The end of death in late modernity: An emerging public health challenge

Health promotion discourses often assume that death and loss are someone else's business—usually palliative care or bereavement care. Palliative care and bereavement care, in their turn, provide direct service, acute care approaches to death and loss. Between these two approaches, little health promotion is evidenced. This paper critiques the assumptions both make about death in late modernity arguing that death and loss are increasingly social experiences for people that require active support and community development from the ‘new’ public health. The past therapeutic emphasis and the secularized view of death are receding. A new approach to death and loss is needed and the new public health may have an important major role to play in addressing these changes.     

高原移居内地人群与世居内地人群心血管疾病调查对比分析

目的探讨从西藏高原移居成都市与世居成都市人群罹患心血管疾病的异同特征和分布规律。方法选择从西藏高原移居成都市且住地相对集中的汉族成人500例为观察组,世居成都市人群500例为对照组,就两组调查人群数、性别、年龄及居住环境进行配对,通过问诊查体和有关检查,结合相关心血管疾病标准做出诊断。采用Stata(Ver5.0)统计软件进行资料分析,两组计数资料比较采用χ2检验。结果观察组心血管疾病总患病率(16%)及心血管疾病亚组人群中高血压(19.8%)和风心病患病率(0%)均明显低于对照组(42.0%,26.4%,2.4%)(P均<0.05),其他各类心血管疾病患病率两组差异均无显著性(χ2=0～2.25,P均>0.05);男性心血管病总患病率(37.2%)对照组高于观察组(49.6%)(χ2=7.33,P<0.05),两组均显示心血管疾病随年龄增加而增加,尤其61～80岁中对照组更为显著(χ2=12.39,P<0.05)。结论高原移居成都市人群高血压患病率低于世居成都市人群,显示部分高原高血压在移居成都后血压可恢复正常;世居成都市人群风心病患病率高于高原移居成都市人群,表明气候潮湿在风心病发病中可能为一独立的重要诱因;世居成都市人群中男性心血管病总患病率高于西藏移居成都市人群,同时,世居成都市人群中,老年心血管疾病患病率高于西藏移居成都市人群,均提示该性     

Healthy Cities: the new public health and supportive research

This paper views Healthy Cities as a local expression of thenew public health. It then discusses the potential contributionsof and issues involved in research supportive of policies forhealth at local and national levels. Finally, it suggest the roles Healthy Cities can play in sustainingthe new view of health-making through its functions as politicalreality and policy laboratory.     

Drug use, misuse, and the urban environment

Urbanization is probably the single most important demographic shift world-wide throughout the past and the new century and represents a sentinel change from how most of the world's population has lived for the past several thousand years. As urban living becomes the predominant social context for the majority of the world's population, the very ubiquity of urban living promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with health (e.g. depression) and risk behaviours (e.g. exercise patterns), relatively little research has systematically assessed how the urban environment may affect drug use and misuse. In this paper we will propose a conceptual framework for considering how different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential directions for future research.     

The effectiveness of human impact assessment in the Finnish Healthy Cities Network

OBJECTIVES: To develop a framework for analysing the effectiveness of prospective assessment and to apply the framework to human impact assessments (HuIA) carried out in the Finnish Healthy Cities Network. METHODS: The framework was formed by synthesizing and developing the themes that emerged from the published literature on effectiveness. The research material consists of interviews with people who participated in the assessment process in the municipalities (19 interviews). The research material also included assessment documents, proceedings of working meetings, municipal policy documents, background material and project reports produced in the municipalities studied. The research datasets were examined by content analysis. RESULTS: HuIA increased the decision-makers' awareness of effects and functioned as a tool for empowerment. The latter was apparent, for instance, in the social welfare and healthcare sector, finding a role for itself in decisively co-ordinating interdisciplinary work and actively seeking to alleviate identified negative effects. The assessment process also opened up the planning process, committed various actors to the decision, helped select the right alternative and promoted social learning. CONCLUSIONS: From the viewpoint of preparation and decision-making, the effectiveness of a HuIA increases when assessment becomes a recurring process and an integral part of an organization's activities. Integration of an assessment into permanent structures or activities, such as drawing up programmes or preparing strategies, helps the results of the assessment to be seen more clearly. From the viewpoint of decision-making, it is also important to strengthen the decision-makers' expertise in prospective assessment. When the effectiveness of HuIA is looked at in a new way (i.e. from the viewpoint of goal achievement, decision-making or learning), a more comprehensive interpretation can be given.     

