Urban Medicine and UrbanHealth

Chavanant Sumanasrethakul

Department of Preventive and Social Medicine

Faculty of Medicine Vajira Hospital

Urban

Operative meaning of Urban

• Municipal area?• City?• Megacity?• Metropolis?

No common universal definition for urban/r ural areas or population

• Belarus– Urban localities are human settlements that in accordance with legislation have

the status of towns• Canada

– Urban areas include all greater metropolitan areas (even though they contain s ome rural areas) and smaller metropolitan areas. Urban areas have a minimum

population of 1000 people and a population density of at least 400 per square ki lometer based on the previous census population counts

• Dominic Republic– Urban zones refer to areas in municipalities

• Estonia– Urban areas include towns and townships, while rural areas include villages

• Libya– Urban refers to every district of 50000 or more inhabitants

• Mexico– Urban refers to localities with population over 2500.

http://unstats.un.org/unsd/demographic/sconcerns/densurb/Defintion_of%20Urban.pdf

No common universal definition for urban/r ural areas or population

• Sweden .– 200Locality is a group of buildings normally not more than meters apart from

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• Turkey– Urban refers to settlements with population of 20001 and over.

• United Kingdom– Urban refers to built up area with a population of more than approximately one thousand (10

00 19991) basedonpopulation as at• United Stated of America

– - aaaa aaaa aaaaaa aaaaaaa a aa aa aaaaaaa aa aaaaaa aaaaaa aa aa aaaaa aaaaaaaaaa aa a aaaaaaa aaaaaaaa aaa aaaaaaaa a()50,0 00.“() 50rban fringe that together have a minimum residential population of at least ,

000 1000people and generally an overall population density of at least , aaa aaaaaa aaaa aa aaa aaaa aaaaa.

http://unstats.un.org/unsd/demographic/sconcerns/densurb/Defintion_of%20Urban.pdf

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Analysis of “urban” definition• 105 countries based their urban data on administrative

criteria, lim it ing it to the boundaries of state or provincial capitals, municipalitiesorotherlocalj ur i sdi ct i ons; 83 use t hi s as t hei r sol e met hod of d istinguishingur ban f r omr ur al .

• aaaaaaaaa aaaaaa aaaaaa aa 100 population size or population density , withminimumconcentrationsrangingbroadly, from200 to50000 inhabitants; 57 uset hi s as t hei r sol e u

rbancr i t er i on.• 2 5 countries specify economic characteristics assignificant, thoughnot excl

- usive, indef i ni ng ci t i es t ypi cal l y, t he pr opor t i on of t he l a - bour f or ce empl oyed i n non agr i cul t ur al act i v i t i es

• 18 countries count the availability of urban infrastructure in their definit ions, including the presence of paved st reets

, water supply system s, sewerage system s, or elect ric lighting.

• 25 countries provide no definition of“urban” at al l• 6 countries regard their entire population aa aaaaa

http://unstats.un.org/unsd/demographic/sconcerns/densurb/Defintion_of%20Urban.pdf http://www.demographia.com/db-define.pdf

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Oxford dictionary

•Medicine1 . the science or practice of the diagnosis,

treatment, and prevention of disease (in techni cal use often taken to exclude surgery).

2. a drug or other preparation for the treatment or prevention of disease

WHO

• Health– Wellbeing in biological, psychological, social

and spiritual aspects

Background of urban health and medicine

from various organizations

Urban Medicine and Metropolitan Health 1st International Conference

19 2007Berlin, September th,

• Urban areas attract poverty, and poverty createssickness.

•“ Urban Medicine ” refers to the patterns of disease that are found more often in major urban areas than e

lsewhere. HIV/AIDS, infectious diseases, or psychiatri c illness in citizens of immigrant origin all require speci al provision of treatment. The contamination of drinkin g water supplies with antibiotics is one example of ho w medicine interacts with other areas of life in major u

rban areas.

College of Medicine at Chicago University of Illinois

• Unique medical school curriculum to prepare- physician leaders to serve urban communities.

