Building Healthy Cities A Focus on Interventions

Cover......Page 1
Acknowledgments......Page 5
Contributors......Page 7
Contents......Page 11
1.0. WHAT IS A CITY AND WHAT IS “URBAN HEALTH”?......Page 14
2.0. GROWTH OF CITIES WORLDWIDE......Page 15
3.0. THE HEALTH OF URBAN POPULATIONS......Page 16
4.0. URBAN HEALTH INQUIRY AND PRACTICE......Page 23
5.0. THIS BOOK......Page 24
REFERENCES......Page 25
I - Populations......Page 29
1.0. INTRODUCTION......Page 30
2.0. KEY HEALTH ISSUES FOR HOMELESS PEOPLE......Page 31
2.2. Infectious Diseases......Page 32
2.3. Chronic Diseases......Page 33
2.5. Other Health Conditions......Page 34
2.8. Children in Homeless Families......Page 35
3.1. Population Size and Migration......Page 36
3.3. Income and Housing......Page 37
3.4 Social Welfare System......Page 38
3.5. Health Care System......Page 39
3.6. Urban Geography......Page 41
3.7. Urban Governance......Page 42
4.0. THE EFFECTS OF HOMELESSNESS ON POPULATION HEALTH......Page 43
5.0. POTENTIAL STRATEGIES TO IMPROVE THE HEALTH OF HOMELESS PEOPLE......Page 45
REFERENCES......Page 47
1.0. INTRODUCTION......Page 53
2.1 Poverty......Page 54
2.3. Working but Struggling: Earning a “Living Wage”......Page 55
3.0. STRUCTURAL AND POLICY FACTORS CREATING ECONOMIC DEPRIVATION IN URBAN ENVIRONMENTS......Page 56
4.1. Studies from the Published Literature......Page 59
4.2 Economic Deprivation and Health in Urban Environments......Page 62
5.0. POLICIES AND STRATEGIES TO IMPROVE THE WELL-BEING OF THE ECONOMICALLY DEPRIVED......Page 65
6.0. CONCLUSION......Page 68
REFERENCES......Page 69
1.0. OVERVIEW OF RACIAL/ETHIC MINORITY HEALTH......Page 72
2.0. MINORITY GROUPS, URBAN LIFE, AND HEALTH......Page 74
3.0. HEALTH DISPARITIES: THE ROLE OF RACE, SOCIOECONOMIC STATUS, AND THE URBAN ENVIRONMENT......Page 76
4.0. MINORITY GROUPS AND THE URBAN ENVIRONMENT......Page 79
5.0. RESIDENTIAL SEGREGATION AND GENTRIFICATION......Page 80
6.0. ENVIRONMENTAL JUSTICE AND HEALTH......Page 82
REFERENCES......Page 83
2.0. DEMOGRAPHY OF LGBT PEOPLE......Page 87
3.0. HOW CITIES AFFECT LGBT HEALTH......Page 89
3.1. Social Environment......Page 90
3.2. Physical Environment......Page 92
4.0. SPECIAL POPULATIONS OF URBAN LGBT PEOPLE......Page 93
5.0. HOW LGBT POPULATIONS AFFECT THE OVERALL HEALTH OF CITIES......Page 96
6.0. HEALTH ISSUES AFFECTING LGBT POPULATIONS......Page 98
7.0. BARRIERS TO HEALTH CARE......Page 101
8.0. POTENTIAL STRATEGIES FOR IMPROVING THE HEALTH OF SEXUAL MINORITIES GROUPS IN THE CITY......Page 102
REFERENCES......Page 104
1.0. MIGRATION TO THE CITIES: THE PROCESS OF IMMIGRATION......Page 110
2.1. Communicable Disease......Page 112
2.2. Chronic Disease......Page 117
3.0. STRUCTURAL BARRIERS TO CARE......Page 122
4.0. PROMOTING HEALTH AND PREVENTING DISEASE 4.1. Creative Clinical Programs......Page 124
4.2. Community-Based Health Programs......Page 125
5.0. CONCLUSION......Page 126
REFERENCES......Page 127
1.0. INTRODUCTION......Page 133
2.1. Prevalence......Page 134
2.4. Age of Onset......Page 135
2.6. Racial/Ethnic Differences......Page 139
2.7. Medical Consequences......Page 140
3.0. DRUG USE AND URBAN ENVIRONMENTS......Page 142
3.1. Urban comparisons......Page 143
3.2. The Urban Context......Page 145
