BMA Medical College and Vajira Hospital Urban health care Chavanant Sumanasrethakul MD., M.Sc. Department of Preventive and Social Medicine

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”

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

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

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

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

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

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

BMA Medical College and Vajira Hospital 5 disciplines of urban health 1 st : Complexity 2 nd : Diverse of population 3 rd : Unique assets and problems 4 th : Context matters 5 th : Solving problems skills

BMA Medical College and Vajira Hospital 1 st : 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

BMA Medical College and Vajira Hospital 2 nd : 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

BMA Medical College and Vajira Hospital 3 rd : 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

BMA Medical College and Vajira Hospital 4 th : 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

BMA Medical College and Vajira Hospital 5 th : Solving problems skills Scientific knowledge Technical knowledge Organizational knowledge Political knowledge

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?

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

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

BMA Medical College and Vajira Hospital Factors influencing personal exposures to air pollution in urban environments

BMA Medical College and Vajira Hospital “Urban poverty is not because of distance from infrastructure and services but from exclusion.” (KNUS)

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)

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

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)

BMA Medical College and Vajira Hospital “Dealing with the gap in urbanize community”