What Is Urban Planning

Urban planning, also referred to as city planning, is an applied, multi- and interdisciplinary field that is concerned with the interaction between populations and the environments in which they live. Urban planners are employed in a variety of sectors (public, private, and nonprofit community based), and their tasks include the preservation of historic districts in downtown areas, the development of legislation that guarantees the reduction of environmental hazards in communities of color, and...

What Are the Budgetary and Allocative Implications of the Decisions

Most cost effectiveness analyses only report an incremental cost effectiveness ratio (ICER). Decision makers will ordinarily require at least two additional pieces of information before making a decision about allocating resources to the intervention under consideration. First, they will need to ascertain the budgetary implications of such a decision. Recall that two interventions can have the same ICER although one's incremental costs and effects are small and the others are large. Decision...

Uncertainty in Cost Effectiveness Analysis

Several aspects of a cost effectiveness analyses are often uncertain. For example, the precise values of some of the parameters in the analysis may be uncertain. Many models incorporate assumptions and extrapolations. U.S. guidelines recommend looking at three types of uncertainty (Gold, et al., 1996). Parameter uncertainty refers to examining how model results vary when parameter values are changed. Parameter uncertainty is best examined by performing sensitivity analysis, in which changing...

This Book

This book is intended to be one step toward the systematic study of urban health and a bridge between urban health inquiry and public health practice. As such, this book is divided into three sections. The first section discusses some specific populations in urban areas, providing both descriptions of their health status and discussions about the urban determinants of the health of these groups. It was the charge of the authors of these chapters to consider the health of specific populations in...

The World Cities Project Wcp An International Example Of Health Services Research On Cities

The World Cities Project (Rodwin and Gusmano, 2002 World Cities Project, 2004) compares health systems, health and quality of life in the four largest cities of the wealthy nations belonging to the OECD New York, London, Paris and Tokyo. These cities are surely among the best studied cities in the world. Our principal common units of analysis are their historic urban cores (Figure 1) but often studies extend to their surrounding first rings and greater metropolitan regions. What we have termed...

The Editors

The preceding six chapters in many ways are the most optimistic chapters of this book. These chapters offer practical examples of interventions that have been implemented in cities that have the potential to improve population health (ranging from city-wide efforts to local, small-scale interventions). They also present focused theoretic frameworks that can help guide our thinking about how we can conceive of, and implement interventions to improve urban health. These chapters then offer...

Statistical Analysis Of Group Level Studies

We present here the basic elements for statistical analyses of group level studies. The full range of possible analyses involving clusters, strata, weights and contextual settings is quite complicated. We thus give details for more simple designs and discuss their extensions. For more details there are several references such as Cochran (1977) and Korn and Graubard (1999). Continuous outcomes are the main focus in this presentation but equivalent procedures for binary and censored outcomes are...

Residential Mobility

High residential mobility rates stem from many factors common to slum living conditions, including difficulties in meeting rent payments, job loss, evictions, flooding, and the like. With such high rates of mobility, a sizeable number of residents live for only short durations in the community. Whether such short-term residents ought to be included in a longitudinal research database is not obvious. In the case of the Nairobi DSS, a three-month period of stay was taken to be the minimum spell...

Organization of the Chapter

In the sections of the chapter that follow, we examine the concepts and tools of multilevel health research with an eye to discovering how they may apply to the urban poor of the developing world. Households, Social Networks, and Neighborhoods (Section 2.0) is concerned with the theory, that is, with the micro-mechanisms of social interaction that influence individual health, taking effect through social networks, the organizational structures of neighborhoods, and the organizational and...

Multilevel Models

The government provided an opportunity for social science to verify the existence of neighborhood effects, but how can we study those effects without the powers of the state behind us Fortunately, the statistical sophistication of behavioral scientists has improved since the time of Mayer and Jencks' critique. It is now widely recognized that multilevel models can sort out the differences between compositional and contextual effects. The statistical logic of multilevel modeling was discussed in...

Mixed Methods Research

Urban health research requires a combination of epidemiologic observations, ecological characterization, and a description of the lived experience of individuals living in a given environment. This type of holistic description affords opportunities for measurement and analysis at the individual level, the community level, and the macrosocial level. Thus, urban health research can benefit from a mixed methods approach (Creswell, 1995 Tashakkori and Teddlie, 1998 Creswell, et al, 2003 Borkan,...

