Urban Health Program Research Articles

Measuring the quality of diabetes care in urban and rural Indian health programs.

The purpose of this study was to compare the quality of diabetes care provided to American Indians/Alaska Natives (AI/AN) by urban and rural Indian health programs. Medical record review data collected by the Indian Health Service as part of the Diabetes Care and Outcomes Audit in 2002. Seventeen urban Indian health clinics and 225 rural Indian health programs. All urban AI/AN patients (n = 710) and random sample records of rural AI/AN patients (n=1420). Adherence to guidelines for process measures and intermediate outcomes of diabetes care. Compared to the rural sample, urban patients were more likely to have received diabetes education during the prior year (P < or = .05). Annual dental examinations were less common among urban patients than rural patients (19% vs 41%, P < or = .001). Completion of laboratory testing and immunizations were similar in both groups. Adjusted mean levels for intermediate outcomes of diabetes care and the percentage achieving recommended levels varied slightly but were not statistically or clinically significant. Few differences in the quality of diabetes care were found between urban and rural Indian health sites. Differences in the receipt of dental examinations may reflect differences in resources and staffing between urban and rural settings. This study serves as a baseline for the assessment of ongoing interventions aimed at improving the quality of care.

Adolescents' Self-Reported Risk Factors and Desire to Talk About Family and Friends

Summary Adolescents entering an urban mental health program completed Adquest, an 80-item self-report inventory asking about important areas in their life such as school and education, work, health, sexuality, substance abuse, personal and family life. This article examines how much adolescents wanted to talk about family and friends with their counselors, gender and age differences in this desire, and how that is mediated by behavioral risk factors. Irrespective of the existence of coping problems and behavioral risks, adolescents expressed a strong desire to discuss family, and, to a lesser extent, friends, in counseling. From a clinical standpoint, this finding highlights Adquest's limitations because it is based on an individual, behavioral risk paradigm rather than on more systemic factors in the lives of these adolescents. Implications regarding the use of practice-based research to facilitate reflective practice are discussed.

Reforming American Indian/Alaska Native Health Care Financing: The Role of Medicaid

Chronic underfunding of American Indian and Alaska Native (AIAN) health care by the federal government has weakened the capacity of the Indian Health Service, tribal governments, and the urban Indian health delivery system to meet the health care needs of the AIAN population. I describe the current role of Medicaid in financing health care services for American Indians/Alaska Natives and offer 3 suggestions for reforming Medicaid financing of AIAN health care: (1) apply a 100% federal matching rate to the cost of Medicaid services furnished by urban Indian health programs; (2) apply a 100% federal matching rate to the cost of Medicaid services furnished by referral to AIAN patients of hospitals or clinics operated by the Indian Health Service, tribes, tribal organizations, or urban Indian health programs; and (3) exempt AIAN Medicaid beneficiaries who receive services from such hospitals or clinics from state reductions in Medicaid eligibility and benefits.

Transferring responsibility from an international NGO to local government: experience from the Yala Urban Health Programme, Nepal

Transferring responsibility from an international NGO to local government: experience from the Yala Urban Health Programme, Nepal

Transferring responsibility from an international NGO to local government: experience from the Yala Urban Health Programme, Nepal

This article describes the response of the Yala Urban Health Programme and its predecessors to urban health problems in Patan, Nepal, over 20 years. The initial response was to take responsibility for filling the gap in essential services; however, since 1998, the response has changed, to become an eight-year phased transfer of responsibility to local government, with the following goal: “To improve the health of all in Patan, particularly the poor and marginalized, by establishing an effective, accessible and sustainable primary health care system. This will be a public–private–NGO partnership coordinated by the city council.” Six years into the process, there are encouraging signs that local government will indeed take up the challenge of coordinating essential health services for the city. We describe here the factors we believe have contributed to a successful handover, some of the problems encountered so far and the uncertainties that remain. Perhaps the most important factor for success is that leaders in the international NGO and the municipality have been willing to take risks. By modelling an attitude of service and valuing the service given by others, the balance of risk may have been tipped in favour of success.