4.0. FUTURE DIRECTIONS......Page 150
REFERENCES......Page 151
1.0. INTRODUCTION......Page 161
2.0. URBAN CHARACTERISTICS THAT MAY AFFECT THE HEALTH OF CHILDREN 2.1 Health Insurance Status......Page 162
2.2. Socio-Economic Status (SES) and Social Capital......Page 163
2.4. Urbanization and Industrialization......Page 164
3.0. HOW CHILDREN CONTRIBUTE TO THE OVERALL HEALTH OF CITIES 3.1. Infant Mortality Rate (IMR)......Page 165
3.2. Asthma......Page 166
3.3. Injury......Page 168
3.4. Obesity......Page 170
3.5. Mental Health and Urban Youth......Page 171
4.0. CHILD HEALTH BENEFITS OF LIVING IN THE URBAN ENVIRONMENT......Page 174
5.0. RESEARCH GAPS......Page 175
REFERENCES......Page 176
1.0. THE HEALTH STATUS OF OLDER ADULTS IN URBAN AREAS: ISSUES AND CHALLENGES 1.1. Demography......Page 183
1.2. Key Health Issues......Page 187
2.0. HOW URBAN LIVING MAY AFFECT THE HEALTH OF OLDER ADULTS......Page 191
2.1. Physical Environment......Page 192
2.2. Housing......Page 193
2.3. Transportation......Page 194
2.4. Activities of Older Adults......Page 196
3.0. HOW OLDER ADULTS CONTRIBUTE TO THE HEALTH OF THEIR COMMUNITIES......Page 197
4.1. Environmental Engineering......Page 198
4.2. Social Mobilization......Page 199
4.4. Health System Reform......Page 200
5.0. CONCLUSION......Page 201
REFERENCES......Page 202
1.0. INTRODUCTION......Page 206
2.0. THREE TRANSFORMATIONS......Page 207
3.0. LOOKING BENEATH THE URBAN AVERAGES......Page 210
4.1. The Epidemiological Transition......Page 211
4.2. Urban Burdens of Disease......Page 212
4.3. The Service Environment......Page 214
5.1. Environmental Threats to Health......Page 215
5.2. Tuberculosis......Page 216
5.4. Urban Malaria......Page 217
5.6. Reproductive Health......Page 219
5.7. Obesity and Related Chronic Diseases......Page 221
5.8. Accidents, Violence, and Injuries......Page 222
5.9. Mental Health......Page 223
REFERENCES......Page 224
1.0. URBAN POPULATION AND HEALTH......Page 228
2.2. Pollution......Page 229
2.3. Health Consequences......Page 230
3.0. URBAN RESIDENTIAL PLANNING AND HEALTH......Page 231
5.0. THE CITY AND SOCIAL HEALTH......Page 232
6.2. Sanitation and Water Quality......Page 233
7.0. FOOD QUALITY AND HEALTH......Page 234
9.0. POTENTIAL STRATEGIES FOR IMPROVING THE HEALTH OF PEOPLE IN CITIES OF NEPAL 9.1. Urbanization and Health......Page 235
9.3. Urban Community and Health......Page 236
9.4. Urban Services and Health......Page 237
REFERENCES......Page 238
12. Integrative Chapter......Page 241
II - Methods......Page 244
1.0. INTRODUCTION......Page 245
2.0. HUMAN ADAPTATION 2.1. Changes in Human Settlement Patterns......Page 246
2.3. Discussion of Anthropological Work on Urban Stressors......Page 247
3.0. HUMAN VARIATION......Page 250
4.1. Race: The Pitfalls of “Natural” Categories......Page 253
4.2. Anthropology in Urban Health......Page 254
4.3 The Anthropologist’s Toolkit......Page 255
REFERENCES......Page 257
1.0. WHAT IS EPIDEMIOLOGY AND WHAT ROLE CAN IT PLAY IN URBAN HEALTH RESEARCH?......Page 261
2.0. DIFFERENT PERSPECTIVES ON THE EPIDEMIOLOGIC STUDY OF URBAN HEALTH......Page 263
3.0. EPIDEMIOLOGY AND URBAN HEALTH......Page 265
3.1. Epidemiologic Approaches......Page 266