Introduction

Health services research is, by nature, multidisciplinary, for it draws on the methods, concepts, and theories of social sciences, which are relevant to the study of how the organization and financing of health services can improve the delivery of health care services (Gray, et al., 2003). While medicine and public health, too, are multi-disciplinary enterprises drawing on such disciplines as molecular biology, physiology, anatomy, genetics, epidemiology and more, health services research...

Intervention Studies

In intervention studies, the investigator controls the exposure status of study participants. The randomized clinical trial, which has the central elements of randomization to control and comparison arms, is generally used to evaluate the efficacy of therapeutic regimens, including drug therapies. A key strength of the randomized clinical trial is control of selection bias and confounding through randomization. The design has potential application to occupational and environmental exposures in...

Info

Household and Cluster Poverty Status (b) Sub-Saharan Africa surveys (n 13). Household and Cluster Poverty Status (c) Latin American surveys (n 11). Household Poor Household Poor Household Not Household Not Cluster Poor Cluster Not Cluster Poor Cluster Not Household Poor Household Poor Household Not Household Not Cluster Poor Cluster Not Cluster Poor Cluster Not Figure 3. Predicted Proportion of Births Attended by a Doctor, Nurse or Trained Midwife, by Household and Cluster Poverty (Source...

Inferring Causality

Because the data for many planning studies are non-experimental, moving from association to inferences about causality is a key focus of many regression studies. The most common approach is to explicitly model the determinants of endogenous variables by using simultaneous equations methods. An example is the recent work of Raphael and Rice (2002), who while not planners per se studied a question that touches on an economic development issue within planning does an individual's labour market...

Housing Policy

Adequate housing is one of the most basic human needs and since at least the 1930's, government has been actively involved in encouraging the creation of more housing. The largest government housing programs take the form of economic incentives that encourage housing construction and purchase, but these programs also include direct government provision of housing as well as the use of mandates. Today, the largest subsidy of housing is through the federal tax system. The total subsidy from...

Discounting

Discounting is an economic concept that reflects that people value future costs and health effects less than those that occur in the immediate future (Redelmeier and Heller, 1993). The rationale for discounting comes from the recognition that money invested today will be worth more in the future similarly, money borrowed today will be paid back at a higher value because of interest charged on the loan. For cost effectiveness analyses, where the tradeoff between money and health is being...

Cost Convenience andor Constraint Group Sampling

Sometimes people must be sampled by groups and are influenced by common group effects (even if those group effects are not of primary interest to the investigators). Suppose a city has 50 neighborhoods and each neighborhood has its own local medical care (i.e. doctors, clinics, etc.). A study to examine if there are underlying gender differences (male versus female) on opinions about the adequacy of medical care in that city is being conducted among 400 men and 400 women. But clearly the...

Competencies for Urban Clinicians

Physicians, nurses, dentists, psychologists, and other urban clinicians should be able to describe how different types and levels of exposure to urban living conditions affect well-being. Depending on their discipline and specialty area, they should also be able to explain how urban living influences the clinical course and management of common illnesses (e.g., asthma, depression, hypertension, diabetes, influenza), characterize significant disparities in health within urban populations, and...

Climate

Climate is an interesting example of a characteristic of the urban environment that affects both the prevalence of homelessness and the health of homeless people. Certain cities in warm regions may become a preferred destination for people who are homeless or at high risk for homelessness. As noted above, in cities with warmer climates, a larger proportion of the homeless population is likely to be found on the street rather than in shelters. People living on the street are more likely to be...

Centers or Institutes on Urban Health

Other universities have chosen to create institutes or centers on urban health. These organizations usually include researchers and sometimes practitioners from several disciplines, conduct research and service projects within urban settings, and often offer continuing education, academic courses, and fieldwork opportunities. Unlike academic departments, they usually do not offer degrees or academic tenure to their faculty. Often, they rely heavily on grants and contracts for financial support,...