FOCUS ON: Community Care of Older Adults

Peri Rosenfeld is a senior research scientist in the Division of Nursing, the Steinhardt School of Education, New York University (NYU), and the nursing research coordinator at NYU Medical Center. Charlene Harrington is a professor in the School of Nursing, University of California at San Francisco. Holly Michaels Fisher is the executive director of VNS CHOICE and the vice president of program planning for the Visiting Nurse Service of New York. Suzanne McCabe is a planning analyst for VNS CHOICE. Donna Clemmens is an assistant professor, the director of the Urban Health Program, and the coordinator of the Community Health Nursing Program in the Division of Nursing, the Steinhardt School of Education, NYU. Malvina Kluger is the projects manager at the Hartford Institute. Nursing Counts, highlighting data that illustrate the value of nursing, appears in the AJN as a periodic column and is provided by the John A. Hartford Foundation Institute for Geriatric Nursing, the Division of Nursing, New York University, New York City, www.hartfordign.org.

Global, national, and local approaches to mental health: examples from India.

Neuropsychiatric disorders and suicide amount to 12.7% of the global burden of disease and related conditions (GBD) according to World Health Organization (WHO) estimates for 1999, and recognition of the enormous component of mental illness in the GBD has attracted unprecedented attention in the field of international health. Focusing on low- and middle-income countries with high adult mortality, this article discusses essential functions of international agencies concerned with mental health. A review of the history and development of national mental health policy in India follows, and local case studies consider the approach to planning in a rural mental health programme in West Bengal and the experience in an established urban mental health programme in a low-income community of Mumbai. Local programmes must be attentive to the needs of the communities they serve, and they require the support of global and national policy for resources and the conceptual tools to formulate strategies to meet those needs. National programmes retain major responsibilities for the health of their country's population: they are the portals through which global and local interests, ideas, and policies formally interact. International priorities should be responsive to a wide range of national interests, which in turn should be sensitive to diverse local experiences. Mental health actions thereby benefit from the synergy of informed and effective policy at each level.

The Urban Health Program to encourage minority enrollment at the University of Illinois at Chicago College of Medicine.

Since 1969, the University of Illinois at Chicago College of Medicine has worked to recruit, admit, and graduate a more diverse population of physicians. The state of Illinois ranks third in the nation in the number of African American residents, and fifth in the number of Latinos, and these groups together account for approximately 60% of Chicago's population. To attract applicants from these groups, the medical school created the Medical Opportunities Program and its successor, the Urban Health Program, to maximize this pool of applicants. Outreach activities at undergraduate colleges, in association with premedical organizations, identify underrepresented-minority (URM) students who should receive support in their applications. The organizations assist in monitoring the applications of URM candidates. Also, the medical college created academic and social support programs for its URM students: a prematriculation program, small-group review sessions for every major course in the first two years of the curriculum, help for second-year students preparing for the United States Medical Licensing Examination Step 1 and fourth-year students preparing for Step 2, and support for organizations for minority students. Over its 30 years, the program has had a substantial impact on the number of URM students entering the medical college, other medical schools, and other health professions. Over these years, the proportion of URM students in the medical college's overall enrollment rose from 10% to 23%. Also, a higher proportion of the college's URM graduates than its non-URM graduates practice in the Chicago area.

