Health Of Urban Populations Research Articles

Beyond Urban Penalty and Urban Sprawl: Back to Living Conditions as the Focus of Urban Health

Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.

Cities and Health: History, Approaches, and Key Questions

The majority of the world's population will live in cities in the next few years, and the pace of urbanization worldwide will continue to accelerate over the coming decades. Such a dramatic demographic shift can be expected to have an impact on population health. Although there has been historic interest in how city living is associated with health, this interest has waxed and waned and a cogent framework has yet to evolve that encompasses key issues in urban health. In this article, the authors discuss three alternate approaches to the study of urban health today; these include considering urban health from the perspective of a presumed urban health penalty, from an urban sprawl perspective, and more comprehensively, considering how urban living conditions may be associated with health. The authors also propose three key questions that may help guide the study and practice of urban health in coming decades. These include considering what specific features of cities are causally related to health, the extent to which these features are unique to a particular city or are different between cities, and ultimately, to what extent these features of cities are modifiable in order to allow interventions that can improve the health of urban populations.

Urban Bioethics: Adapting Bioethics to the Urban Context

Urban bioethics is an area of inquiry within the discipline of bioethics that focuses on ethical issues, problems, and conflicts relating to medicine, science, health care, and the environment that typically arise in urban settings. Urban bioethics challenges traditional bioethics (1) to examine value concerns in a multicultural context, including issues related to equity and disparity, and public health concerns that may highlight conflict between individual rights and the public good, and (2) to broaden its primary focus on individual self-determination and respect for autonomy to include examination of the interests of family, community, and society. Three features associated with urban life-density, diversity, and disparity-affect the health of urban populations and provide the substrate for identifying ethical concerns and value conflicts and creating interventions to affect population health outcomes. The field of urban bioethics can be helpful in creating ethical foundations and principles for public health practice, developing strategies to respect diversity in health policy in a pluralistic society, and fostering collaborative work among educators, social scientists, and others to eliminate bias among health professionals and health care institutions to enhance patients' satisfaction with their care and ultimately affect health outcomes. Educational programs at all levels and encompassing all health professions are needed as a first step to address the perplexing and important problem of eliminating health disparities. Urban bioethics is both contributing to the social science literature in this area and helping educators to craft interventions to affect professional attitudes and behaviors.

Cities and population health

A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention.

RELATIONSHIP BETWEEN GASEOUS AIR POLLUTANTS AND CARDIOVASCULAR ADMISSIONS: A STUDY IN 14 SPANISH CITIES

ISEE-29 Introduction: Since year 1997, the EMECAS project evaluates the effect of current air pollution on the health of urban population in Spain. In this paper we present the results for the association between gaseous air pollution and hospital admissions for cardiovascular diseases. Methods: Daily emergency admissions for all cardiovascular diseases (CVS) (ICD-9: 390–459), heart diseases (HD) (ICD-9: 410–414, 427, 428); ischemic heart diseases (IHD) (ICD-9: 410–414), and cerebrovascular diseases (Stroke) (ICD-9: 430–438) were collected from hospital records (1995–1999). Air pollutants data were obtained from local networks. Variables for 24 hours daily levels of SO2, and NO2; 8 hours maximum moving average of CO and ozone; and, lastly, 1 hour maximum of SO2, NO2 and ozone were constructed. Magnitude of association in each city was estimated using generalized additive models (GAM) of Poisson controlling for confusion and overdispersion. Lagged effects, up to three days, for each cause and pollutant were examined. Data were analysed using S-Plus GAM function with more stringent convergence criteria. Combined estimates were obtained under a ′fixed effects’ model, and, if heterogeneity, under ’random effects’ one. For ozone the analyses were restricted to the warm period (May to October). Results: Concurrent and one day were the most consistent lags showing associations, only ozone showed a more delayed relationship. In the combined estimates an increase of 10 ug/m3 in SO2 daily levels was associated with a 1.3% (95% CI: 0.2–2.5%) increase in the number of hospital admissions for CVS, and 1.7% (95% CI: 0.7–2.9%) for HD. The same increase in concentrations of NO2 was significantly associated with a 0.4% increase in CVS, and 0.9% in HD admissions. For ozone the corresponding estimates were 0.7 in both cases. An increase in 1 mg/m3 levels of CO was associated with an increase of 2.1% in CVS, and 4.2% in HD admissions. Only ozone presented some suggestion of association with stroke. In two pollutant models the coefficients of SO2 and NO2 were affected after control for other pollutants. On the contrary, CO and ozone were unaffected by the inclusion of the second pollutant. Conclusions: A short-term association between increases in daily levels of air pollutants and the number of daily admissions for cardiovascular diseases in the Spanish cities was found with greater estimates for heart diseases. CO and ozone showed an independent effect of the other pollutants.

