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Urban medicine meaning


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Urban medicine meaning

  1. 1. Urban Medicine and Urban Health <ul><li>Chavanant Sumanasrethakul </li></ul><ul><li>Department of Preventive and Social Medicine </li></ul><ul><li>Faculty of Medicine Vajira Hospital </li></ul>
  2. 2. Urban
  3. 3. Operative meaning of Urban <ul><li>Municipal area? </li></ul><ul><li>City? </li></ul><ul><li>Megacity? </li></ul><ul><li>Metropolis? </li></ul>
  4. 4. No common universal definition for urban/rural areas or population <ul><li>Belarus </li></ul><ul><ul><li>Urban localities are human settlements that in accordance with legislation have the status of towns </li></ul></ul><ul><li>Canada </li></ul><ul><ul><li>Urban areas include all greater metropolitan areas (even though they contain some 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 kilometer based on the previous census population counts </li></ul></ul><ul><li>Dominic Republic </li></ul><ul><ul><li>Urban zones refer to areas in municipalities </li></ul></ul><ul><li>Estonia </li></ul><ul><ul><li>Urban areas include towns and townships, while rural areas include villages </li></ul></ul><ul><li>Libya </li></ul><ul><ul><li>Urban refers to every district of 50000 or more inhabitants </li></ul></ul><ul><li>Mexico </li></ul><ul><ul><li>Urban refers to localities with population over 2500. </li></ul></ul>http :// unstats . un . org / unsd / demographic / sconcerns / densurb / Defintion_of%20Urban . pdf
  5. 5. No common universal definition for urban/rural areas or population <ul><li>Sweden . </li></ul><ul><ul><li>Locality is a group of buildings normally not more than 200 meters apart from each other and having at least 200 inhabitants. In Sweden localities are defined as urban and all area outside the localities as rural. </li></ul></ul><ul><li>Thailand </li></ul><ul><ul><li>Urban refers to municipal areas </li></ul></ul><ul><li>Turkey </li></ul><ul><ul><li>Urban refers to settlements with population of 20001 and over. </li></ul></ul><ul><li>United Kingdom </li></ul><ul><ul><li>Urban refers to built up area with a population of more than approximately one thousand (1000) based on population as at 19991 </li></ul></ul><ul><li>United Stated of America </li></ul><ul><ul><li>Census Bureau-defined Urbanized Areas (UAs) are defined to represent human settlements with over 50,000 people. A UA is defined by Census Bureau as an “area consisting of a central place(s) and adjacent urban fringe that together have a minimum residential population of at least 50,000 people and generally an overall population density of at least 1,000 people per square mile of the land area. </li></ul></ul>http :// unstats . un . org / unsd / demographic / sconcerns / densurb / Defintion_of%20Urban . pdf
  6. 6. 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>
  7. 7. Analysis of “urban” definition <ul><li>105 countries based their urban data on administrative criteria, limiting it to the boundaries of state or provincial capitals, municipalities or other local jurisdictions; 83 use this as their sole method of distinguishing urban from rural. </li></ul><ul><li>100 countries define cities by population size or population density , with minimum concentrations ranging broadly, from 200 to 50000 inhabitants; 57 use this as their sole urban criterion. </li></ul><ul><li>25 countries specify economic characteristics as significant, though not exclusive, in defining cities-typically, the proportion of the labour force employed in non-agricultural activities </li></ul><ul><li>18 countries count the availability of urban infrastructure in their definitions, including the presence of paved streets, water supply systems, sewerage systems, or electric lighting. </li></ul><ul><li>25 countries provide no definition of “urban” at all </li></ul><ul><li>6 countries regard their entire population as urban </li></ul>http :// unstats . un . org / unsd / demographic / sconcerns / densurb / Defintion_of%20Urban . pdf http :// www . demographia . com / db - define . pdf
  8. 8. ราชบัณฑิตยสถาน <ul><li>เวชศาสตร์ [ เวดชะสาด ] [ น .] ชื่อตํารารักษาโรคแผนโบราณ , วิชาว่าด้วยการรักษาโรคโดยการใช้ยา </li></ul><ul><li>เวชกรรม [ น .] การรักษาโรค . </li></ul>
  9. 9. Oxford dictionary <ul><li>Medicine </li></ul><ul><ul><li>the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery). </li></ul></ul><ul><ul><li>a drug or other preparation for the treatment or prevention of disease </li></ul></ul>
