with assistance of a second researcher who recorded field notes and also asked questions. Focus group discussions and interviews were recorded in their fully and transcribed verbatim. To ensure confidentiality and privacy of participant were used fake names. Focus group discussion guiding questionnaires and in-depth individual interviews were used to document the data. These procedures were developed based on the research team’s viewpoints and experts who were familiar with urban development’s and health issues as well as library sources and objectives of the study. These questionnaires dealt with concepts regarding various health dimensions of artificial lakes construction. Validity of questionnaires was certified through a pilot study, and needed content, succession, and timing reforms were used after this process. We arranged sessions with municipality to make them aware of the study and asked for any permission required. In addition, informants were clarified about the whole research, from its objectives to the methods and confidentiality of the data, and all agreed to take part voluntarily. Main investigator managed the whole interviews. FGD was held in the office of surrogate of mayor with all informants agreed on. We started from general and comprehensive questions in the individual interviews and FGDs, and it progressed to detailed questions by the time. Recording and writing the interviews and FGDs were done in the papers word-by-word. We used Graneheim approach for data analysis [16]. The transcribed documents were handled for their meaning units, and finally were coded. Next, codes based on the meaning units represented by informants and their similarities and discrepancies were extracted and grouped. Having a list of usual social determinants and main categories, data analysis were conducted using content analysis matrix [17] and then, new classes were extracted as analysis continued and they were put in the body of the total data analysis. In order to increase reliability, all codes and themes were checked mutually by research team and at the end of each interview a summary of it was presented to the interviewees. To objectivity of the data, codes by two researchers were used and codes and categories were compared. The methods for obtaining the trustworthiness of the findings, included combining the data collected through the individuals’ interviews and focus group discussions, Long-term relationship with the participants and subject of the study, extensive research report writing, reviews by participants and observers. In order to observe the ethics of the research, the following points were adhered to; receiving written and informed consent, stated objectives of the study, permission to record the data, maintaining the anonymity of the participants, the right to withdraw from the study, putting the results of the study to participants, and obtaining approval of the ethics committee of the university.


This study was conducted in municipality of district 22 of Tehran, in 2012. Participants had a mean age of 30 years old and their education varied from B.A to Ph.D. Based on the list of codes, an overall conceptual framework for the effects of an urban manmade lake and its multiple spaces on intermediary determinates of health was developed, (Figure 1) indicated the conceptual framework. conceptual framework includes Multiple spaces of manmade lakes consist of: playing spaces, Recreational –health spaces & areas, Reception and residency temporary space, Special spaces, Sport spaces, Green spaces that any of this spaces have different facilities .These spaces have multi-function for people in region 22 and all of Tehran. Then, these functions affect determinants of health and finally effects on the health and wellbeing of individuals and society.

Citation: Shojaei P and Karimlou M. Conceptual Framework of Social Determinants of Health of City Development Project. Austin J Public Health Epidemiol. 2017; 4(2): 1060. ISSN:2381-9014