Barriers To Health Care

Many of the health problems that affect LGBT people disproportionately result from or are exacerbated by prejudice, discrimination and stigma (Brotman, et al., 2002 Cahill, et al., 2002 Dean, et al., 2000 Diaz and Ayala, 2001 Meyer, 2001). In addition, such forces clearly play a role in LGBT people's willingness and ability to access health services as well as the quality of services they receive. These impediments can be rooted in the biases of providers, institutionalized in agency policies...

Assessing Urban Health Workforce And Educational Needs

The education of urban health professionals is shaped by the existing intellectual and conceptual frameworks for urban health, by the pedagogical approaches that educators employ and by the requirements of accrediting bodies and the structure of schools and programs of various disciplines. Another critical influence comes from assessments of workforce needs. In any given time and place, the content and structure of urban health workforce education results from the interactions of these...

Addressing Selectivity Bias

In what follows, we outline how selectivity biases can stem from the choices made by respondents whether in terms of migration, residential mobility, or group participation and discuss the statistical tools available to assess the importance of this bias and protect inference against it. Cross-sectional designs provide only a few such tools, whereas longitudinal data much expand the possibilities. The essence of the problem can be seen in a highly simplified depiction of locational choice. Let...

Minority Groups And The Urban Environment

As stated throughout this chapter, minorities are more likely to live in urban cities, where features of the urban environment either enhance or negatively affect health. Individuals' characteristics have been seen as the panacea to produce and promote positive health outcomes. However, individuals live and interact with their peers in urban areas under circumstances that provide an enhancing or damaging milieu for health. Therefore, it is important to understand how features of the social...

Special Populations Of Urban Lgbt People

In addition to a city's social environment, physical environment, and provision of health services, the composition, diversity and density of urban populations also play a role in the health of urban LGBT residents because they include sub-populations of LGBT people facing special health needs or barriers to care. For instance, census data suggest that individuals in same-sex couples are as racially diverse as the general U.S. population (Rubenstein, et al., 2003), and more than a quarter of...

Welfare Economic Theory

Other critics have raised questions about welfare economic theory as a basis for cost effectiveness analysis. While a full review of theory is available elsewhere, I restrict my comments here to considerations that are important for applying CEA to urban health. Welfare theory is a branch of economics that examines the desirability of alternative allocation of resources (Garber and Phelps, 1997 Brouwer and Koopmanschap, 2000). (It is not at all about welfare, financial assistance to...

Eleven Principles Of The Who Health Cities Project

The following section considers those basic principles underlying the building of healthy cities. It briefly presents the eleven principles that the World Health Organization has repeatedly presented in documentation about the WHO Healthy Cities project to characterise healthy cities (Goldstein, 2000 Tsouros, 1990). Each paragraph explains how these principles can be interpreted to construct healthy cities. The 11 principles of a healthy city are shown in Table 1. 1. The meeting of basic needs...

Monetized Measures of Poverty

Researchers investigating the determinants of urban health in the U.S. or Europe often take for granted the availability of income data for households and aggregated data on median incomes, rates of poverty, and the like for census tracts and other geographic entities. In developing countries, however, data such as these are seldom available in general, and are almost never available from censuses. In part this is because wage and salary work is far from being the dominant form of employment in...

Chronic Diseases

Common chronic diseases, including hypertension, diabetes, chronic obstructive pulmonary disease (COPD), seizures, and musculoskeletal disorders, are often undiagnosed or inadequately treated in homeless adults. Relatively little research has focused on these medical conditions in the homeless population. The prevalence of hypertension was higher among homeless clinic patients than among non-homeless patients at an inner-city primary care clinic (65 vs. 52 ) (Szerlip and Szerlip, 2002). The...

References

Advisory Council for the Elimination of Tuberculosis. (1992b). Prevention and control of tuberculosis among homeless persons. Recommendations of the Advisory Council for the Elimination of Tuberculosis. Morbidity & Mortality Weekly Report, Recommendations & Reports 4 13-23. Advisory Council for the Elimination of Tuberculosis (1992a). Prevention and control of tuberculosis among homeless persons. Recommendations of the Advisory Council for the Elimination of Tuberculosis. Morbidity &...

