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. Mass gatherings Spontaneous (e.g. Pope's Funeral) Planned Recurrent events different locations (e.g. Olympics, Expo) Recurrent event same location (e.g. Hajj, Wimbledon) 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. Implications of MGs The impacts may be Short term, long term impact Direct and indirect impact Visible and invisible impact Positive and negative impacts Individual Health service system Health-related environment

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. 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 2010 World Expo. Shanghai

10. West of Huangpu River: 0.9 km 2 East of Huangpu River: 2.38 km 2 Enclosed area: 3.28 km 2

11. Measure relevant health indicators 20092011 Potential Health Impacts of Expo 2010 Healthy Environments Increase in green areas Improve waste disposal/sanitation Improve road safety Improve air quality Increase in smoke- free areas Improvement of Health System Improve public health emergency response Improve capacity of emergency service Quit smoking class Health Policy/Legislation Smoke free Clean air Safe drinking water/food Healthy nutrition Community & Individual Capacity Increase in physical activity Improved in nutrition Reduce tobacco use Reduced harmful use of alcohol Promotion of health of host city population Absolute improvements Relative (Equity gains, gradients)

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

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

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

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 advisory group Define concepts to be measured within the domains of health impact Define indicators, methodology, and equity dimension for each concept or sub-concept

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

19. Concept Map  H Sys  Soc Env  Literacy  PhysEnv  Policy  H Status  WaterFood Safety Disease Control AlcoholPhys Act Tobacco Domain  Environmental Health Infectious DiseasesNCD Areas of Priority

20. Example Concept Map Area: NCD  Sub-area: Tobacco  Smoking Cessation H Sys  Social Mobilisation for Tobacco-Free Shanghai Soc Env  Knowledge attitudes & skills related to smoke-free livingLiteracy  Smoke-free public places (enforcement of regulations) PhysEnv  Smoke-free RegulationsPolicy  Smoking by Children & Ados Smoking by Adults Health Status  Tobacco Domain  NCD Areas of Priority

21. Concepts  Indicators  Methods Analyse service provision and use by agreed social groups Documentary Process records Guidelines Training Use of service Smoking Cessation H Sys ?? Website activity ? Volunteer action Social Mobilisation Soc Env Analyse by agreed social groups SurveyKAP indicatorKnowledge attitudes and skills Literacy Enforcement by locality? InspectionsComplianceSmoke-free public places Phys Env Regulations apply to all? DocumentaryRecord of regulations Smoke-free Regulations Policy SurveyCurrent daily smoking Smoking by Adults Analyse by agreed social groups SurveyCurrent daily smoking Smoking Child/Ados H Status Equity IssueMethodsIndicatorsConcepts Tobacco Control NCDDomain

22. Priority Areas 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 ……

23. Principle of 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) and Authoritative Integrated

24. DomainPriority AreaSub-areaIndicator Health Status NCD13 Infectious Disease11 Injury Prevention11 Integrated indicator13 PolicyNCD12 Finance investment13 Phys EnvInfectious Disease22 Environmental Health 714 Overview of Indicators 6 domains, and 66 indicators To be continued …

25. DomainPriority AreaSub-areaIndicator Literacy & behaviour NCD47 Infectious Disease45 Injury Prevention11 Env. Health11 Integrated indicator12 Soc EnvNCD33 Infectious Disease11 Environmental Health11 H SysNCD22 Infectious Disease47 Integrated indicator12 Emergency25 … 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. Sub-areaIndicatorData (before EXPO) Public placeGood sanitation in public place 90% Waste Proportion of rubbish Treatment 76.9 ％ AirProportion of days meeting standard of air quality 90.5% Green landGreen land coverage38% Houseper-capita living space16.5m 2 WaterCentral treatment proportion of waste water 85% Safety drinking waterA new water resources 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. Photo http://flickr.com/photos/qifei_20/2716066817/sizes/l/http://flickr.com/photos/qifei_20/2716066817/sizes/l/ Thank You!