Areas Of Law That Shape Our Cities

The forms or techniques of legal intervention described above are not unique to cities or the built environment. However, these techniques are reflected in numerous laws and government policies that affect the built environment and physical shape of our urban centers. The following section explores the specific areas of law that are most significant in shaping our cities. In many of these areas, the relevant laws are promulgated at the state or local level and there are significant variations...

Cities Are Complex and Multiple Competing Influences May Be Important Determinants of Health

As discussed in several chapters in this book, cities are complex communities of heterogeneous individuals and multiple factors may be important determinants of population health in cities. For example, in order to understand the role that racial ethnic heterogeneity plays in shaping the health of urban populations, it is important to understand both the role of segregation in restricting access to resources in urban neighborhoods (Acevedo-Garcia, et al., 2003) and the potential for greater...

Assessing Urban Poverty And Living Standards

The discussion thus far has been concerned with the organizing concepts of multilevel health research, the working assumption being that these concepts have broad applicability to urban populations in poor countries. Because the multilevel litera ture has been tilted so heavily toward developed-country urban research, much remains to be learned about applicability. In this and the next two sections of the chapter, we consider the empirical tools that have been developed for three key areas of...

F

Fair Housing Act of 1968, 48, 73 Falls, by older adults, 182, 183, 185 Family Medical Leave Act, 94 Fast food restaurants, 71, 164 Fat, dietary, 216-217 Fecal occult blood testing, 111 Federal-Aid Highway Act, 510 Federal Housing Act of 1954, 508 Federal Housing Authority, 365, 505, 509 Feeding tubes, 195 Female-headed households, poverty levels of, 44, 45 Filariasis, 482-483 Filipinos, tuberculosis in, 107 Firearms as pediatric injury cause, 163 as suicide method, 113, 166 Firm clustering, 368...

Interviews and Qualitative Approaches

Forsyth (2002), in an article entitled Planning Lessons From Three U.S. New Towns of the 1960s and 1970s Irvine, Columbia, and The Woodlands, examined these three master-planned communities to determine the degree to which private sector experiments in design and development could effectively limit sprawl, support and enhance diversity, and facilitate sustainability. Using our urban planning themes, this study tackles the themes of economic development, urban design, equity and social justice,...

T

Take Care New York initiative, 544-548 Tax incentives, 505 for housing, 508 Technical efficiency, 441 Temporary Aid to Needy Families (TANF), 27-28, 36, 57 Tenement House Act, 507 Third age, 193 Tibetan immigrants, tuberculosis in, 106-107 Time-series analysis, 411-413 of airborne particle exposure, 418 Tobacco products availability in urban areas, 158 sale to minors, 556 Tobacco use. See also Smoking among sexual minority group members, 92 Tokyo, Japan homelessness in, 20 World Cities Project...

Info

Note Physical functioning activities are walking a quarter of a mile, walking up ten steps, standing for two hours, sitting for two hours, crouching kneeling, reaching over the head, reaching out, using fingers to grasp, lifting ten pounds. Unable indicates unable to perform alone and without aids. Figure 5. Percentage of Persons Age 70 and Over Who Are Unable to Perform Any One of Nine Physical Functions, by Sex and Race, 1995 (Sources Federal Interagency Forum on Age-Related statistics 2000...

Databases at Health Care Facilities

Databases at health care facilities provide a crude measure of health care uptake and are probably the best resources available. Databases have been used to assess STD prevalence, HIV prevalence and infective endocarditis. However, simply counting the number of individuals who present with a particular illness tends to underestimate the true scope of the problem. Of course, these types of observations are needed in order to launch more rigorous investigations. As existing electronic databases...

The Anthropologists Toolkit

Anthropologists use a wide variety of methods to study people within their cultural context. Anthropologists are perhaps best known for their use of participant observation in the process of doing ethnography. Participant observation is a research strategy in which the researcher spends an extended period in the research setting observing (in a number of different ways) actual day-to-day behaviors and practices (Schensul, et al., 1999). Prolonged engagement in the setting allows the observer to...

Experiential Learning

Educational research suggests that having the opportunity to practice skills and apply concepts to real world settings increase the likelihood that learning can be generalized to practice. To achieve this, many urban health training programs have designed experiential learning including service learning, internships, fieldwork and practicums. These experiences allow students to appreciate the complexity of urban communities, to interact with community residents and other professionals, to apply...

What Is Epidemiology And What Role Can It Play In Urban Health Research

Epidemiology is derived from the Medieval Latin term epidemia, meaning an epidemic, and reflects the origins of epidemiology as the discipline concerned with tracking and controlling disease epidemics. Modern epidemiology has expanded its scope and many definitions for epidemiology have been suggested, some at odds with one another (Swinton, 2004). Most epidemiologists might characterize their discipline as the study of the distribution of disease and of the causes (or determinants) of that...

What Is A City And What Is Urban Health

We all know what cities are or at least we think we do. However, it is more likely that each of our personal experiences has shaped what we think of when we discuss cities and that each of us has a different image of city in our own head. We may be in good company. Saul Bellow, the novelist and Nobel Prize laureate, in discussing how Americans think of New York City, suggested That is perhaps like asking how Scotsmen feel about the Loch Ness monster. It is our legendary phenomenon, our great...

