Urban medicine


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  • Scientific knowledge offers frameworks for understanding how variables at different levels combine within cities to influence health and disease. Technical knowledge includes the ability to measure, assess and intervene effectively within the urban environment. Organizational knowledge yields the ability to make institutional decisions that change practices and policies, and build coalitions for urban health. Political knowledge produces the capacity to mobilize resources to achieve health objectives.
  • Urban medicine

    1. 1. Urban Medicine Chavanant Sumanasrethakul BMA Medical College and Vajira Hospital
    2. 2. Why do we need to understand urban health? <ul><li>“ The health of the urban poor is not better than their rural counterparts – and can be often be much worse .” </li></ul><ul><li>PIERCE 2007 </li></ul>
    3. 3. Urban health penalty <ul><li>Urban dwellers have the greater health problems and risk factors than suburbs and rural people. </li></ul><ul><li>Andrulis 1997 </li></ul>
    4. 4. Urban / Rural: Are they different? <ul><li>“ Urban health problems are not markedly different from those in rural area, but their solution are quite different ” </li></ul><ul><li>World Bank 2007 </li></ul>
    5. 5. Principles <ul><li>“ Urban health is based on core healthy cities principles of equity , intersectoral cooperation , community involvement and sustainability .” </li></ul><ul><li>World Bank 2007 </li></ul>
    6. 8. Urbanization <ul><li>Increases in </li></ul><ul><ul><li>Size </li></ul></ul><ul><ul><li>Density </li></ul></ul><ul><ul><li>Heterogeneity </li></ul></ul><ul><li>Associated changes in factors such as </li></ul><ul><ul><li>Population mobility </li></ul></ul><ul><ul><li>Industries </li></ul></ul><ul><ul><li>Deindustrialization </li></ul></ul><ul><ul><li>Social justice </li></ul></ul><ul><ul><li>Proximity of rich and poor </li></ul></ul><ul><li>Conjures negative image of </li></ul><ul><ul><li>Pollution </li></ul></ul><ul><ul><li>Crime </li></ul></ul><ul><ul><li>Poverty </li></ul></ul><ul><ul><li>anonymity </li></ul></ul>
    7. 9. เขตเมือง <ul><li>พระราชบัญญัติเทศบาล พ . ศ . ๒๔๙๖ มีเกณฑ์ในการพิจารณาพื้นที่เขตเมืองดังนี้ </li></ul><ul><li>จำนวนประชากรในท้องถิ่นนั้น ( มากกว่า๑๐๐๐๐ คนขึ้นไป ) </li></ul><ul><li>ความเจริญทางเศรษฐกิจของท้องถิ่น </li></ul><ul><li>ความสำคัญทางการเมือง และศักยภาพในการพัฒนา </li></ul>
    8. 10. Urban Medicine: Definition <ul><li>คำว่า “ Urban” ตาม Oxford Dictionary ให้ความหมายไว้ว่า “ เป็นสิ่งที่เกิดขึ้นในเมืองหรือเป็นลักษณะของเมือง ” (Occurring in or characteristic of city) </li></ul>
    9. 11. <ul><li>Urban health </li></ul><ul><li>หมายถึงการศึกษี่เก่ยวข้องกับสุขภาพของประชากรในเขตหรือชุมชนเมือง </li></ul><ul><li>Urban Medicine </li></ul><ul><li>หมายถึงเวชศาสตร์ที่เกี่ยวข้องกับปัญหาที่เกิดขึ้น ในชุมชนเมือง หรือปัญหาทางการแพทย์ ที่เป็นลักษณะเฉพาะของเขตหรือชุมชนเมือง </li></ul>
    10. 12. Characteristic of Cities <ul><li>Centralization </li></ul><ul><li>Verticality </li></ul><ul><li>Concentration </li></ul><ul><li>Diversity </li></ul><ul><ul><li>Social </li></ul></ul><ul><ul><li>Economic </li></ul></ul><ul><ul><li>Material </li></ul></ul><ul><li>Information and communication </li></ul><ul><li>Mechanization </li></ul><ul><li>Political authority </li></ul>
    11. 13. ความแตกต่างของชุมชนชนบท และชุมชนเมือง
    12. 14. 5 disciplines of urban health <ul><li>1 st : Complexity </li></ul><ul><li>2 nd : Diverse of population </li></ul><ul><li>3 rd : Unique assets and problems </li></ul><ul><li>4 th : Context matters </li></ul><ul><li>5 th : Solving problems skills </li></ul>
