Developing healthy cities indicators for evidence-based policy making and urban planning in India: a Delphi approach

The Healthy Cities initiative promotes health, equity, and sustainable development through a place-based approach. Its assessment requires diverse yet integrated indicators for systematically collecting and analyzing data on health determinants and outcomes. In response to the 2021 call to develop 500 Healthy Cities monitored through an expanded Ease of Living Index, this study aims to create a comprehensive set of indicators for assessing the healthy cities in India using a two-stage methodology. Stage 1 involved a comparative analysis of existing frameworks, India’s Ease of Living Index and the WHO South-East Asian Region Healthy City Network Assessment Tool leading to the identification of 112 indicators categorized into 28 sub-determinants, and 8 determinants. This paper presents stage 2 findings, which apply a Policy Delphi approach combined with Modified Delphi approach – identified via a PRISMA-guided systematic literature review – to refine and finalize the identified indicators. Two iterative rounds of surveys facilitated consensus-building among a diverse panel of experts to validate the relevance of indicators. The study resulted in 144 validated indicators to support academicians, planners, and government officials in systematic data collection and evidence-based healthy city assessment and planning, addressing India’s diverse social, economic, political, environmental, legal, commercial, and technological contexts.