Specification of Research Question

Clear specification of a research question is the necessary first step in all etiologic and interventional epidemiologic research and is often one of the hardest. More specifically, the greatest challenge in the epidemiologic study of urban health is in adequate specification of research questions that address how and why urban living may affect health. There are three primary reasons why this task may be particularly challenging in urban health. First, much of what may be considered urban...

Community Organizing In Urban Neighborhoods

This particular intervention has been designed to enhance the urban core of American grid cities which tend to have been planned without any provisions of significant public gathering places. Community organizing in urban neighborhoods can reverse alienation and foster a sense of responsibility that counteracts urban blight it encourages residents to take initiative against social disorder and physical deterioration (Wilson, 1996). Neighborhood stewardship manifested in physical improvements of...

Equity and Social Justice in Planning

Equity and social justice constitutes another primary theme that guides planning practice and urban health. In terms of urban health, an equity and social justice perspective guiding urban planning research and practice would build on the health disparities approach to prioritize improved and expanded health care services to those individuals and populations experiencing the worst health outcomes and who are least able to pay for services, for example, low-income, elderly, racial ethnic...

Potential Strategies For Improving The Health Of People In Cities Of Nepal

The process of rapid urban growth is inevitable in Nepal but it should be harnessed in a planned way to ensure a safe urban environment as well as the health and well being of urban citizens. Therefore, health concerns should be the heart of urban planning and urban environmental management practices. Environmentally friendly urban planning and healthy city programs should be the key to planned development and management of urban growth. The Health Impact Assessment of urban policies, programs,...

The Urban Core as a Unit of Analysis

In contrast to studies of health system performance at the national level, comparison of world cities provides spatial boundaries within which to assemble local data on the characteristics of populations, the density of medical resources, the extent of health insurance coverage, and other neighborhood and health system characteristics. For this reason we defined an urban core for New York City, London, the Paris Region, and Tokyo Figure 1 . Our definition of the urban core was guided by five...

Case Control Studies

The case-control design has been used extensively to characterize occupational and environmental causes of cancer, but much less frequently for other diseases, and it has had limited application specifically to urban environmental health problems. The design has proved particularly useful for cancer, as there is often a lengthy period from the time of first exposure until excess risk is manifest. The cases and controls themselves are the principal source of information on exposure. Some...

Demography Of Lgbt People

The nature, composition and size of the gay community have been the subject of much debate. Indeed, whether or not LGBT people constitute a community at all is often questioned. And if such a community exists, how ought it be defined Is this a community that can be defined geographically or by its institutions and organizations Or is this an imagined community that exists, not in any spatial location, but in the sense of a shared affinity and common purpose Woolwine, 2000 Are its members...

Framing The Problem 21 Life in the Grid City

Most American towns and cities have been laid out with a grid pattern comprised of streets and side streets crossing at right angles Figure 1 . Such a simple network of orthogonal streets that intersect in a regular manner creates rectangular or square city blocks. The rationale of city planning to shape the urban environment with this pattern of vertical and horizontal streets lies in increased connectivity the possible routes between any given two points is maximized. Short of diagonal...

Residential Segregation And Gentrification

A major problem of urban cities is the residential segregation of minority groups, which leads to economic constraints, lack of social and material resources, and diminished social capital. Residential segregation results, in part, from two of the most dominant demographic trends in almost all cities in the U.S., suburbanization i.e., white flight and metropolitan deconcentration Browne, 2000 Immergluck, 2001 Massey and Denton, 1988 . Metropolitan deconcentration reflects the process of...

Programs for Special Populations

Since special populations - for example, ethnic minorities, poor immigrants, and injection drug using IDU populations are concentrated in cities, the urban health services research literature includes many studies of programs for these groups Solomon, et al., 1991 Juday, et al., 2003 . Such programs include those for people with tuberculosis and HIV AIDS Ryan White as well as needle exchange and other programs for IDU populations. Infectious diseases like hepatitis, tuberculosis, and HIV AIDS...

The Costs of Longitudinal Approaches

None of the advantages from longitudinal research comes without cost, especially if long durations of observation are needed to monitor the health outcomes of interest. Consider studies of seasonal variations in health, the effects of climate or ecological change, mortality and morbidity due to diseases with long latency periods, and the impact of behavioral interventions whose effects are slow to develop. In rich countries such as the U.S., the extra costs have not precluded longitudinal...