The daily public health nursing practice: the Montreal infectious diseases unit as an example

The health of urban populations depends on multiple factors, among them access to health and social services. The Montreal Public Health Department (PHD) is part of such services, where a number of nurses are working within a multidisciplinary team. It is through the description of the work accomplished by the team for infectious diseases control and prevention, and the vignettes of real life events related to the follow-up of syphilis, tuberculosis and hepatitis A cases, as well as quarantined individual exposed to SARS that the authors want to illustrate the work of the urban public health nurses. The examples are preceded by a description of the socio-demographic characteristics of the city of Montreal, that influence health problems, and therefore nurses' work.

Confronting the challenges in reconnecting urban planning and public health.

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.

Is Urban Regeneration Good for Health? Perceptions and Theories of the Health Impacts of Urban Change

An important issue for the geography of health in urban areas concerns how urban change arising from renewal of inner-city areas relates to health of urban populations. In this paper we examine ways in which urban regeneration schemes in Britain are attempting to incorporate consideration of health impact into their planning and development. It concentrates especially on diverse ways that different stakeholders perceive the outcomes of these schemes and the significance for health. The paper is based on two case studies of urban development projects, focusing on housing improvement and training for unemployed people, in a London borough where levels of deprivation are high and various forms of social exclusion affect large numbers of people. The methods used aimed to represent the views of different types of stakeholders, by means of interviews and focus groups with a range of stakeholders in these schemes. Health impact assessment needs to be evidence based. We discuss the evidence for potential health impact of regeneration projects through effects on housing and employment as determinants of health. We focus especially on the ways in which this evidence can be viewed and used by different stakeholders, and how far their perceptions seemed to match with research findings from public health. We consider the potential and the limitations for health improvement associated with urban regeneration in view of the case studies presented here.

Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health.

This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation's jails and prisons. As a result, US incarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered.

Health promotion in the city: a structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in US metropolitan areas, 1980-1995.

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

To mitigate, resist, or undo: addressing structural influences on the health of urban populations.

Young to middle-aged residents of impoverished urban areas suffer extra-ordinary rates of excess mortality, to which deaths from chronic disease contribute heavily. Understanding of urban health disadvantages and attempts to reverse them will be incomplete if the structural factors that produced modern minority ghettos in central cities are not taken into account. Dynamic conceptions of the role of race/ethnicity in producing health inequalities must encompass (1) social relationship between majority and minority populations that privilege the majority population and (2) the autonomous institutions within minority populations that members develop and sustain to mitigate, resist, or undo the adverse effects of discrimination. Broad social and economic policies that intensify poverty or undermine autonomous protections can reap dire consequences for health. Following from this structural analysis and previous research, guiding principles for action and suggestions for continued research are proposed. Without taking poverty and race/ethnicity into account, public health professionals who hope to redress the health problems of urban life risk exaggerating the returns that can be expected of public health campaigns or overlooking important approaches for mounting successful interventions.