Ahmed M Bayoumi 30 The Concept Of Economic Analysis In Health Care

A tenet of economics is that resources are scarce relative to wants (Drummond, et al., 1987). That is, there will never be enough money available to pay for everything. Accordingly, decision makers require some guidance in how to optimally allocate resources in order to maximize well-being. Consider, for example, two different antiretroviral regimens to prevent transmission of HIV from pregnant women to their fetuses. If the regimens are equally effective but differ in costs, a rational...

Springer

Library of Congress Cataloging-in-Publication Data Handbook of urban health populations, methods, and practice edited by Sandro Galea, David Vlahov. p. cm. Includes bibliographical references and index. ISBN 0-387-23994-4 1. Urban health-Handbooks, manuals, etc. I. Galea, Sandro. II. Vlahov, David. ISBN-10 0-387-23994-4 Printed on acid-free paper. ISBN-13 978-0387-23994-1 2005 Springer Science+ Business Media, Inc. All rights reserved. This work may not be translated or copied in whole or in...

Some More Terminology For Group Level Samples

We have so far presented a simple picture of neighborhood group level effects which in fact may be largely adequate for group based interventions but not for large neighborhood based surveys. While the full details of very complicated Neighborhood Level sampling are beyond the scope of this introductory chapter, the reader may encounter these in designing or reading neighborhood studies. These include Clusters, Strata and Weights. Clusters is another name that is commonly used to denote what...

Working but Struggling Earning a Living Wage

Having an annual income above a poverty level wage is no guarantee that families can make ends meet. Increasingly, there is focus on levels of income needed for economic sufficiency or a 'living' wage (Boushey, et al. 2001 Sklar, et al., 2001 Mishel, et al., 2003). While this wage varies substantially by region of the country, the range is between 6.25 and 12.00 dollars per hour. While not recognized by the federal government as having unacceptably low incomes, the struggles to provide for...

Community Ratings of Quality of Life

Who should provide quality of life weights for use in cost effectiveness analyses From an urban health perspective, the recommendation that community ratings be used raises two significant concerns. First, some health situations may be insufficiently familiar to members of the general population (Froberg and Kane, 1989a). Thus, editing and misinformation biases may result in respondents not truly evaluating the intervention of interest, but rather their (mis)interpretation thereof. For example,...

Conclusion

Cost effectiveness analysis is the principal method for examining the efficiency of health interventions, with both widespread acceptance and official sanction from a number of governmental agencies. Although some have criticized such analyses as a means on which to base decisions, three important caveats to the use of CEA are necessary. First, such analyses are models that attempt to estimate efficiency, but the application of such analyses should always question the models assumptions to...

Evaluation of Urban Health Competencies

Evaluation of educational programs enables faculty, administrators, student and employers to determine whether the identified competencies have been achieved. While traditional evaluation methods of testing and writing papers are often used, other approaches deserve consideration. Some academic programs have introduced capstone projects that require students to synthesize knowledge and competencies and to demonstrate mastery of critical skills. Others have employed a portfolio approach, in...

Health And Disease

Immigrants are affected by both communicable disease and chronic disease. They may bring these illnesses and disorders with them, or they may acquire them subsequent to their arrival in the U.S. This section focuses on those diseases that are highly prevalent among various immigrant groups in urban areas of the U.S. and that have been the focus of research. The incidence and prevalence of these diseases are discussed, as well as potential risk factors for their occurrence and the availability...

Putting Everything Together for Complex Surveys

As indicated earlier, urban surveys can be conducted using multilevel strata and cluster sampling along with weights. It is statistically possible to simultaneously adjust for all of the effects from each of these components provided the correct sampling design is specified in the analysis. Either robust covariance methods or mixed models can be used. However, when the outcomes are are binary or survival (censored time to event) robust covariance models are better (Diggle, et al,. 1994 Shah, et...

Cognitive and Experiential Requirements of Utility Surveys

For some outcome measures, providing utility ratings may be cognitively or emotionally challenging. The utility elicitation methods with the strongest theoretical bases require individuals to consider scenarios in which they must trade off a chance of death or future survival. Individuals who have a hard time understanding such scenarios, or find them too psychologically disturbing, may give responses that are systematically too high (reflecting an unwillingness to accept the trade off, for...

Analyzing The Results

The incremental cost effectiveness ratio (ICER) will estimate the amount needed for a gain in one unit of health effect. But what constitutes an attractive ICER No consensus exists on the appropriate threshold at which an intervention stops being cost effective, although many decision makers consider interventions with a cost-effectiveness ratio of greater than 50,000 to 100,000 per quality adjusted life year (QALY) to be economically unattractive for interventions when analyzed from the...

Introduction

Improving the health of urban populations requires a workforce of practitioners, managers, researchers and policy makers with the requisite knowledge and skills. In this chapter, we consider the education of urban health professionals, defined here as practitioners, public health staff, advocates, managers and researchers working to improve the health of urban populations. Our review begins with an examination of the unique characteristics of urban health and its key principles, then, discusses...