MALNUTRITION AMONG YOUNG CHILDREN IN SQUATTER SETTLEMENTS OF KARACHI - A CONTINUING HEALTH PROBLEM

POS18 In order to assess the growth and nutritional status as part of the baseline survey of the Urban Health Program in squatter settlement of Karachi conducted by the Community Health Sciences Department of AKU, we went to each house in the area and conducted anthropometric measurements on children under five years of age who were present at home at the time of interview. We recorded height and weight of 5231 children born in the period 1-59 months preceding the survey. Among them 51% were males and 49% were females. We assessed the nutritional status of these children in terms of weight for age (general malnutrition), height for age (stunting) and weight for height(wasting) using the international reference population of the United States National Center for Health Statistics (NCHS) and the Center for Disease Control (CDC), as recommended by WHO. We evaluated the nutritional status by calculating the extent to which the anthropometric measurements deviated from measurements for the reference population of children as defined by NCHS/CDC. Overall, 42 % of the total children were underweight whereas 12.6 % were severely underweight for their age. On average, 49% of children under five years of age were stunted while 25.5% were severely stunted. The prevalence of wasting was 12.5% while severe wasting was found to be 2.6%. There was no significant difference between the sexes. Survey findings are consistent with other nutritional surveys and indicates that malnutrition remains a major public health problem in Pakistan. Both stunting and wasting are indications of long term malnutrition and disease related to poverty and under-development within the population.

The Healthy Neighborhoods Project: a local health department's role in catalyzing community development.

Studies show that community development approaches to health education may lead not only to improved social, economic, and health status but also to increased individual participation in health education and preventive health care activities. However, because of categorical funding restraints and philosophical issues, local health departments have rarely given control of defining project outcomes to the community. One such project was in a low-income urban neighborhood in the San Francisco Bay Area. In this Healthy Neighborhoods Project, the health department catalyzed community development and organization in a multiethnic public housing complex. As a result, an empowered community successfully advocated to improve public safety by installing street speed humps and increased street lighting. After project completion, residents initiated several additional health actions, including the removal of a neighborhood tobacco billboard. This article describes the project, which may serve as a model for other urban public health programs to explore their role in community empowerment.

Public health crises of cities in developing countries

During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care programs in the rural areas of developing countries. Until the past five years urban health was not seen as a special health problem. Population pressure in the rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. This sudden concentration of large populations in small geographical areas has resulted in the urban health crises of the developing world. The poor who live in the slum areas have no access to adequate health services, they experience frequent epidemics of communicable diseases like cholera, they live within a heavily polluted environment, and their children have very poor health because they are not immunized and are malnourished. The paper agrees with approaches which have been championed by development agencies to address the urban health crises. These approaches propose the reorientation of urban health systems to include adoption of PHC for urban health programs, intersectoral collaboration and extra budgetary support. The paper argues for further strengthening of the reorientation approach by adjusting the development planning model. It is proposed that the urban plan be integrated into the national development plan so that emerging urban health crises can receive special attention in resource allocation.

Child survival in big cities: the disadvantages of migrants.

Data from 15 Demographic and Health Surveys are used to examine whether rural-urban migrants in developing countries experience higher child mortality after settling in towns and cities than do lifelong urban residents, and if so, what individual or household characteristics account for this. Findings indicate that children of female migrants from the countryside generally have much poorer survival chances than other urban children. This survival disadvantage is more pronounced in big cities than in smaller urban areas, among migrants who have lived in the city for many years than among recent migrants, and in urban Latin America than in urban North Africa and sub-Saharan Africa. Within big cities, higher child mortality among migrant women is clearly related to their concentration in low-quality housing, and in part to fertility patterns at early ages of children and mother's educational attainment at later ages. Excess child mortality among urban migrants may also result from factors associated with the migration process, that are outlined in this study but not included in the analysis. Evidence of moderately high levels of residential segregation of migrant women in big cities suggests that opportunities exist for urban health programs to direct interventions to this disadvantaged segment of city populations.

Book reviews

Journal Article Book reviews Get access Insect and rodent control through environmental management: a community action programme. World Health Organization (WHO) in collaboration with the United Nations Environment Programme. Price: Sw. fr. 90; price in developing countries Sw. fr. 63. Jo Lines Jo Lines Urban Health Programme London School of Hygiene and Tropical MedicineUK Search for other works by this author on: Oxford Academic PubMed Google Scholar Health Policy and Planning, Volume 7, Issue 3, September 1992, Pages 308–310, https://doi.org/10.1093/heapol/7.3.308 Published: 01 September 1992

Increasing the graduation rates of minority medical students.