3.2. Study Design......Page 268
3.3. Analytic Considerations......Page 269
4.1. Specification of Research Question......Page 270
4.2. Definitions of Urban, Intra-urban Spaces, and Urbanization......Page 271
4.3. Cities Are Complex and Multiple Competing Influences May Be Important Determinants of Health......Page 273
5.0. THE FUTURE: WHAT IS THE ROLE OF EPIDEMIOLOGY IN THE STUDY OF URBAN HEALTH?......Page 274
REFERENCES......Page 275
2.0. TYPES OF GROUP LEVEL STUDIES USED IN URBAN HEALTH......Page 279
2.2. Cost, Convenience, and/or Constraint Group Sampling......Page 280
3.0. STATISTICAL PROPERTIES AND DESIGNS OF GROUP LEVEL SAMPLES......Page 282
3.1. It Is Often Difficult to Determine Whether or Not There Is a Group Level Effect......Page 283
4.2 Stratified Sampling at the Neighborhood Level......Page 284
4.3. Weighted Observations......Page 285
4.4. Complex Survey Designs......Page 286
5.0. CONTEXTUAL SETTINGS AND ANALYSES OF INTEREST......Page 287
6.1. Analysis of Individual Effects in (Clustered) Group Level Designs......Page 288
6.4. Analyses of Stratified Designs......Page 291
6.5. Analyses of Subpopulations in Stratified Designs......Page 292
7.0. PLANNING URBAN GROUP LEVEL STUDIES (SAMPLE SIZE AND POWER)......Page 294
REFERENCES......Page 295
1.0. INTRODUCTION......Page 297
2.0. URBAN STUDIES AND HEALTH SERVICES RESEARCH......Page 298
3.0. HEALTH SERVICES FOR “INNER CITY” POPULATIONS......Page 299
3.1. Safety-Net Providers......Page 300
3.2. Health Insurance Programs for the Poor and Underserved......Page 301
3.5. Race, Ethnicity, Culture and Access to Medical Services......Page 302
5.0. BEYOND “INNER CITY” POPULATIONS AND MEASURING HEALTH SYSTEMS PERFORMANCE......Page 303
6.0. A RESEARCH AGENDA ON HEALTH SERVICES AND THE CITY......Page 304
6.1. A Framework for Comparing Cities, Health Services and Health......Page 305
7.0. THE WORLD CITIES PROJECT (WCP): AN INTERNATIONAL EXAMPLE OF HEALTH SERVICES RESEARCH ON CITIES......Page 307
7.1. The Urban Core as a Unit of Analysis......Page 308
7.3. Health Care Resources......Page 309
7.4. Similarities and Differences......Page 310
7.5. Applying the Framework for Comparing Cities, Health Services, and Health to Four World Cities......Page 312
8.0. CONCLUSION......Page 313
REFERENCES......Page 314
1.0. INTRODUCTION......Page 319
2.0. HOUSEHOLDS, SOCIAL NETWORKS, AND NEIGHBORHOODS......Page 321
2.1. Theory......Page 322
2.2. What Is an Urban Neighborhood?......Page 324
2.3. Neighborhood Heterogeneity......Page 325
2.4. How Strong Is the Empirical Evidence?......Page 326
3.0. ASSESSING URBAN POVERTY AND LIVING STANDARDS......Page 328
3.1. Overview......Page 329
3.2. Monetized Measures of Poverty......Page 330
3.4. Measures Based on Proxy Variables......Page 331
3.5. New Strands of Research on Measurement......Page 333
3.6. Monitoring Change Over Time......Page 337
3.7. Measuring Neighborhood Poverty and Affluence......Page 339
4.0. URBAN SOCIAL NETWORKS AND SOCIAL CAPITAL......Page 342
4.1. Measuring Social Networks......Page 343
4.2. Measuring Social Capital......Page 345
4.3. The Overlap of Social Networks and Capital......Page 346
5.0. WHAT CAN BE LEARNED FROM LONGITUDINAL STUDIES?......Page 348