我国八个大中城市院前急救流行病学调查分析

目的 调查我国大中城市院前急救患者流行病学情况,探讨院前急救病例特点.方法 从我国8个大中城市急救中心系统数据库中导出2008年度全部数据,就其有完整记录的资料进行统计分析.结果 (1)院前急救组调度时间、到达时间、现场时间、返回时间、出车总时间、急救半径分别为(2.16±1.10)min,(14.01±6.82)min,(12.12±5.96)min,(14.08±6.85)min,(42.34±20.21)min和(8.50±4.18)km,院前非死亡组分别为(2.19±1.13)min,(14.15±7.14)min,(11.60±6.72)min,(14.92±6.89)min,(41.86±19.53)min和(8.63±4.31)km,院前死亡组分别为(2.10±1.08)min,(13.68±7.14)min,(25.25±12.34)min,(13.75±6.48)min,(54.74±25.47)min和(7.86±3.91)km,院前非心脏性猝死组分别为(2.09±1.03)min,(13.58±6.78)min,(25.53±12.34)min,(13.60±6.54)min,(53.79±23.77)min和(7.67±3.86)km,院前心脏性猝死组分别为(2.12±1.02)min,(14.10±7.05)min,(24.79±12.08)min,(13.79±6.61)min,(54.80±25.36)min和(7.90±3.92)km.院前死亡组的调度时间、到达时间、返回时间、急救半径均明显小于院前非死亡组,前组的现场时间、出车总时间均明显大于后者(P＜0.05或P＜0.01).院前心脏性猝死组的调度时间、返回时间与院前非心脏性猝死组的差异无统计学意义(P＞0.05),但前组的到达时间、出车总时间、急救半径均明显大于后组,而现场时间明显小于后组(P＜0.05或P＜0.01).(2)院前急救组、院前非死亡组、院前死亡组、院前非心脏性猝死组、院前心脏性猝死组的病例数均以第一季度为最多,其最少时间段分别是4:00-6:00、4:00-6:00、4:00-6:00、22:00-24:00、2:00-4:00,其最多时间段分别是20:00-22:00、20:00-22:00、8:00-10:00、2:00-4:00、8:00-10:00.(3)在241 876例院前急救病例中,创伤类患者是院前急救中最多的,年龄以21～50岁青壮年最多;其余依次是神经系统、循环系统、其他、消化系统、呼吸系统、中毒类,且神经系统、循环系统、呼吸系统类均以51岁(尤其是70岁)以上的中老年最多;其他、消化系统类均有两个高峰年龄段,其一是21～30岁青年阶段,其二是70岁以上的老年;中毒类以21～50岁青壮年最多,其中急性酒精中毒是最常见的病因.(4)在12 568例院前死亡病例中,循环系统、其他、呼吸系统、神经系统、消化系统类的死亡分别居第一、二、四、五、八位,均以51岁(尤其是70岁)以上的中老年最多,其中心脏性猝死又是循环系统类的死亡中最多的;创伤、中毒类的死亡分别居第三、六位,均以21～50岁青壮年最多.(5)男性患者院前急救的数量、总死亡量及院前心脏性猝死均明显高于女性.(6)院前死亡患者占院前急救的5.20%,院前心脏性猝死占院前急救的1.29%,院前心脏性猝死占院前死亡的24.87%,院前心脏性猝死占循环系统类死亡的67.33%.结论 (1)创伤与心脏性猝死已分别成为我国大中城市最常见的院前急救和致死原因.(2)加强心脑血管病和呼吸系统疾病防治,提高中老年患者的常见急危重症早期识别与院前急救水平对降低死亡率有重要意义.(3)加强安全生产、遵守交通法规、强化法制意识将是降低创伤,尤其是交通意外伤发生及其死亡的有力于段.     