Structural Barriers To Care

An analysis of data from the 1989 and 1990 National Health Interview Surveys and the 1989 Insurance and 1990 Family Resource Supplements found that, compared to native-born residents, foreign-born residents of the U.S. were more likely to be uninsured, less likely to have private insurance or Medicare, and somewhat more likely to have Medicaid (Thamer and Rinehart, 1998). Subsequent legal reforms at both the state and federal levels may have impacted even further immigrants' ability to obtain...

Building as Product and Process

In order to direct the debate between scientists, practitioners and policy decision makers about building health cities, some conceptual clarification is required (Lawrence, 1993). First, it is necessary to distinguish between building as a product (that is the analysis of the built environment as the physical outcome of decisions about how to accommodate human life in cities) and building as process (by referring to the multiple sets of processes that occur in cities and between cities and...

Health Burdens Experienced By Economically And Socially Deprived Urban Populations

Studies of individual and population health for those living in urban areas have consistently demonstrated the variation in health status by context, race, income, and gender. While patterns of disparity differ for various outcomes, a consistent relationship of increased morbidity and mortality has been observed for economically disad-vantaged urban populations compared to their less deprived counterparts for outcomes such as cardiovascular disease, homicide, mental health, asthma, and...

Secondhand Smoke

Among indoor pollutants, secondhand smoke (SHS) is closely linked with increased childhood asthma morbidity (Ehrlich, et al., 1992). There are various methods for assessing SHS exposure in the home microenvironment, each with their advantages and disadvantages (Jaakkola and Jaakkola, 2002). Most commonly, exposure is estimated indirectly, employing time-activity information with questionnaire data (Leaderer, 1990) (Klepeis, 1999a Klepeis, 1999b Klepeis, et al., 2001). Parents caregivers are...

V

Vancouver, British Columbia drug enforcement in, 143 drug treatment programs, 565 food programs, 566 homeless shelter beds per capita in, 26 street-nurse program in, 567 Supervised Injection Site, 567 Vancouver Injection Drug Users Study (VIDUS), 569 Vascular disease, as dementia cause, 183, 185 Verticality, of cities, 482 Veterans, homeless, 22 Veterans Health Administration, services for of older adults, 186 of street youth, 21 of transgender people, 87 Vietnamese immigrants and refugees, 104...

Urban Residential Planning And Health

In the absence of zoning and subdivision regulations, city growth and expansion occur through the informal land development process led by the land brokers. The process is neither logical nor orderly. People first purchase land on an urban fringe, build houses and then attempt to bring in basic services and infrastructure. They do this through the uncoordinated individual decisions and, parcel by parcel development of land. This has resulted in erratic patterns of street layout, often causing...

References

Active Living Research Web Site, 2004, San Diego, CA (June 11, 2004) http www.activelivingresearch.org. AICP (American Planning Association, American Institute of Certified Planners website), 2004, Washington D.C., (May 22, 2004) www.planning.org aicp. Arnstein, S.R. (1969). A Ladder of Citizen Participation. J.Am. Inst. Plann. 35 216-244. Banerjee, T. (2001). The Future of Public Space Beyond Invented Streets and Reinvented Places. J. Am. Plann. Assoc. 67(1) 9-24. Basolo, M.V. (1999). The...

How Cities Affect Lgbt Health

Research has focused on understanding the health disparities among urban populations, though parsing out the ways in which urban life contributes to or ameliorates risk behavior and or poor health outcomes of specific populations has proven complicated (e.g., House, et al., 2000 Baquet, et al., 2002 Schulz, et al., 2002). We are aware of no studies that specifically address how urban characteristics affect the health of LGBT people. While most studies of LGBT health have used urban samples,...

Statutes And Cases

Clean Air Act, 42 U.S.C. 7401 et seq. Clean Water Act, 33 U.S.C. 1251 et seq. Comprehensive Environmental Response, Compensation, and Liability Act of 1980, 42 U.S.C. 9601 et seq. Moderately Priced Dwelling Unit Ordinance, Montgomery County Code, Md., Chapter 25A. Safe Drinking Water Act, 42 U.S.C. 300(f) et seq. Solid Waste Disposal Resource Conservation and Recovery Act, 42 U.S.C. 6901 et seq. Toxic Substances Control Act, 15 U.S.C. 2661-2671. Berman v. Parker, 348 U.S. 26 (1954) Kelo v. City...

Future Directions

At a time of budget cutbacks, the DPHOs offer a framework for targeting scarce DOHMH community outreach resources to New York's most vulnerable communities. The DPHOs, though, are not wholly responsible for these highest-risk populations they are rightly the responsibility of every program in the DOHMH, with the DPHOs assuming a coordinating role. Also, policy and regulatory efforts, which can be enormously effective in improving the health of large numbers of people, necessarily occur at a...

Health Services

To expand beyond the first aid function that a walk-in service offers, the program targets two important conditions that can be effectively addressed in schools asthma and impaired vision. To better manage asthma, nurses are being trained to assess asthma severity and appropriateness of medication, so that when appropriate, they can advocate for regimen review to both the parent and the child's physician. To better identify those with impaired vision and especially those at risk for amblyopia,...

