Urban medicine

BMA Medical College and Vajira Hospital

Urban Medicine

Chavanant SumanasrethakulBMA Medical College and Vajira Hospital

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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Urban health penalty

Urban dwellers have the greater health problems and risk factors than suburbs and rural people.

Andrulis 1997

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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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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

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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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เขตเมื�อง

พระราชบั�ญญ�ต�เทศบัาล พ.ศ. ๒๔๙๖ มื�เกณฑ์�ในการพ�จารณาพ�!นท�"เขตเมื�องดั�งน�!

• จ$านวนประชากรในท'องถิ่�"นน�!น (มืากกว)า๑๐๐๐๐ คนข-!นไป)

• ความืเจร�ญทางเศรษฐก�จของท'องถิ่�"น

• ความืสำ$าค�ญทางการเมื�อง และศ�กยภาพในการพ�ฒนา

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Urban Medicine: Definition

• ค$าว)า “Urban” ตามื Oxford Dictionary ให้'ความืห้มืายไว'ว)า “เป7นสำ�"งท�"เก�ดัข-!นในเมื�องห้ร�อเป7นล�กษณะของเมื�อง” (Occurring in or characteristic of city)

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• Urban healthห้มืายถิ่-งการศ-กษ�"เก)ยวข'องก�บัสำ8ขภาพของประชากรในเขตห้ร�อช8มืชนเมื�อง

• Urban Medicine ห้มืายถิ่-งเวชศาสำตร�ท�"เก�"ยวข'องก�บัป9ญห้าท�"เก�ดัข-!น ในช8มืชนเมื�อง ห้ร�อป9ญห้าทางการแพทย� ท�"เป7นล�กษณะเฉพาะของเขตห้ร�อช8มืชนเมื�อง

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Characteristic of Cities

1. Centralization2. Verticality3. Concentration 4. Diversity

1. Social2. Economic3. Material

5. Information and communication6. Mechanization7. Political authority

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ความืแตกต)างของช8มืชนชนบัท และช8มืชนเมื�อง

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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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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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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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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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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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5th: Solving problems skills

• Scientific knowledge

• Technical knowledge

• Organizational knowledge

• Political knowledge

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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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Factors influencing personal

exposures to air pollution in urban

environments

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Interventions

Healthoutcome

Conceptual framework for Urban health

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• 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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Responses to Health Threats in Cities (health hazard in the city)

1. HIV/AIDS, Tuberculosis, and Malaria2. Other Communicable Diseases esp. emerging disease from

animal3. Non-communicable Diseases4. Substance Use and Mental Health5. Injuries, Road traffic and Urban Occupations6. Air Quality and Other Environmental Health Threats7. Violence8. Innovative Methods and Measurements9. Other

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“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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“Healthy urban governance and integrated approaches to interventions are key pathways to reducing health inequity. Securing more resources for health investments in urban settings, coupled with fairer distribution of those resources, is vital.”

KNUS 2008

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“Urban poverty is not because of distance from infrastructure and services but from exclusion.”

KNUS 2008

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“Dealing with disparity in urbanize community”