哈尔滨市51家集中空调通风系统污染状况调查

目的为了解哈尔滨市公共场所集中空调通风系统的污染状况,加强监督管理和提供清洗建议。方法根据北方特有冬季供暖期的特点,首次提出通过监测供暖期前后的污染情况。通过对51家商场,宾馆,超市等公共场所进行采样检测,建立北方城市特有的污染趋势变化规律。结果 3月16日-3月22日的采样中,显示公共场所集中空调系统的菌落总数,送风真菌总数,风口风管积尘量100.0%超标,均属于中度污染和重度污染,在7月17日和8月3日的采样检测中,结果显示公共场所集中空调系统的菌落总数,送风真菌总数,风口风管积尘量总计有28.6%的超标和嗜肺军团菌检出率。结论建议最佳清洗时间为供暖期结束后,本文的检测结果和清洁工作的建议方案针对国内外其他具有冬季供暖的地区具有借鉴和大范围推广作用。     

Homeless encampments: connecting public health and human rights

The COVID-19 pandemic is exacerbating longstanding issues related to homelessness, including lack of affordable housing, unemployment, poverty, wealth inequality, and ongoing impacts of colonization. Homelessness is often accompanied by narratives rooted in individual blame, criminalization, and reinforcement of substance use and mental health-related stigma. Visible homelessness, in the form of encampments, is a manifestation of government policy failures that neglect to uphold the human right to housing, and demonstrate eroding investments in affordable housing, income and systemic supports. Encampments make visible that some in our community lack basic determinants of health such as food, water, sanitation, safety, and the right to self-determination. In order for public health to effectively and equitably promote health and enact commitments to social justice, we argue that public health must adopt a human rights approach to housing and to homeless encampments. Embracing a human rights perspective means public health would advocate first and foremost for adequate housing and other resources rooted in self-determination of encampment residents. In the absence of housing, public health would uphold human rights through the provision of public health resources and prohibition on evictions of encampments until adequate housing is available.     

The persistence of ancient settlements and urban sustainability

We propose a dedicated research effort on the determinants of settlement persistence in the ancient world, with the potential to significantly advance the scientific understanding of urban sustainability today. Settlements (cities, towns, villages) are locations with two key attributes: They frame human interactions and activities in space, and they are where people dwell or live. Sustainability, in this case, focuses on the capacity of structures and functions of a settlement system (geography, demography, institutions) to provide for continuity of safe habitation. The 7,000-y-old experience of urbanism, as revealed by archaeology and history, includes many instances of settlements and settlement systems enduring, adapting to, or generating environmental, institutional, and technological changes. The field of urban sustainability lacks a firm scientific foundation for understanding the long durée, relying instead on narratives of collapse informed by limited case studies. We argue for the development of a new interdisciplinary research effort to establish scientific understanding of settlement and settlement system persistence. Such an effort would build upon the many fields that study human settlements to develop new theories and databases from the extensive documentation of ancient and premodern urban systems. A scientific foundation will generate novel insights to advance the field of urban sustainability.     

Is cancer prevention influenced by the built environment? A multidisciplinary scoping review

The built environment is a significant determinant of human health. Globally, the growing prevalence of preventable cancers suggests a need to understand how features of the built environment shape exposure to cancer development and distribution within a population. This scoping review examines how researchers across disparate fields understand and discuss the built environment in primary and secondary cancer prevention. It is focused exclusively on peer-reviewed sources published from research conducted in Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States from 1990 to 2017. The review captured 9958 potential results in the academic literature, and this body of results was scoped to 268 relevant peer-reviewed journal articles indexed across 13 subject databases. Spatial proximity, transportation, land use, and housing are well-understood features of the built environment that shape cancer risk. Built-environment features predominantly influence air quality, substance use, diet, physical activity, and screening adherence, with impacts on breast cancer, lung cancer, colorectal cancer, and overall cancer risk. The majority of the evidence fails to provide direct recommendations for advancing cancer prevention policy and program objectives for municipalities. The expansion of interdisciplinary work in this area would serve to create a significant population health impact.