Pedagogical Approaches To Teaching Urban Health

To prepare health professionals with the specific competencies needed to work effectively in cities requires the development of pedagogical methods suited to these aims. Pedagogy includes learners, students, academic settings, and the methods and content of teaching. We review here methods to recruit students and faculty particularly suited for this work, approaches to interdisciplinary teaching, experiential and service learning, and various formats for organizing urban health education. The...

Dominance

An intervention which results in lower net costs and enhanced health effects than an alternative strategy is deemed to dominate the alternative. However, the number of dominant interventions are relatively few (examples include prenatal care for pregnant women and some immunizations) (Tengs, et al., 1995). For non-dominant intervention, the decision maker must decide whether the incremental cost is low or high relative to the health effect that is, whether the intervention represents good value...

Race Ethnicity Culture and Access to Medical Services

Studies that focus on health care for inner city populations often document and explain the relationship between race, ethnicity and access to quality health care. Big cities often serve as the sites for this research because their populations are so diverse. These studies highlight significant barriers to access faced by racial and ethnic minorities (Andrulis, 2000 Garbers, et al., 2004 Kotchen, et al., 1998 Ray, et al., 1998 Seid, et al., 2003). What accounts for these persistent barriers to...

Urban Health Risks And Risk Factors

In keeping with this chapter's focus on social epidemiology, in what follows we highlight health risks for which this perspective might prove especially helpful. As is well known, social epidemiology conceives of several levels or structures of communica-bility, including the air-, water-, and food-borne transmission mechanisms featured in conventional epidemiology the spread of disease through sexual contacts and sexual networks as well as networks of injectable-drug users and the beneficial...

Monitoring Change Over Time

Little is yet known of the dynamics of poverty in the cities of developing countries. The study of change requires longitudinal data, and, as we discuss later in the chapter, such data are far from being common in the developing world. But longitudinal studies are now beginning to appear in greater numbers. Although the literature on poverty dynamics has been dominated by studies of rural areas thus far (for an introduction, see Baulch and Hoddinott, 2000), urban poverty dynamics are also...

Longitudinal Research in Slums

Many factors will need to be weighed in selecting the communities to serve as study sites. There are considerations of feasibility. In some communities an unfriendly political climate or social disorganization may preclude the possibility of identifying study participants and following them over time in other communities, the study population may be too mobile or simply too small in total to meet the research goals. (But because residential mobility is often of independent interest in...

Urban design

Methodological approaches in planning research related to urban design have been influenced primarily by architectural thought. This includes methods that focus on normative, or non-positivist approaches, descriptive research, typologies, and attempts to measure urban design in ways that are objective and reproducible. (Non-positivist approaches do not follow classical deductive logic, and so do not test hypotheses. Non-positivist approaches can include inductive case study methods or...

A

Proportion of Population in Urban Areas, by Region, 1950-2030 (Source Data from United Nations Department of Economic and Social Affairs Population Division. 2004 World Urbanization Prospects the 2003 Revision. Report No. ESA P WP.190 March 2004 ). physical environment, the social environment, and availability of and access to health and social services. We discuss each of these briefly here and refer the reader to other work that discusses each of these mechanisms in more detail...

Departments of Health

Urban departments of health are a primary consumer of the products of health educational programs, i.e., health professionals, and they are also the bodies accountable for the health of urban populations. Thus, they are key stakeholders in the development of the urban health workforce. To date, however, municipal health departments have not had a defined role or a strong voice in professional education. More often, their role has been limited to providing internships, sponsoring continuing...

Anthropology Uses a Combination of Emic and Etic Perspectives

Anthropologists investigate cultural phenomena from the point of view of an external observer (an etic perspective) and from the point of view of individuals who live within the culture (an emic perspective). Since the time of Bronislaw Malinowski in the early 20th century, anthropologists have been aware of the fact that experts who study a culture may or may not have the same view about the culture as do individuals who live in that culture. This may be evident in particular in studies of...

Food Programs

Food programs offer an excellent point of contact and can attract people who may not otherwise attend health clinics. Along with a nutritional meal, participants have the opportunity to connect with health care professionals in a casual setting. Many meal programs have participants who attend on a regular basis. This provides an opportunity to develop trusting relationships between participants and health workers. For the regular attendees there is an opportunity to dispense medications. In...

Government Facilities

A final set of laws and policies that impact both the physical environments of our urban areas and the health of urban populations are the decisions governments make about what government infrastructure and facilities will be provided and where and how these are built. In addition to roads and transportation systems, discussed above, governments provide parks and recreation facilities, as well as schools, libraries, and numerous government offices. When these facilities are well designed and...

New Departures

Drake and Cayton's (1993) research did not immediately reorient urban sociology, but in time it did lead to new departures. Their legacy was picked up and carried forward by others including, most prominently, Elijah Anderson (1978 1990) and William Julius Wilson (1987 1996). Anderson spent years doing field work, observing life in bars, shops, and street corners in the most troubled areas of the black community. His vivid ethnographies of black urban life are compelling sociological...

The Incremental Cost Effectiveness Ratio ICER

The results of a cost effectiveness analysis are typically expressed as an incremental cost effectiveness ratio (ICER). Mathematically, the incremental cost effectiveness of a program, designated B, relative to another program, designated A, is calculated as Note that the costs and effects are net values that is, they reflect both expenditures and savings in the cases of costs and gains and losses in the case of health effects. Thus, the ICER is the cost of obtaining one extra unit of health...

