Whose Health in Whose City? A Systems Thinking Approach to Support and Evaluate Plans, Policies, and Strategies for Lasting Urban Health

Round 1

Reviewer 1 Report

The paper focuses on very broadly understood urban health and urban planning in the context of urban environment and COVID-19 pandemic. In my opinion, it is very important and current topic.

The title is adequate to the research problem being undertaken.

The paper has been correctly divided into relevant sections, and their content coincides with their titles.

Introduction part explain the idea of the paper in a good way.

The correct terminology was used. The language of the article is mature, correct, adequate. Important questions were asked here. 

Footnotes and bibliography are correctly formulated.

The authors cited a number of strategic documents discussing the studied phenomenon from various angles. The authors cite also a number of very current references.I consider the references review to very broad and well prepared. The authors indicated over 120 items.

 

It was a great pleasure to read this paper, which is so mature and well prepared. The examples in the individual cities were very interesting. This is a very well thought out and written article. 

 

Discussion part is supported by the results.

The technical part of the article does not raise any objections. T

he work is aesthetic.   

 

As the only remark that is perfect, I propose to clearly define the purpose of the paper.

 

Author Response

Dear Reviewer, please find attached a detailed reply to your comments. Please also find a revised version of our manuscript, with tracked changes. Our best regards, the Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

The paper focuses on the links between urban environment and health in a much broader context than recent publications or international associations' proposals. Though urban planning has supported human health and well-being for more than a century when the garden city idea of. E. Howard aimed to solve or at least decrease the urban environmental problems with a pioneering urban planning method and regulation. However, neither the early 20th-century planning ideas nor modernisation concepts of the mid 20th century brought relevant solutions. Authors are right when saying, that all earlier health-driven perspectives have drifted away by a profit-oriented development. the result is well-known in the form and symptoms of global climate crises, the decrease of biodiversity, etc.

The overall structure of the paper is logical,  method and results are well introduced. The method based on systems approach thinking has the same relevance as the research aims, namely the links between health and cities. A very wide reference is given for the method too. Still, urban planning, policies and strategies are evaluated in a very complex way to find the relevant links, impacts of the urban environment on human health.

Four case studies chosen for detailed evaluation offer a good fundament for the systems thinking approach. Here, the authors mention shortly a list of 25 European cities of high density. The further selection is based on policí tools as reliability, validity and generality, or similarity. Still, there are some more well-known city-lists that rank European or global cities according to their liveability or green character where green is more than urban green infrastructure but all aspects that belong to be green to be eco-friend. No wonder, that among the four cities chosen by the authors we can see Copenhagen and Vienna or Berlin which are often highly ranked as liveable and/or green cities.

Results are clearly defined and the discussion part is clear. I wonder what is the main further research ideas for the conclusion part.

I could accept the paper in the present form though some thought the case study selection way could be added and detailed.

 

 

Author Response

Dear Reviewer, please find attached a detailed reply to your comments. Please also find a revised version of our manuscript, with tracked changes. Our best regards, the Authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Thank you for inviting me to review the manuscript “Whose health in whose city? A systems thinking approach to support and evaluate plans, policies, and strategies for lasting urban health” which intend to evaluate the impact potential of local urban governance on public health, using a system thinking epistemological approach.

After reading the whole manuscript, I found some major concerns related to the search method, structure of the manuscript, results, and the implications of this work. My suggestions to improve the manuscript are as follows:

• Introduction:

+ The authors did not define well the term “Systems Thinking epistemological approach” and the background/application of this approach in the field of study. Could the authors ground more in the literature of the recent application in the study field?

+ Authors mentioned the “COVID-19 pandemic” quite a lot but the selected policy tools in the four case studies were released before this pandemic. So, is this information relevant to the discussion of these policies? Could the author clarify the sentence “This concept was found particularly valuable during the first months of the COVID-19 pandemic, with many bottom-up initiatives rapidly spreading in urban communities to protect the right to health for all people, in particular for vulnerable groups (e.g. the elderly)”?

• Method and materials:

+ This section should provide sufficient details on how the study was carried out and allow the work to be reproduced by an independent researcher. Nevertheless, some of the Method sections of this manuscript (2.1, 2.2, and sub-sections of these sections) were focusing on the Literature review rather than report the technical steps of the method. I suggest shortening them and moving them to the Introduction part. Then, please report what method and steps that you really carried out for this work.

+ Section 2.3 is missing.

+ Please insert the reference/link to the selected policy tool. For instance, there is not any link or reference to the “London Health Inequalities Strategy” in either table 1 or subsection 2.4.1.

• Results and discussion

+ Figure 1 and the paragraph “A systems diagram…. to the single case studies.” should be part of the method and materials but not the results sections. Is it the result of your work or from the previous one (Cristiano et al., 2020)? Please highlight the real contribution of this work in this diagram and explain how this new contribution was added.

+ The discussion of this work is not clear since sections 3.1-3.4 are just the narrative summary of the selected policy tools.

+ The discussion was not consistent among case studies. For instance, why the keywords “health”, “healthy”, or “health care” were considered only in Berlin and Vienna but not in London and Copenhagen. Since when these words were defined as the keywords?

+ In the section “Possible leverage points”, please make some clear messages derived from the author’s work. In the current version, the authors cited intensively the previous works in the literature. It made readers very confused.

• Conclusion

+ Who is the target audience of your work?

 

 

Please insert the line number of the manuscript. It will be easier for the reviewers on the specific comments.

Author Response

Dear Reviewer, please find attached a detailed reply to your comments. Please also find a revised version of our manuscript, with tracked changes. Our best regards, the Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Thank you for inviting me to review the revised version of the manuscript “Whose health in whose city? A systems thinking approach to support and evaluate plans, policies, and strategies for lasting urban health”.

Thank the authors for addressing most of my comments from the previous version. The authors provided some justifications for his/her own choices in the arrangement/structure of the manuscript (MS). The MS is much better in the current version. Only the last suggestion, the author should clarify in the legend of Figure 1 that the red parts are the new contribution of this work compared to the previous work Cristiano et al., 2020. This would help readers to understand what are the contributions of this work.

After that, the MS is ready for publication.

Author Response

Dear Editor and Reviewer,

 

please let us thank you again for your attentive reading and for your fruitful comments and suggestions.

 

The only remaining comment was addressed by adding the suggested text to the caption for Figure 1, as marked in bold green below:

 

“Figure 1. Systems diagram of a city in relation to its urban health (adapted and expanded from Cristiano et al., 2020; the red parts are the new contribution of this work compared to such article) [SED = socioeconomic determinants; UDH = unhealthy diet and habits]

 

Thanks again for all of your support.

 

Kind regards,

 

the Authors

Author Response File: Author Response.docx