Global urbanization and impact on health

Nearly half the world's population now lives in urban settlements. Cities offer the lure of better employment, education, health care, and culture; and they contribute disproportionately to national economies. However, rapid and often unplanned urban growth is often associated with poverty, environmental degradation and population demands that outstrip service capacity. These conditions place human health at risk. Reliable urban health statistics are largely unavailable throughout the world. Disaggregated intra-urban health data, i.e., for different areas within a city, are even more rare. Data that are available indicate a range of urban health hazards and associated health risks: substandard housing, crowding, air pollution, insufficient or contaminated drinking water, inadequate sanitation and solid waste disposal services, vector-borne diseases, industrial waste, increased motor vehicle traffic, stress associated with poverty and unemployment, among others. Local and national governments and multilateral organizations are all grappling with the challenges of urbanization. Urban health risks and concerns involve many different sectors, including health, environment, housing, energy, transportation, urban planning, and others. Two main policy implications are highlighted: the need for systematic and useful urban health statistics on a disaggregated, i.e., intra-urban, basis, and the need for more effective partnering across sectors. The humanitarian and economic imperative to create livable and sustainable cities must drive us to seek and successfully overcome challenges and capitalize on opportunities. Good urban planning and governance, exchange of best practice models and the determination and leadership of stakeholders across disciplines, sectors, communities and countries will be critical elements of success.     

"海洋文化城市"与长三角沿海城市发展

“海洋文化城市”是一种崭新的城市文明形态,既不同于一般的海滨城市,又与恶性损耗海洋文化资源、刺激经济增长的“海洋经济型城市”有着本质区别。目前,长三角沿海城市的形象定位。与“海洋文化城市”存在着严重的错位。廓清“海洋文化城市”的理论内涵,不仅可以丰富长三角沿海城市发展思路,还能够为沿海城市发展提供科学的实践路径。     

Resistance to first-line tuberculosis drugs in three cities of Nigeria

Objectives To determine the levels of resistance to first‐line tuberculosis drugs in three cities in three geopolitical zones in Nigeria. Methods A total of 527 smear‐positive sputum samples from Abuja, Ibadan and Nnewi were cultured on BACTEC‐ MGIT 960. Drug susceptibility tests (DST) for streptomycin, isoniazid, rifampicin and ethambutol were performed on 428 culture‐positive samples on BACTEC‐MGIT960. Results Eight per cent of the specimens cultured were multi‐drug‐resistant Mycobacterium tuberculosis (MDR‐TB) with varying levels of resistance to individual and multiple first–line drugs. MDR was strongly associated with previous treatment: 5% of new and 19% of previously treated patients had MDR‐TB (OR 4.1 (95% CI 1.9–8.8), P = 0.001) and with young adult age: 63% of patients with and 38% without MDR‐TB were 25–34 years old (P = 0.01). HIV status was documented in 71%. There was no association between MDR‐TB and HIV coinfection (P = 0.9) and gender (P > 0.2 for both). Conclusions  MDR‐TB is an emerging problem in Nigeria. Developing good quality drug susceptibility test facilities, routine monitoring of drug susceptibility and improved health systems for the delivery of and adherence to first‐ and second‐line treatment are imperative to solve this problem.     

提高全民健康水平将上海建设成为现代化的健康城市

目的:建设健康城市是上海现代化的根本要求,他对支持上海经济社会和环境的发展具有重要意义.上海提出健康城市项目的目的就是要使上海各项生态环境指标和总体环境质量、卫生服务水平和人民健康水平继续保持领先水平.方法:在先期试点基础上,上海市政府在2003年9月正式公布建设“健康城市“目标,并制订了“三年行动计划“.结果:在健康城市项目建设中,上海首期提出了健康环境、健康食品等8个健康目标,并列出了104个指标.结论:上海是中国第一个提出建设“健康城市“的特大型城市,上海建设健康城市具有中国特色,在实施健康城市中社会组织与上海市民是主要力量.     

Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities network

The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/- 1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4 where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension.     

城乡交界地区育龄妇女生殖道感染现状及综合防治探讨

目的 调查城乡交界地区育龄妇女生殖道感染状况以及相关因素，在人口流动性大的地区，探索降低育龄妇女生殖道感染有效可行的综合防治策略。方法 在陕西省关中平原地区的城乡交界处采用多阶段随机抽样的方法，抽取340名非经期已婚育龄妇女进行问卷调查，同时进行妇科检查及相应的实验室检查。结果 各类生殖道感染总患病率为76．8％。常见的生殖道感染性疾病为慢性宫颈炎、阴道炎、附件炎，患病率分别为51．2％、27．4％、15．0％。其相关的危险因素有：文化程度初中以下、无经济来源、未使用避孕套、性病知识得分低、经期使用不洁物品及经期有过性生活、配偶对本人生病就医持消极态度、既往患过滴虫性阴道炎。结论 在人口流动性大的城乡交界处，应因地制宜，积极调动各方面力量进行生殖道感染的防治。动员政府管理部门提供政策支持；利用计生部门提供完善的服务网络和做社会工作的经验；同时医疗卫生部门可加大其宣传力度，加强技术人员培训，坚持开展普查普治工作；以家庭为干预单位，提高妇女的自我保健意识，积极动员男性参与。在多方面共同努力下，建立一套综合防治模式，降低生殖道感染患病率，促进生殖健康。     

Do Healthy Cities Work? A Logic of Method for Assessing Impact and Outcome of Healthy Cities

In this article, we discuss an appropriate methodology for assessing complex urban programs such as the WHO European Healthy Cities Network. The basic tenets and parameters for this project are reviewed, and situated in the broader urban health tradition. This leads to a delineation of the types of questions researchers can address when looking at a complex urban health program. Such questions reach appropriately beyond traditional public health concepts involving proximal and distal determinants of health (and associated upstream, midstream, and downstream rhetoric). Espousing a multi-level, reciprocal pathways perspective on Healthy Cities research, we also adopt a distinction between impacts and outcomes of Healthy Cities. The former are value-driven, the latter intervention-driven. These approaches lead to the acknowledgment of a logic of method that includes situational and contextual appreciation of unique Healthy City experiences in a Realist Evaluation paradigm. The article concludes with a reflection of evaluation and assessment procedures applied to Phase IV (2003-2008) of the WHO European Healthy Cities Network and an interpretation of response rates to the range of methods that have been adopted.