Nutrition

As the process of globalization occurs, so too does urbanization. Though the exact relationship may not be clear, it is obvious that these are related events. With globalization comes increasing 'modernization' of diets in large urban settings (Sobal, 1999). Modernization of global diets towards a Western model of eating is more common in cities around the world than it is in more rural, outlying areas. Therefore, although food may be highly available, it is also more processed, creating food...

The Benefits of Longitudinal Designs

The advantages of longitudinal approaches to health research are well understood, and we need only briefly restate them here. First, longitudinal designs allow the temporal ordering of behavior, exposure to risks, and health outcomes to be established. For instance, the benefits of vaccination for child survival can be traced from the point when a particular child receives the vaccine. During the course of follow-up, a host of time-varying factors may come to impinge on the child's health...

Trauma and Injuries

Trauma and injuries are significant hazards associated with life on the street (Staats, et al., 2002). In a sample of homeless and marginally housed people in San Francisco, 32 of the women and 27 of the men had been sexually or physically assaulted in the last year (Kushel, et al., 2003). Among women, being homeless (compared to being marginally housed) was associated with a more than 3-fold increase in the risk of sexual assault. In Sydney, Australia, 58 of shelter residents reported...

And Power

We assume that the reader has some background on general power and sample size estimation and focus here on issues that are unique to Group Level Urban Studies. Most power estimation approaches have been developed for the simpler settings of group clinical trials where the studies can be controlled and made more balanced (Raab, 2001). While power estimation methods will become more advanced with time, to date only some approaches exist to estimate power sample size for complex Group Level...

Urban Population And Health

Nepal is primarily a rural nation but is rapidly urbanizing. Nepal's average annual growth rate of the urban population is 6.65 compared to the national population growth rate of 2.25 (Population Census 2001 2002). At present, there are 58 municipalities, and a total urban population of 3.28 million urban residents or 13.9 of the national population. Should this trend continue, half of the population of Nepal will be living in urban areas by the year 2035 (Asian Development Bank, 2000). About...

Identifying Slum Communities

The maps provided by government agencies do not always depict the geographic extent of slum communities with any accuracy indeed, in some cases these maps would appear to suffer from systematic omissions. As Parker, et al., (2003, p23) describe their experience in identifying slums in Uttar Pradesh, The most significant and serious urban disadvantages were encountered in settlements whose existence is not recognized by government. Many of these settlements are vast and have been in existence...

The Health Of Urban Populations

Why then should we concern ourselves with cities and their relationship to population health In some ways, having established that cities are the predominant circumstance of living in the twenty-first century one can argue that cities are ubiquitous, and their impact so pervasive, that it is difficult to consider any aspect of health without thinking of the role of cities. Arguably, multiple academic disciplines produce research that is essentially premised on the existence and the importance...

Urban Studies And Health Services Research

As Scott Greer (1983) observed over two decades ago, What is striking to those who have been immersed in urban studies and then have become interested in the social response to health and ill health is the extreme segregation of the two areas of inquiry. From the heyday of 19th century European public health movements which focused on the importance of sanitation (clean water supply, sewers and garbage disposal) and improvements in housing conditions, to twentieth century interventions aimed at...

Group Intervention

An intervention is delivered to an entire neighborhood or perhaps more often to a Teaching Group of persons that initially were unrelated prior to the intervention (Cornfield, 1978 Hoover, 2002b). Independently of the intervention, the group itself may exert some effect on the outcome and or the intervention may be delivered with differing effectiveness to different groups. For example (since it costs too much to treat each person one on one) an alcohol cessation program is delivered to classes...

Randomized Experiments

There is evidence on the preceding question that responds to Mayer and Jencks' challenge to correct selection bias by randomly assigning families to particular neighborhoods. Five cities are engaged in applying a scientifically valid, randomized experiment on poor people, their choice of residence, and their behavioral and health outcomes. Sponsored by the U.S. Department of Housing and Urban Development, and begun during the Clinton years, these programs help science to progress, even if at...

Quality Adjusted Life Years QALYs

QALYs are calculated by dividing the expected survival into discrete life states, assigning a quality of life weight to each health state, multiplying the quality of life weight of each state by the duration of time spent in the state, and summing across all health states (Zaric, et al., 2000 Carr-Hill, 1989). Consider a hypothetical 35-year-old HIV-positive woman who is projected to live for 12 years before developing acquired immune deficiency syndrome (AIDS) and 5 years afterwards. Although...

Approaches to Exposure Assessment

The exposures of urban populations to pollutants may be measured with the goal of characterizing the distribution of exposures and determining those factors that lead to exposure, particularly those exposures above limits of acceptability. They may also be measured in support of epidemiological studies. Depending on the purpose, approaches range in intensity from making detailed and sometimes sophisticated measurements to characterize individual exposures to classifying exposures of large...

Governance

Governance refers in general to the idea that governing in many places and at many scales has moved from predominantly public sector government policies and methods, to mechanisms that feature a greater reliance on the nonprofit charitable sectors, on the voluntary sector, and on individuals and communities for providing and sustaining social and community programs. There has been for example in the U.S. at the local level more reliance on parents to provide time and material resources for...