  10. 10. WHO <ul><li>Health </li></ul><ul><ul><li>Wellbeing in biological, psychological, social and spiritual aspects </li></ul></ul>
  11. 11. Background of urban health and medicine from various organizations
  12. 12. Urban Medicine and Metropolitan Health 1st International Conference Berlin, September 19th, 2007 <ul><li>Urban areas attract poverty, and poverty creates sickness. </li></ul><ul><li>“ Urban Medicine ” refers to the patterns of disease that are found more often in major urban areas than elsewhere. HIV/AIDS, infectious diseases, or psychiatric illness in citizens of immigrant origin all require special provision of treatment. The contamination of drinking water supplies with antibiotics is one example of how medicine interacts with other areas of life in major urban areas. </li></ul>
  13. 13. College of Medicine at Chicago University of Illinois <ul><li>Unique medical school curriculum to prepare physician-leaders to serve urban communities. </li></ul><ul><li>Disparities in health outcomes based on gender, ethnic, and a number of socio-economic factors have been well documented, and are more likely to be encountered in diverse urban settings </li></ul><ul><li>Four general themes </li></ul><ul><ul><li>Community </li></ul></ul><ul><ul><li>Cross-Cultural Clinical Skills </li></ul></ul><ul><ul><li>Health Disparities  </li></ul></ul><ul><ul><li>Leadership and Advocacy </li></ul></ul>
  14. 14. UNC School of Medicine <ul><li>Describe heath disparities and challenges that urban underserved populations face </li></ul><ul><li>Diagnose and treat specific disease processes found in urban underserved populations including: HIV/AIDS, other STDs, mental illness, substance abuse and addiction. </li></ul><ul><li>Practice with an increased multicultural awareness and competence in the diverse population of a large metropolitan area (Charlotte) </li></ul><ul><li>Describe how family physicians develop relationships with community members/leaders and use techniques of primary care research to improve health care service to a diverse community </li></ul><ul><li>Identify and use community resources to improve the health of underserved populations </li></ul>
  15. 15. University of Wisconsin School of Medicine and Public Health <ul><li>Providing health care for urban populations and to reducing health disparities </li></ul><ul><li>Medical students in the Training in Urban Medicine and Public Health program will learn about: </li></ul><ul><ul><li>Challenges and rewards of providing health care in an urban setting </li></ul></ul><ul><ul><li>Health disparities </li></ul></ul><ul><ul><li>Accessing community resources </li></ul></ul><ul><ul><li>Enhancing cultural skills </li></ul></ul><ul><ul><li>Engaging with communities </li></ul></ul><ul><ul><li>Developing and implementing population-based health promotion projects </li></ul></ul>
  16. 16. Osaka City University <ul><li>Urban environmental </li></ul><ul><li>Industrial medicine </li></ul><ul><li>Public Health </li></ul><ul><li>Sport medicine </li></ul><ul><li>Medical Informatics </li></ul><ul><li>Legal medicine </li></ul><ul><li>Infectious disease </li></ul>
  17. 17. ISUH <ul><li>Facilitate the exchange of perspectives, research methods, and data on the study of diseases in urban areas. </li></ul><ul><li>Study the effects of urbanization on health </li></ul><ul><li>Evaluate and help develop programs that lessen urban health risks and promote well-being of people living in urban areas . </li></ul>
  18. 18. Knowledge Network for Urban Settings (KNUS) <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><ul><li>Urban poverty is not because of distance from infrastructure and services but from exclusion . </li></ul>
  19. 19. World Bank <ul><li>Urban health problems are not markedly different from those in rural area, but their solution are quite different </li></ul><ul><li>Urban health is based on core healthy cities principles of equity , intersectoral cooperation , community involvement and sustainability . </li></ul>
  20. 20. WHO on World Health Day 2010 <ul><li>Majority of population are living in urban with furthermore growing </li></ul><ul><li>More life and health threatening condition were founded in urban settings </li></ul><ul><li>Rapid and unplanned urbanization can have negative consequences for the health and safety </li></ul>
  21. 21. Condition of urban setting
  22. 22. Urban and rural populations of the world: 1950–2030 Department of Economic and Social Affairs, Population Division. World urbanization prospects: the 2005 revision. New York: United Nations, 2006.
