Urban health care

1. Urban health care Chavanant Sumanasrethakul MD., M.Sc. Department of Preventive and Social Medicine

2. Backgrounds • Health (WHO) “a state of complete physical, mental and socialwell-being and not merely the absence of disease or infirmity” • Healthcare (WHO) all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations”

3. Urbanization • Increases in • Size • Density • Heterogeneity • Associated changes in factors such as • Population mobility • Industries • Deindustrialization • Social justice • Proximity of rich and poor • Conjures negative image of • Pollution • Crime • Poverty • anonymity

4. Why do we need to understand urban health? “The health of the urban poor is not better than their rural counterparts – and can be often be much worse.” PIERCE 2007

5. Urban health penalty Urban dwellers have the greater healthproblems and risk factors than suburbs and rural people. Andrulis 1997

6. Urban / Rural: Are they different? “Urban health problems are not markedly different from those in rural area, but their solution are quite different” World Bank 2007

7. Principles “Urban health is based on core healthy cities principles of equity, intersectoralcooperation, community involvement and sustainability.” World Bank 2007

8. Framing the issue of urban health • Ways to contend with urbanization as a general influence on the behavior of city residents • Ways to contend with the health behavior of the inner city, where problems associated with urban areas are most severe

9. 5 disciplines of urban health • 1st: Complexity • 2nd: Diverse of population • 3rd: Unique assets and problems • 4th: Context matters • 5th: Solving problems skills

10. 1st: Complexity • Factors • Political, social and economic factors • Units • Individual, family, community, municipal, regional, national and global levels • Systems • Health care, education, criminal justice, environmental protection, housing and employment • Population density and heterogeneity

11. 2nd: Diverse of population • More immigrants, more ethnic and lifestyle variability, and greater disparities in socioeconomic status • Cultural and communications skills, the anthropological knowledge, and the epidemiological evidence

12. 3rd: Unique assets and problems • use energy more efficiently, tolerate better differences in values and behavior, and have a richer array of health, social service and community-based organizations than rural or suburban communities. • urban residents are healthier than their non-urban counter-parts. But cities also have higher rates of many illnesses, more access to health-damaging resources (e.g., drugs and guns), and higher levels of the income disparities associated with poor health

13. 4th: Context matters • Broader biological, social and political context • Human biology • time (a historical perspective) • space (a geographical perspective) • culture (an anthropological perspective) • other factors • influence the patterns of health and disease at the individual and populations levels

14. 5th: Solving problems skills • Scientific knowledge • Technical knowledge • Organizational knowledge • Political knowledge

15. The challenges of urban health • How to organize and prioritize interventions for better healthin the complex urban environment? • How to ensure better access to health services and outcomes for all? • How to integrate interventions across sectors to improve the health outcomes of the poor? • How to find tools and resources to measure the impacts of existing and new intervention? • How to identify entry points where health components can be viably introduced into urban development projects?

16. Themes of urban health care • Environmental health • Water sanitation & hygiene • Urban transport • Urban solid waste management • Housing • Impact of climate change & global warming • Urban crime & violence • HIV/AIDS in urban areas • Providing health services in urban areas • Vulnerable urban populations • Planning & monitoring for health outcomes

17. Factor determining susceptibility in Urban population • Age-related windows of vulnerability • Health status as a determinant of susceptibility • The role genetic factors • Gender related differential • Socioeconomic factors

18. Factors influencing personal exposures to air pollution in urban environments

19. “Urban poverty is not because of distance from infrastructure and services but from exclusion.” (KNUS)

20. Current situation • Infectious diseases (eg. HIV/AIDs) • one of the urban health threats which is associated with several social determinants • Increasing in road traffic injuries • Urban violence and crime affect • Urban lifestyle • Poor nutrition and lack of sufficient food cause underweight • Inappropriate consumption and lack of physical activity from change in occupational and leisure activities leads to overweight people • Urban living environment • Quality of housing and shelter is a strong health determinant • Living in unsafe location (flooding and industrial pollution)

21. A number of issues and interventions are identified and combined intervention package have been developed • Low classes intervention A • Middle classes intervention B • High classes intervention C Combination of intervention for urban people

22. “The keys to achieve health equity in urban settings are to create a nurturing society that protects the vulnerable, ensures a healthy living and working environment, and provides a universal system to respond to health needs.” KNUS MGDs (Millennium development goal)

23. “Dealing with the gap in urbanize community”