5.1. The Benefits of Longitudinal Designs......Page 349
5.2. The Costs of Longitudinal Approaches......Page 350
5.3. Longitudinal Research in Slums......Page 352
5.4. Identifying Slum Communities......Page 353
5.5. Understanding Slum Dwelling Units and Households......Page 354
5.6. Residential Mobility......Page 355
REFERENCES......Page 356
1.0. INTRODUCTION......Page 363
2.0. PRECURSORS......Page 365
3.1. The Disappearance of Jobs is an Urban Health Issue......Page 366
3.2. The Disappearance of the Urban Black Middle and Working Classes......Page 367
4.1. Critical Objections......Page 368
4.2. Externally Affected Communities or Internal Community Effects?......Page 369
4.4. Multilevel Models......Page 370
5.1. Mechanisms: Example of Neighborhood Birth Weight......Page 372
5.2. Social Capital as a Theory of Mechanism Linking Macro to Micro......Page 373
5.3. Neighborhood Boundaries......Page 375
5.4. Integral Measures......Page 376
6.0. CONCLUSION......Page 377
REFERENCES......Page 378
1.0. INTRODUCTION......Page 381
2.1. Economic Development Planning......Page 382
2.2. Urban Design......Page 384
2.3. Equity and Social Justice in Planning......Page 385
2.4. Governance and Institutional Management......Page 386
2.5. Sustainability and Urban Planning......Page 388
3.1. Historical Approaches......Page 389
3.2. Interviews and Qualitative Approaches......Page 390
3.4. Triangulation: Multiple Regression, Photographic Documentation, and Field Work/Participant Observation......Page 391
4.0. METHODOLOGICAL CHALLENGES IN URBAN PLANNING RESEARCH......Page 393
4.1. Economic Development......Page 394
4.2. Urban design......Page 396
5.0. FUTURE DIRECTIONS......Page 400
REFERENCES......Page 401
1.0. INTRODUCTION......Page 405
2.0. FRAMEWORKS FOR EXPOSURE ASSESSMENT 2.1. Concepts and Models of Human Exposure......Page 408
2.2. Approaches to Exposure Assessment......Page 410
3.2. Ecological Studies......Page 412
3.3. Cross-Sectional Studies......Page 415
3.4. Cohort Studies......Page 416
3.5. Case-Control Studies......Page 417
3.6. Intervention Studies......Page 418
4.0. CASE STUDIES 4.1. Airborne Particles and Morbidity and Mortality......Page 419
4.2. Inner City Asthma......Page 421
5.0. RISK ASSESSMENT......Page 426
REFERENCES......Page 427
1.0. INTRODUCTION......Page 432
1.1. An Urban Health Perspective: Focus on the Disadvantaged......Page 433
2.2. A Note on Terminology......Page 434
3.0. THE CONCEPT OF ECONOMIC ANALYSIS IN HEALTH CARE......Page 437
4.1. Strategies......Page 438
4.2. Costs......Page 439
4.4. Quality of Life Weights......Page 440
5.1. The Role of Modeling......Page 441
7.0. TECHNICAL AND ALLOCATIVE EFFICIENCY......Page 442
8.0. ALTERNATIVES TO COST EFFECTIVENESS ANALYSIS......Page 443
9.0. CONTROVERSIES IN COST EFFECTIVENESS ANALYSIS AND URBAN HEALTH 9.1. Does Cost Effectiveness Analysis Discriminate against the Disadvantaged?......Page 444
9.2. Are Cost Effectiveness Analyses Transferable from One Urban Center to Another?......Page 447
9.4. How Can Other Considerations, Particularly Those Relating to Health Equity, Be Combined with Cost Effectiveness Analysis by Decision Makers?......Page 449
10.0. CONCLUSION......Page 450
REFERENCES......Page 451
22. Integrative Chapter......Page 455