  23. 23. Framework of urban health
  24. 24. Examples of special characteristics of populations in urban area <ul><li>Homeless people </li></ul><ul><li>Health of economically deprived populations in cities </li></ul><ul><li>Racial/ethnic minority and health: the role of urban environment </li></ul><ul><li>Sexual minority groups </li></ul><ul><li>Health and health access among urban immigrants </li></ul><ul><li>Urban environment, drug use, and health </li></ul><ul><li>The health of children in cities </li></ul><ul><li>Older adults </li></ul>
  25. 25. Health outcome Conceptual framework for Urban health KNUS Interventions
  26. 26. Factors influencing personal exposures in example of air pollution in urban environments KNUS
  27. 27. 5 disciplines of urban health (KNUS) <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>
  28. 28. 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>
  29. 29. 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>
  30. 30. 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>
  31. 31. 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>
  32. 32. 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>
  33. 33. <ul><li>A number of issues and interventions are identified and combined intervention package have been developed </li></ul><ul><li>EXAMPLE </li></ul>Combination of intervention for urban people Health and related health issues improvement for urban dwelling <ul><li>Low classes intervention A </li></ul><ul><li>Middle classes intervention B </li></ul><ul><li>High classes intervention C </li></ul>
  34. 34. <ul><li>“ Dealing with disparity in urbanize community for better health outcome” </li></ul>
  35. 35. Course for Urban Medicine <ul><li>Urban setting (Bangkok Metropolis) </li></ul><ul><li>Health and medicine related issues </li></ul><ul><li>Anthropological feature in urban </li></ul><ul><li>Diversity of economic, social status and cultural aspects </li></ul><ul><li>Accessibility to health care center according to GIS, service system </li></ul><ul><li>Special setting of health care service in Bangkok Metropolis (compare with those in provincial zone) </li></ul>
  36. 36. 19 departments in BKK <ul><ul><li>สำนักอนามัย  </li></ul></ul><ul><ul><li>สำนักสิ่งแวดล้อม  </li></ul></ul><ul><ul><li>สำนักวัฒนธรรม กีฬา และการท่องเที่ยว  </li></ul></ul><ul><ul><li>สำนักยุทธศาสตร์และประเมินผล  </li></ul></ul><ul><ul><li>สำนักพัฒนาสังคม  </li></ul></ul><ul><ul><li>สำนักผังเมือง  </li></ul></ul><ul><ul><li>สำนักป้องกันและบรรเทาสาธารณภัย  </li></ul></ul><ul><ul><li>สำนักงานคณะกรรมการข้าราชการ </li></ul></ul><ul><ul><li>สำนักงบประมาณกรุงเทพมหานคร </li></ul></ul><ul><ul><li>สำนักการศึกษา  </li></ul></ul><ul><ul><li>สำนักการระบายน้ำ  </li></ul></ul><ul><ul><li>สำนักการโยธา  </li></ul></ul><ul><ul><li>สำนักการจราจรและขนส่ง </li></ul></ul><ul><ul><li>สำนักปลัดกรุงเทพมหานคร  </li></ul></ul><ul><ul><li>สำนักเทศกิจ  </li></ul></ul><ul><ul><li>สำนักงานเลขานุการผู้ว่าราชการ </li></ul></ul><ul><ul><li>สำนักเลขานุการสภากรุงเทพมหานคร  </li></ul></ul><ul><ul><li>สำนักการคลัง </li></ul></ul><ul><ul><li>สำนักการแพทย์ </li></ul></ul>