BMA Medical College and Vajira Hospital Urban health care Chavanant Sumanasrethakul MD., M.Sc....
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Transcript of BMA Medical College and Vajira Hospital Urban health care Chavanant Sumanasrethakul MD., M.Sc....
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BMA Medical College and Vajira Hospital
Urban health care
Chavanant Sumanasrethakul MD., M.Sc.Department of Preventive and Social Medicine
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BMA Medical College and Vajira Hospital
Backgrounds
• Health (WHO)
“a state of complete physical, mental and social well-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”
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
Urban health penalty
Urban dwellers have the greater health problems and risk factors than suburbs and rural people.
Andrulis 1997
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
Principles
“Urban health is based on core healthy cities principles of equity, intersectoral cooperation, community involvement and sustainability.”
World Bank 2007
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
5 disciplines of urban health
• 1st: Complexity• 2nd: Diverse of population• 3rd: Unique assets and problems• 4th: Context matters• 5th: Solving problems skills
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
5th: Solving problems skills
• Scientific knowledge
• Technical knowledge
• Organizational knowledge
• Political knowledge
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BMA Medical College and Vajira Hospital
The challenges of urban health
• How to organize and prioritize interventions for better health in 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?
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
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
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BMA Medical College and Vajira Hospital
Factors influencing personal
exposures to air pollution in urban
environments
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BMA Medical College and Vajira Hospital
“Urban poverty is not because of distance from infrastructure and services but from exclusion.”
(KNUS)
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BMA Medical College and Vajira Hospital
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)
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BMA Medical College and Vajira Hospital
• 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
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BMA Medical College and Vajira Hospital
“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)
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BMA Medical College and Vajira Hospital
“Dealing with the gap in urbanize community”