Needle Exchange Programs NEPs

NEPs are very effective as points of contact for marginalized individuals who are using injection drugs. Although most NEPs are designed to be hassle-free and provide a quick exchange, they can also serve to direct participants to health care professionals. Some NEPs are affiliated with health care facilities that can provide rapid access to care if the staff are able to identify clients in need of attention as well as offer important interventions (Stein, et al., 2002 Stein, et al., 2002a...

Economic Development Planning

The first theme that guides a great deal of urban planning is economic development. Broadly defined, this theme includes transportation, housing, and community economic development, and is primarily concerned with the economic vitality of communities, cities, counties, regions, and states. From an urban health perspective, on the one hand, an economic development strategy for investigating urban health might consist of linking urban health disparities with maldistributions of wealth and...

Social Obstacles

Perhaps the most troubling obstacle for drug users seeking treatment is that, historically, the response to drug addiction in North America has been one of law enforcement. Addiction is seen as a criminal issue rather than a health issue. Accordingly, drug users may be reluctant to seek medical services because they fear criminal repercussions to their actions and there is evidence that police presence may reduce the willingness of drug users to access available health services (Wood, et al.,...

Get Checked for Cancer

Each year more than 1,500 New Yorkers die of colon cancer, more than 1,200 New York City women die of breast cancer and more than 150 die of cervical cancer (New York City Department of Health and Mental Hygiene, 2004b). Only half of New Yorkers age 50 and older report ever having undergone colon cancer screening via sigmoidoscopy or colonoscopy. One in four women aged 40 and older has not had a mammogram in the past two years, and one in seven women report never having had a Pap smear. Colon...

Structural And Policy Factors Creating Economic Deprivation In Urban Environments

Social Factor Urbinasitation

A conceptual framework describing how urban environments affect the health of economically deprived populations is useful for identifying determinants of, and solutions to, poorer health among this group (Heyman, 2000 Krieger, 2001). The poverty and economic deprivation noted in the earlier sections of this chapter are the consequences of historical economic, social, and political processes that have contributed to the unequal development of urban areas and to the economic and racial...

Precursors

The notion that urban life is a source of risk both physical and social has a long history to it (Boyer, 1978). Early examples include W.E.B. Du Bois' 1896 study, Philadelphia Negro, which discussed the bad sanitary conditions and death rate in the Seventh Ward (1978). One year later, Emile Durkheim (1951) published the discovery that suicide rates vary in relation to the density and intensity of group ties, as well as between urban and rural areas. And in 1903, Georg Simmel (1997) wrote an...

Human Variation

Humans are enormously varied in their appearance, their social systems, and their cultures. It is important to understand human variation and to appreciate the enormous disparities we see in rates of illness among population groups (Panel on DHHS Collection of Race and Ethnicity Data, 2004). In the context of human variation, people are also subject to uneven distribution of resources and stressors in their environments that can lead to health disparities. There are numerous levels at which...

Sentinel Disease Surveillance

Sentinel disease surveillance gives an indication of the burden of disease within the population. Examples of this include standardized surveillance programs for STDs, HIV, tuberculosis and overdose deaths. This type of analysis can show trends of disease burden over time. Therefore, correlations can be made between these trends and specific health care interventions to determine their impact. This type of data collection can be limited by a failure to access some of the higher risk groups.

A Case Study The Sunnyside Piazza 51 The Setting

In 2000, the Sunnyside Neighborhood in Portland, OR was plagued by a variety of problems, including a large transient population, social disorder, street litter, noise, and parking violations. The neighborhood, laid out on the grid network (Figure 1), was composed of 65 renters, low to moderate income, and predominantly white residents. A local church offered free dinners on Wednesdays and Fridays to the homeless population of Portland. The neighborhood was exposed to an onslaught of...

How Can Other Considerations Particularly Those Relating to Health Equity Be Combined with Cost Effectiveness Analysis

Most applications of cost effectiveness analysis focus only on efficiency and neglect equity implications associated with the distribution of changes in health and wealth. That is, there is no attention paid to how widely the health effects are distributed. While what gain matters, who gains may matter as much or more (Culyer, 2001 Ubel, et al, 1996 Holm, 1998 Culyer and Wagstaff, 1993). To illustrate, consider three interventions (A, B, and C), each associated with an increase of 200 QALYs...

Contextual Settings And Analyses Of Interest

Predictor or exposure variables of interest for a study can occur either at the Group (or Neighborhood) Level, the Individual Level, or both. For Group Level exposures, all persons in the same group share the same value for that exposure while Individual Level exposures can vary among different people in the same Group. For example let the question of interest be whether the ratio of the number of policemen to people in a neighborhood is associated with that neighborhood's members level of fear...

Examples Of Urban Planning Research

In this section, we select studies by urban planners that illustrate the variety of ways that these various themes have been used. These studies by no means comprise a comprehensive literature review, but instead indicate possible means to bridge the divide between urban health and urban planning. Varying methods were used in these studies, as are used throughout planning research. In this section, we aim to highlight not only the variation in substantive focus (as organized using the themes...