Health risk and inequitable distribution of liquor stores in African American neighborhood

In this paper we examine whether the physical availability of alcohol is greater in predominantly African American communities compared to predominantly white communities as indicated by the presence of off premises liquor stores. We investigate the extent to which the income status of the residents of a community mediates the relationship between community racial composition and alcohol availability; and explore whether the intersection of race and class places low income African American communities at increased risk to have such stores located in their communities. Multivariate analytic techniques are used to examine the relationship between community racial composition, median income of neighborhood residents and per capita number of alcohol outlets in 194 census tracts in Baltimore, Maryland. The analysis found that liquor stores are disproportionately located in predominantly black census tracts, even after controlling for census tract socioeconomic status. Census tracts that are both low income and predominantly African American have substantially more liquor stores per capita than other census tracts. Although it is beyond the scope of the present study, our data reveal significant associations between the presence of liquor stores and the risk of health-related social problems in low income neighborhoods. More research needs to be done on the impact of alcohol on the social, psychological, and physiological health of low income urban populations.

Habitat and health: the role of environmental factors in the health of urban populations.

The findings of Dr. Fullilove, as well as the success of Zap Asthma and the campaign against lead poisoning, are strong arguments against all three of the mind-sets mentioned above. They show that urban deterioration is largely a product of economic forces, not of some moral failure of urban residents, and that money spent on improving an urban environment has the collateral effect of giving residents the sense of hope and optimism and the feeling that they area contributing to their health, which will make them better stewards of that environment. They show the importance of tapping into the energy and interests of the community, while at the same time addressing political resistance to helping disadvantaged communities. They show that progress takes time, and that successful programs try to improve an existing community rather than making it over at once. They show that urban problems are manageable. And, they show that community groups and outside agencies can accomplish a great deal by working together and putting aside the parochial differences and mutual mistrust that grow out of the Alamo syndrome.

The ‘healthy’ city, expertise, and the regulation of space

This paper critically examines the concept of the ‘healthy’ city as it has been articulated in the health promotion literature and the policy documents and programme evaluations of the World Health Organization's Healthy Cities project. It begins by discussing the emergence of this concept within health promotion and the new public health, then questions the claim that the Healthy Cities project represents a fundamentally new approach to urban health problems. Attention is drawn to the continuing modernist belief in the power of science and in rational administrative solutions to problems. The paper focuses on some assumptions, limitations and implications of the strategy of ‘community participation’, which is a key feature of the Healthy Cities project and Health for All by the Year 2000. It is concluded that it is important for those who are concerned about advancing the health of urban populations to critically examine the basic concepts of Healthy Cities and the new public health.

Health and social status of an elderly urban population in Sri Lanka

Although Sri Lanka has generally a young demographic profile, with decreasing overall mortality and birth rates, its population is aging gradually and will continue to do so in the future. In order to have an idea of the needs of the elderly a survey was conducted in a sample of randomly selected Sinhalese elders living in an urban community. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessments were done. Ten percent of the respondents had at least one ADL impairment. Another ten percent had only IADL impairment. The commonest ADL to be affected were bathing and feeding. Children and the family provide all care for the impaired elderly. The family support system should be encouraged and assisted to prevent the necessity for more formal and expensive institutional care. A large proportion of the elderly were handicapped with defects in vision and hearing and the absence of teeth. Correction of these defects would improve both quality of life of these subjects and reduce their risk of accidents.

Monitoring the Health of Urban Populations: What Statistics Do We Need?

Debate about how to obtain the statistics needed to monitor the health of the population has been stimulated by a resurgence of interest, both nationally and locally, in public health. At the moment, it is clear that data systems are not up to the task. Existing national data collection systems are largely concentrated on measuring mortality and monitoring the activities of health services. Thus, work done so far has had to rely on proxy indicators of health, rather than those which would be recommended ideally. In the face of this, central government has started to discuss how to monitor and promote the health of the population