Prospective studies in which a representative sample of people are monitored to track health concerns and diagnostic testing, is also a good way to measure outcomes. These cohort studies are expensive to initiate and sustain but they can contribute important information over time. In Vancouver, the Vancouver Injection Drug Users Study (VIDUS) was instrumental in identifying a major outbreak of HIV and continues to influence policy by providing important information on the course of the HIV epidemic (Strathdee, et al., 1997).
There are also a number of measurable health outcomes that can be monitored to assess needs, evaluate progress and determine the impact of health interventions in urban settings. In the case of illicit drug users, we can examine HIV testing statistics to determine the proportion of individuals that have been tested in the past six months. For those who test HIV positive, the CD4 and viral load measures can also be monitored every three months. We can also look at the uptake of antiretroviral therapy among injection drug users as another good measure of health care coverage (in many urban centers the uptake is sub-optimal due to inadequate services and support). We can analyze the number of annual Pap smears to determine the level of screening in women, and we can examine the number of influenza and pneumococcal vaccinations within specific groups to provide additional measures of primary care uptake.
Finally, we can also look at adverse outcome statistics (i.e., emergency room visits, drug overdoses, injection-related infections, etc.) to determine the health of the community. One important adverse outcome that is sometimes overlooked is the level of public disorder within the community. Public order and safety are intimately linked to individual health and well-being. Communities that are able to improve the health status of their residents invariably see improvements in order and safety.
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