S

Safe Kids Healthy Neighborhood Coalition project, 163 Safety-net providers, in health care, 298-299, 301 San Diego County, California, immigrant population in, 104 San Francisco, California drug overdose-related mortalities in, 134 homeless population, 21, 22 chronic obstructive pulmonary disease among, 23 sexual or physical assaults on, 23 immigrant population, 104 sexually transmitted diseases among, 109 injection drug-related overdoses in, 31 same-sex couples in, 80 San Francisco AIDS...

Examples of Mixed Methods Research

Anthropologists are joining with colleagues in other disciplines to study urban health problems using mixed methods. For example, Brett, Heimendinger, Boender and colleagues (Brett, et al., 2002) conducted open-ended interviews with key informants to understand the social structural and cultural factors that affect regular exercise and good nutrition. These data were then used to develop and test, through quantitative means, an intervention to improve diet. Goldman and colleagues conducted...

Growth Of Cities Worldwide

At the beginning of the nineteenth century, only five percent of the world's population was living in urban areas. By 2003, about forty-eight percent of the world's population was living in urban areas (United Nations, 2004). By 2007 it is estimated that more than half the world's population will be living in urban areas and by 2030, up to sixty percent of the world's population will live in cities (Guidotti, et al., 2001 United Nations, 2004). Overall, the world's urban population is expected...

Note on Terminology

It is important to realize that the health economics literature, and more generally the field of health services research, tends to use the term cost effectiveness analysis in two distinct ways. The first terminology defines CEA as any analysis that calculates the incremental costs relative to a measure of incremental health effects, without consideration of the units with which the effects are measured. For example, this approach would include studies that calculate the cost to avert a case of...

Key Health Issues For Homeless People

The burden of illness and disease is extremely high among homeless people (Levy and O'Connell, 2004). However, any consideration of the common health problems of homeless people must first recognize the large degree of heterogeneity among people who are homeless. Among street youth, single men, single women, and mothers with children, the patterns of illness differ notably. Adolescents suffer from high rates of suicide attempts, sexually transmitted diseases, and pregnancy (Greene and Ringwalt,...

Sustainability and Urban Planning

A final prevailing theme among planners is sustainability. Sustainability focuses on the whole of an urban environment, including resource usage, waste and pollution, economic conditions, the physical and mental health of residents, and the institutions, organizations, natural resources, income endowments, human capital, and social capital that influence all of those systems. Sustainability has taken on an increasingly important role as planners attempt to address the multi-faceted issues of...

Obtaining Valid Hypothesis Tests

There are several instances where ordinary least squares regression will not yield unbiased or consistent estimates of the standard errors of coefficients, and in those cases t-statistics are not valid and so hypothesis tests can be misleading (e.g., cases where regression error terms are not independent and identically distributed). A range of techniques adapts and extends regression analyses to provide valid t-statistics in cases where the classical ordinary least squares assumptions do not...

Cultural Epidemiology

Although anthropologic and epidemiologic research are often complementary (Wiebel, 1988), historically, anthropology and epidemiology have had a somewhat contentious relationship (Trostle and Sommerfeld, 1996). On the surface, this is often attributed to a divergence in methods, but there are also fundamental differences in the types of questions each discipline asks. Both disciplines address the frequency and distribution of disease at the community or group level. Anthropologists, especially...

Quantitative Approaches

Boarnet and Crane (2001a 2001b) used quantitative approaches to study the link between urban design and travel behaviour. They used detailed data on individual travel patterns for portions of Los Angeles, Orange, and San Diego counties in California. In various econometric models, Boarnet and Crane (2001a and 2001b) regressed the number of non-work car trips made by individuals on the individual's sociodemographic characteristics (e.g. age, number of children, gender, and income) and measures...

The Disappearance of the Urban Black Middle and Working Classes

If that was not enough, an ironic rupture in the social fabric of urban black communities was provided by the exodus of black middle-class and working-class families from the city. Nationally, from 1970 to 1995 some seven million blacks moved into the suburbs (Freedman, 2004). Wilson's The Truly Disadvantaged (1987) drew attention to the disintegration of urban black communities caused by suburban pull. Middle-class and working-class black families with jobs were taking their skills and...

Health Disparities The Role Of Race Socioeconomic Status And The Urban Environment

Racial ethnic minority populations tend to have worse health outcomes than the white majority population. However, minority groups, specifically blacks and latinos, also tend to be over represented in the lowest stratum of education and income in our society. Therefore, poverty and racial ethnic minority status tend to cluster nationwide regardless of region and urbanization. This clustering refers to what has been coined by Williams J. Wilson as 'the concentration effects' or the concentration...

Integrative Chapter

The Health of Urban Populations The Editors The preceding ten chapters have each considered the health of a particular urban population, ranging from homeless persons to sexual minority groups, and through the use of Nepal as a case study, to persons in urban areas in developing countries. In this brief integrative chapter we do not aim to summarize what the authors of each chapter have already presented. Rather, we offer our synthesis of common elements that cross chapters, important...

Public Heath And Legal Change

The physical form of our cities has been and will continue to be significantly affected by laws and government policies. As Mark Gelfand has written, federal decisions about interest rates, taxes, military procurement, and scores of other economic matters had a direct and substantial impact upon nearly all facets of urban life (1975). In addition, state and local decisions about zoning, building codes, street design, transportation systems, parks, and schools, as well as policies concerning...