The University of Illinois College of Medicine has operated a program since 1969 to recruit minority students into the college and to increase the graduation rates of these students once they enroll. Known as the Medical Opportunities Program (MOP) until 1978, the program was expanded in 1978 and renamed the Urban Health Program (UHP). The authors of the present paper discuss the results of these programs, particularly the effect of granting minority students delays in completing graduation requirements. The MOP (1969 through 1978) increased graduation rates for minority students from 55 percent for those who graduated on time to 81 percent for both on-time and delayed graduates. Under the first seven years of the UHP (1979 through 1985), more minority students have been offered places, and more have enrolled than in the 10 years of the MOP. The retention rate under the UHP, if it holds, will be higher than that under the MOP. For the combined MOP-UHP period, the retention rate for minority students was 88 percent; 69.8 percent of the graduates were on time, and 30.2 were delayed.

Child mortality and fertility in Colombia: Individual and community effects

The education of a mother is strongly and positively correlated with the survival rate of her children. This paper combines household data from the Colombian Census of 1973 and characteristics of the 900 residential areas in Colombia, to test various hypotheses concerning the mechanism by which mother's education and public policies affect child survival and the distribution of health benefits resulting from policy interventions. The hypothesis is advanced that education provides people with skills in acquiring and decoding new information and thus effectively lowers the costs of using more beneficial child health and contraceptive technologies. Since a primary function of health and family planning programs is to disseminate information on these same technologies, the hypothesis is tested that mother's education and these program interventions may substitute for each other in improving child health and reducing family size. The empirical analysis confirms that in urban areas the availability of medical services, family planning activities, transportational infrastructure and climate, in addition to mother's education, are associated with child mortality ratios and fertility within a birth cohort of mothers. The least educated mothers are the most strongly affected, in terms of their reduced fertility and increased child survival rates, by the local urban health programs. The evidence is, thus, consistent with the substitution hypothesis. No effects of program interventions and medical facilities are found on rural populations, though both child mortality ratios and fertility are lower for more educated rural women.

Health Education Aide Trainee Project

IN SEP'TEMBER 1967 the California division of the American Cancer Society (ACS) began a 2-year project on the use of indigenous i1onprofessional health aides. The HEAT (health education aide trainee) project was initiated to assess the role of these aides in local branches and to analyze the specific health education work they could perfotrm that could not be done as effectively by professional health workers or volunteers in a voluntary health agency. A project coordinator was retained from the, University of California School of Public Health to collect data on the use of indigenous nonprofessional aides in other programs and to discuss the implications of this project with workers in the participating ACS branches. After extensive screening by the health education director of the ACS branch, the project coordinator, and the executive director of each coopera,ting ACS branch, four aides-all women, 23, 33, 35, and 36 years old-were selected to work with certain ethnic minority populations in the San Francisco Bay Area communities. The aides were to determine the needs of the residents and help them modify their behavior concerning cancer; that is, seek early diagnosis and care of the disease. The use of nonprofessional aides in health programs is not new. American Indians have worked as health education aides on their reservations since the mid-1950's (1). Community health aides have been used in California since 1961, particularly in areas with large numbers of migrant agricultural workers (2,3). The Office of Economic Opportunity (OEO) has used community aides in urban health programs to improve communications with disadvantaged families. "They [the aides] possess the precious empathy too often missing among middle class health workers and can serve a vital function as a bridge between patients or potential patients in need of health services" (4).

Comprehensive health planning. 3. New resources for urban health programs.

Comprehensive health planning. 3. New resources for urban health programs. E D SoxCopyRight https://doi.org/10.2105/AJPH.58.6.1030 Published Online: August 29, 2011