Health Legacy Project of the World EXPO 2010 Shanghai, China

1. Health Legacy Project of the World EXPO 2010 Shanghai, China Fan WU M.D. Shanghai Municipal Center for Disease Control and Prevention 2010.4.8

2. Mass Gathering Events • Individuals come together for a collective purpose • Gathering in specific site(s) of variable size • Duration is usually hours to days

3. Types of Mass Gathering (MG)

4. Why do MGs have impacts on our city • Duration • Population • Food/Drinking Water • Disease outbreaks • Requirement on city infrastructure • Safety • Requirement on health system

5. EXPO is changing the city in the way of

6. Individual Health service system Health-related environment Implications of MGs • The impacts may be • Short term, long term impact • Direct and indirect impact • Visible and invisible impact • Positive and negative impacts

7. 2010 World Expo. Shanghai, China

8. 2010 World Expo. Shanghai • Theme：Better City, Better Life • Sub-theme： • Blending of diverse cultures in the city • Economic prosperity in the city • Innovations of science and technology in the city • Remodeling of communities in the city • Interactions between urban and rural areas

9. 2010 World Expo. Shanghai • Long duration: • 1 May 2010 - 31 Oct 2010 • Large scale: • 242 countries and international organizations • Visitors: • 70 million in total 400,000 visitors/day 700,000-800,000 visitors/day on peak

10. West of Huangpu River: 0.9 km2 Enclosed area: 3.28 km2 East of Huangpu River: 2.38 km2

11. Health Policy/Legislation Healthy Environments Community & Individual Capacity Improvement of Health System Smoke free Clean air Safe drinking water/food Healthy nutrition <…more…> Increase in green areas Improve waste disposal/sanitation Improve road safety Improve air quality Increase in smoke-free areas <…more…> Increase in physical activity Improved in nutrition Reduce tobacco use Reduced harmful use of alcohol <…more…> Improve public health emergency response Improve capacity of emergency service Quit smoking class <…more…> Promotion of health of host city population Absolute improvements Relative (Equity gains, gradients) 2009 2011 Measure relevant health indicators Potential Health Impacts of Expo 2010

12. portfolio of actions development & determinants individual & community strengtheninghealth systems developing hp capacity health & equity impacts personal behaviours prevention content hp structures specific laws & regulations healthy settings universal coverage hp financing intersectoral commitments civil society partnerships action on local determinants hp performance

13. How to monitor and measure of all these changes and impact?

14. portfolio of questions development & determinants individual & community strengthening health systems developing hpcapacity How are all sectors of government and industry improving health? How are communities empowered? What improvements in personal behaviours? What is the prevention component of the health system? How is the system more equitable? After the Expo, will Shanghai be better able to run sustainable health promotion?

15. Experience from Beijing Olympic games 6 indicator categories, 56 indicators Health status: e.g. Life satisfaction, ... Health behaviours: (knowledge and practices) of people e.g. prevalence of smoking, … Health environment: e.g.Number of days meeting standard of air quality, … Health care system Health: medical and hospital services, e.g. medicine insurance coverage rate, … Health service: e.g. emergence response time, … Health-related cognition: e.g. The cognation of knowledge about health, …

16. Objectives of the project • Indicators • To set up a group of indicators measuring World Expo health impact • Monitoring • To record all the changes due to the World Expo 2010 • Improving • To offer evidence for future development

17. Set up indicators • Health status • Describe the epidemiologic situation: major health risks and major disease burdens • Define priority areas for this project • Important health risks and disease burdens • Link these to the effects of the World Expo 2010 • Approved by advisorygroup • Define concepts to be measured within the domains of health impact • Define indicators, methodology, and equity dimension for each concept or sub-concept

18. Policy Physical Env Literacy & Behavior Social Env & Community Involvement Improvement of Health System Potential Health Impacts of Expo 2010 Health Status Promotion of health of Shanghai Health equity in different social groups 2009 Measure relevant health indicators 2010

19. Concept Map Domain Areas of Priority NCD Infectious Diseases Environmental Health  Tobacco PhysAct Alcohol DiseaseControl FoodSafety Water  H Status  Policy  PhysEnv  Literacy  SocEnv  HSys 

20. Example Concept MapArea: NCD  Sub-area: Tobacco Domain Areas of Priority NCD  Tobacco  Health Status Smoking by Children & Ados Smoking by Adults  Policy Smoke-free Regulations  PhysEnv Smoke-free public places (enforcement of regulations)  Literacy Knowledge attitudes & skills related to smoke-free living  SocEnv Social Mobilisation for Tobacco-Free Shanghai  HSys Smoking Cessation 

21. Concepts  Indicators  Methods Domain NCD Tobacco Control Concepts Indicators Methods Equity Issue H Status Smoking Child/Ados Current daily smoking Survey Analyse by agreed social groups Smoking by Adults Current daily smoking Survey Policy Smoke-free Regulations Record of regulations Documentary Regulations apply to all? Phys Env Smoke-free public places Compliance Inspections Enforcement by locality? Literacy Knowledge attitudes and skills KAP indicator Survey Analyse by agreed social groups Soc Env Social Mobilisation ? Volunteer action ? Website activity ? H Sys Smoking Cessation Guidelines Training Use of service Documentary Process records Process records Analyse service provision and use by agreed social groups

22. Emergency preparedness and response Network construction …… Infectious Disease Control Disease Control: outbreak alert and response Food safety Sexually Transmitted Diseases …… Injury Prevention Traffic injury …… NCD Prevention and Control Tobacco Control Healthy Diet Physical Activity Harmful use of Alcohol …… Environmental Health Drinking water safety …… Priority Areas

23. Principleof Indicator Selection • Change due to Expo • Should change due to Expo • Likely to change due to Expo • Likely to have high impact during time of Expo or after • Evidence-based • Measurable • Available (Routinely collected) andAuthoritative • Integrated

24. Overview of Indicators 6 domains, and 66 indicators To be continued…

25. …continued

26. Indicators for each domain • Health Status: • mortality from traffic-related injuries • resident satisfaction for normal life • ……. • Policy : • non-smoking policy • finance investment policy • …… • Social environment : • number of automatic condom vending machines • number of physical activity sites • ……

27. Indicators for each domain • Physical environment: • number of days meeting standard of air quality • coverage of Green area • … • Health System: • emergence response time • number of hospitals offering cessation service • … • Health literary and behaviors : • cognation about AIDS prevention in high-risk groups • heavy drink rate • …

28. Domain:Physical Environment Area:Environmental Health

29. Further efforts • Indicators improvement • Data collection in difference periods • Long-term and slow effect • Unpredictable effect • Multi-sectoral cooperation • Sharing information • Data analyses and report

30. Thank You! Photo http://flickr.com/photos/qifei_20/2716066817/sizes/l/