Analysis of Weighted Samples

When it is necessary to use weights to adjust for differential sampling and obtain overall population estimates, the relative weighting must be specified in the statistical analysis. For example, if Wi is the weight of the ith observation to adjust for its sampling probability, then the overall sample mean is Y WiYi Wi and the variance of this overall mean can be estimated by < 72 Wi(Yi- Y)2 W. Similar adjustments for weights are made for other procedures such as multivariate linear logistic...

Culture as a Stressor Cultural Products Pollution Noise

If we define environment broadly as the entire context of human experience - geographical, physical, social, and psychological aspects of life - then we can talk about culture as acting as an intermediary between humans and this environment. Culture may thus be viewed as both a product and a producer of the urban environment (Schell, 1997). Urban environments are at the crossroads of human physical and cultural variation and they encompass a great deal of economic and social difference....

Brief Portrait Of Urban Health

It is difficult to give any comprehensive account of urban health in the developing world that considers the full range of risks facing infants, children, adolescents, prime-age adults, and the elderly. Few developing countries possess reliable vital statistics systems, and much of what is known and statistically generalizable about health must therefore be drawn from sample surveys. Surveys are useful vehicles for the collection of all-cause data on infant and child mortality, to be sure, but...

QALYs and Discrimination

Another concern relating to the disadvantaged stems from the use of QALYs to measure health effects and individuals' potential for increasing quality of life or survival. Consider three individuals who are being considered for a given treatment. One is 40 years old and otherwise healthy, another is 30 years old with HIV infection with AIDS complications, and the third is 70 years old with some mild chronic medical problems. Although all may benefit from the treatment, the 40 year old has the...

Weighted Observations

Numbers that can be assigned to individuals to undo imbalances created either in stratified sampling or in the response rate are referred to as Weights. For some statistical analyses the weight is used to inversely adjust the observation relative to the increased chance to be in the sample. In the previous example where the race-stratified sample was deliberately evenly split into 200 Republicans and 200 Democrats, suppose that the overall population of the city this came from was 100,000...

Design Process

Following these meetings, interested neighborhood groups receive a request for proposals (Figure 2 RFP step 4) and are asked to provide information about their motivation to initiate such a project, the depth of neighborhood participation, and their vision. From the pool of these applications, sites are selected (Figure 2 step 5) for formal development. As a result of the community outreach, a core group of residents is formed in these neighborhoods. The neighborhood core group serves as...

Urban Social Networks And Social Capital

This section is devoted to the tools needed to study social networks and social capital in developing-country cities. Large literatures mainly though not exclusively concerned with developed countries have considered social networks and capital, and we will not attempt to give a comprehensive account here. Fuller treatments are available in Panel of Urban Population Dynamics (2003), which explores the implications of social networks and capital for developing-country health and demographic...

Competencies For Urban Health Professionals

Defining an intellectual framework for urban health and developing appropriate pedagogical methods for teaching this framework set the stage for identifying specific competencies for urban health professionals. Some competencies are required for all categories of workers others are appropriate for particular groups such as clinicians, public health personnel, managers and researchers. Once again, the discussion here focuses on the competencies needed to address the urban context they supplement...

Urban Geography

The forces underlying the urban geography of homelessness are aptly described in the seminal work of Dear and Wolch (Dear, et al., 1987). They examined how dein-stitutionalization, rollbacks in entitlements to social assistance, and changes in the global economy in the late 1970s and early 1980s combined to create complex problems of poverty, inequality, and homelessness in North American cities that persist to this day. Dear and Wolch (1987) argued that these problems manifested themselves in...

Opiate Replacement Therapy

Opiate replacement therapy with methadone and buprenorphine has been shown to reduce the adverse health impacts associated with opiate addiction and to improve health outcomes (Barnett, et al., 2001 Zaric, Barnett, and Brandeau, 2000). The daily dispensing of methadone provides an opportunity for ongoing contact and relationship building and can be linked to ongoing medical care and monitoring. The dispensing of antiretroviral medications along with daily methadone is convenient and acceptable...

Children in Homeless Families

The health of children in homeless families has been the focus of relatively little research. Some but not all studies of these children have found an increased prevalence of behavioral and mental health problems compared to children in housed low-income families (Bassuk, et al., 1997 Vostanis, et al., 1998). Infectious diseases are a significant concern in these children (Ligon, 2000). Up to 40 of children in homeless families in New York City suffer from asthma, a rate six times higher than...

Peer Involvement

Peer involvement is an important and under-explored concept in health service delivery to marginalized populations. Many hard-to-reach individuals may only respond to peer contacts who have an intimate understanding of the obstacles to accessing health care. Successful collaboration with outreach teams has been developed in Vancouver, with a street-nurse program that includes past and present drug users. Similar outreach teams have also been used to attract and support a wide range of other...

The Students

The opening question for any educational program is, Who is in the classroom . No field of study exists in a vacuum and who gets trained in urban health influences practice and research as much as the content of the training. In the U.S. and most other nations, socioeconomic class, ethnicity and income (Educational Testing Service, 2004) limit access to higher and professional education. Acknowledging this reality, some health professional training programs have made special efforts to recruit...