• Disparities in health outcomes based on - gender, ethnic, and a number of socio economic

factors have been well documented, and are mor e likely to be encountered in diverse urban settin

gs• Four general themes– Community – - Cross Cultural Clinical Skills –  Health Disparities – Leadership and Advocacy

UNC School of Medicine

• Describe heath disparities and challenges that urban underserved populations face

• Diagnose and treat specific disease processes found in urban underserved populations including: HIV/AIDS, other STDs, ment

al illness, substance abuse and addiction.• Practice with an increased multicultural awareness and

competence in the diverse population of a large metropolitan ar ea (Charlotte)

• Describe how family physicians develop relationships with community members/leaders and use techniques of primary car

e research to improve health care service to a diverse community

• Identify and use community resources to improve the health of underserved populations

University of Wisconsin School of Medicine and Public Health

•Providing health care for urban populations and to reducing health disparities

• Medical students in the Training in Urban Medicine and Public Health program will learn about:– Challenges and rewards of providing health care in an urban

setting– Health disparities– Accessing community resources– Enhancing cultural skills– Engaging with communities– - Developing and implementing population based healt

h promotion projects

Osaka City University

• Urban environmental• Industrial medicine• Public Health• Sport medicine• Medical Informatics• Legal medicine• Infectious disease

ISUH

• Facilitate the exchange of perspectives, research methods, and data on the study o

f diseases in urban areas.• Study the effects of urbanization on health• Evaluate and help develop programs that

lessen urban health risks and promote well- being of people living in urban areas.

Knowledge Network for Urban Settings(KNUS)

• Healthy urban governance and integrated approaches to interventions are key pathways t

o reducing health inequity . Securing more reso urces for health investments in urban settings,

coupled with fairer distribution of those resourc es, is vital.

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

World Bank

• Urban health problems are not markedly different from those in rural area, but their solu

tion are quite different

• Urban health is based on core healthy cities principles of equity , intersectoral cooperation ,

community involvement and sustainability.

WHO on World Health Day2010

• Majority of population are living in urban with furthermore growing

• More life and health threatening condition were founded in urban settings

• Rapid and unplanned urbanization can have negative consequences for the health

and safety

Condition of urban setting

Urban and rural populat ions of the world:1950 2030–

Department of Economic and Social Affairs, Population Division.   World urbanization prospects: the 2005 revision. New York: United Nations, 2006.

Framework of urban health

Examples of special characteristics of populations in urban area

• Homeless people• Health of economically deprived populations in cities• Racial/ethnic minority and health: the role of urban

environment• Sexual minority groups• Health and health access among urban immigrants• Urban environment, drug use, and health• The health of children in cities• Older adults

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Healthoutcome

Concept ual f r amewor k f or Ur ban heal t h KNUS

Factors influencing

personal exposures in exa

mple of air pollutio n in urban environ

ments

KNUS

5 disciplines of urban health (KNUS)

•1st : Complexity•2nd : Diverse of population•3rd : Unique assets and problems•4th : Context matters•5th : Solving problems skills

1st : Complexity

• Factors– Political, social and economic factors

• Units– Individual, family, community, municipal, regional, n

ational and global levels

• Systems– Health care, education, criminal justice, environment

al protection, housing and employment

• Population density and heterogeneity

2nd : Diverse of population

• More immigrants, more ethnic and lifestyle variability, and greater disparities in socioec

onomic status

• Cultural and communications skills, the anth ropological knowledge, and the epidemiolog

ical evidence

3rd : Uni que asset s and

problems• use energy more efficiently, tolerate better differences

in values and behavior, and have a richer array of hea - lth, social service and community based organization

s than rural or suburban communities.

• - urban residents are healthier than their non urban cou- nter parts. But cities also have higher rates of many ill

- nesses, more access to health damaging resources ( e.g., drugs and guns), and higher levels of the income

disparities associated with poor health

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

5th : Solving problems skills

• Scientific knowledge

• Technical knowledge

• Organizational knowledge

• Political knowledge

• A number of issues and interventions are i dentified and combined intervention packa

ge have been developed

EXAMPLE

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A• Middle classes

intervention B• High classes

intervention C

Combinationof

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Health and related health

issues improve ment for urban dwelling

“ Dealing with disparity in urbanize community f or better health outcom

e”

Course for Urban Medicine

• Urban setting (Bangkok Metropolis)• Health and medicine related issues• Anthropological feature in urban• Diversity of economic, social status and cultural asp

ects• Accessibility to health care center according to GIS,

service system• Special setting of health care service in Bangkok M

etropolis (compare with those in provincial zone)

1 9 departm ents in BKK

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