III - Practice......Page 457
1.0. INTRODUCTION......Page 458
2.0. FRAMING THE PROBLEM 2.1. Life in the Grid City......Page 460
3.0. COMMUNITY ORGANIZING IN URBAN NEIGHBORHOODS......Page 462
4.0. THE STRATEGY: INTERSECTION REPAIR 4.1. An Urban Intervention......Page 463
4.2. Community Outreach......Page 464
4.3. Design Process......Page 466
4.4. Permitting Process......Page 467
4.5. Construction Workshop......Page 468
5.0. A CASE STUDY: THE SUNNYSIDE PIAZZA 5.1. The Setting......Page 469
5.2. Placemaking......Page 470
5.3. Evaluation......Page 473
6.0. CONCLUSION......Page 474
REFERENCES......Page 475
1.0. INTRODUCTION......Page 478
2.3. Building as Product and Process......Page 480
3.0. ELEVEN PRINCIPLES OF THE WHO HEALTH CITIES PROJECT......Page 484
4.0. PREREQUISITES FOR APPLYING PRINCIPLE IN PRACTICE......Page 492
5.0. A NEW AGENDA FOR RESEARCHERS, PRACTITIONERS, AND POLICY MAKERS......Page 495
6.0. CONCLUSION......Page 496
REFERENCES......Page 497
1.0. INTRODUCTION......Page 501
2.0. THE CONNECTION BETWEEN THE BUILT ENVIRONMENT AND HEALTH......Page 502
3.0. THE BASIC LEGAL TOOLS......Page 503
4.1. Zoning and Land Use Laws......Page 504
4.2. Building Codes and Other Regulation of Structures......Page 505
4.3. Housing Policy......Page 506
4.4. Transportation......Page 507
4.5. Economic Incentives for Redevelopment......Page 509
4.7. Government Facilities......Page 510
5.0. PUBLIC HEATH AND LEGAL CHANGE......Page 512
REFERENCES......Page 513
STATUTES AND CASES......Page 517
2.0. KEY CONCEPTS IN URBAN HEALTH......Page 518
3.1. The Students......Page 520
3.2. The Teachers......Page 521
3.4. Special Programs in Urban Health......Page 522
3.5. Continuing Education......Page 523
4.2. Competencies for Urban Clinicians......Page 524
4.5. Competencies for Urban Health Researchers......Page 525
5.1. Universities and Professional Training Programs......Page 526
5.2. Centers or Institutes on Urban Health......Page 528
5.3. Collaboratives and Networks......Page 529
5.4. Accrediting Bodies......Page 530
5.5. Departments of Health......Page 531
6.0. ASSESSING URBAN HEALTH WORKFORCE AND EDUCATIONAL NEEDS......Page 532
REFERENCES......Page 533
1.0. INTRODUCTION......Page 536
2.1. Identify Public Health Needs and Affected Populations......Page 537
2.2. Promote Evidence-Based Interventions......Page 538
2.5. Advocate for Broader Social and Economic Change......Page 539
3.1. Strategies Directed at the Health Care Setting......Page 541
3.2. Strategies Directed at the Physical Environment......Page 545
3.3. Strategies Directed at the School Setting......Page 547
3.4. Strategies Directed at Communities with Greatest Need......Page 549
3.5. Strategies Directed at the Policy Environment......Page 552
REFERENCES......Page 553
1.0. INTRODUCTION......Page 557
2.0. HEALTH NEEDS OF DRUG USERS......Page 558
3.1. Social Obstacles......Page 559
4.0. MODELS OF HEALTH SERVICE DELIVERY......Page 560
4.2. Food Programs......Page 561
4.6. Peer Involvement......Page 562
6.0. INTEGRATION OF CLINICAL SERVICES......Page 563
7.2. Sentinel Disease Surveillance......Page 564
8.0. CONCLUSION......Page 565
REFERENCES......Page 566
29. Integrative Chapter......Page 569
Index......Page 571