    13. 15. 1 st : Complexity <ul><li>Factors </li></ul><ul><ul><li>Political, social and economic factors </li></ul></ul><ul><li>Units </li></ul><ul><ul><li>Individual, family, community, municipal, regional, national and global levels </li></ul></ul><ul><li>Systems </li></ul><ul><ul><li>Health care, education, criminal justice, environmental protection, housing and employment </li></ul></ul><ul><li>Population density and heterogeneity </li></ul>
    14. 16. 2 nd : Diverse of population <ul><li>More immigrants, more ethnic and lifestyle variability, and greater disparities in socioeconomic status </li></ul><ul><li>Cultural and communications skills, the anthropological knowledge, and the epidemiological evidence </li></ul>
    15. 17. 3 rd : Unique assets and problems <ul><li>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. </li></ul><ul><li>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 </li></ul>
    16. 18. 4 th : Context matters <ul><li>Broader biological, social and political context </li></ul><ul><ul><li>Human biology </li></ul></ul><ul><ul><li>time (a historical perspective) </li></ul></ul><ul><ul><li>space (a geographical perspective) </li></ul></ul><ul><ul><li>culture (an anthropological perspective) </li></ul></ul><ul><ul><li>other factors </li></ul></ul><ul><li>influence the patterns of health and disease at the individual and populations levels </li></ul>
    17. 19. 5 th : Solving problems skills <ul><li>Scientific knowledge </li></ul><ul><li>Technical knowledge </li></ul><ul><li>Organizational knowledge </li></ul><ul><li>Political knowledge </li></ul>
    18. 20. Factor determining susceptibility in Urban population <ul><li>Age-related windows of vulnerability </li></ul><ul><li>Health status as a determinant of susceptibility </li></ul><ul><li>The role genetic factors </li></ul><ul><li>Gender related differential </li></ul><ul><li>Socioeconomic factors </li></ul>
    19. 21. Factors influencing personal exposures to air pollution in urban environments
    20. 22. Interventions Health outcome Conceptual framework for Urban health
    21. 23. <ul><li>A number of issues and interventions are identified and combined intervention package have been developed </li></ul><ul><li>Low classes intervention A </li></ul><ul><li>Middle classes intervention B </li></ul><ul><li>High classes intervention C </li></ul>Combination of intervention for urban people
    22. 24. Responses to Health Threats in Cities (health hazard in the city) <ul><li>HIV/AIDS, Tuberculosis, and Malaria </li></ul><ul><li>Other Communicable Diseases esp. emerging disease from animal </li></ul><ul><li>Non-communicable Diseases </li></ul><ul><li>Substance Use and Mental Health </li></ul><ul><li>Injuries, Road traffic and Urban Occupations </li></ul><ul><li>Air Quality and Other Environmental Health Threats </li></ul><ul><li>Violence </li></ul><ul><li>Innovative Methods and Measurements </li></ul><ul><li>Other </li></ul>
    23. 25. <ul><li>“ 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.” </li></ul><ul><li>KNUS MGDs (Millennium development goal) </li></ul>
    24. 26. <ul><li>“ 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.” </li></ul>KNUS 2008
    25. 27. <ul><li>“ Urban poverty is not because of distance from infrastructure and services but from exclusion .” </li></ul>KNUS 2008
    26. 28. <ul><li>“ Dealing with disparity in urbanize community” </li></ul>