Methodological Complexities and the Use of GIS in Conducting a Community Needs Assessment of a Large U.S. Municipality

Reliable assessment of health and social needs within a community ensures that local input drives strategic planning and programmatic decisions. Results are used to determine the priorities and focus of local public health departments and to support the activities of health and social service agencies. We utilized a geographic information system in the planning, administration, and analysis of a recent community needs assessment to ensure a reliable and randomly distributed sample of a diverse urban population and to allow for small geographic area analysis of disease prevalence data. Collection of location data at the time of the 3,361 face-to-face assessment interviews allowed for the association of spatial data with measures of health conditions and behaviors. Results of the assessment indicated a need for public health programs designed to address emerging public health concerns in the community. Incorporating a spatial component in analyses of morbidity and needs assessment data allows for efficient integration of demographic and socio-economic census data and permits ad hoc analyses of varied and changing geographic strata.     

Urban health: an urban planning perspective

Urban planning processes and practices, and their impacts on the health and well being of citizens, are numerous and take many forms. Creating living urban environments that are conducive to health and well being requires an integrated approach between urban planners and health professionals. This article focuses on the almost 100 years of experience of Canada's National Capital Commission (NCC) in developing urban plans (policy plans, master plans) for planning and building Canada's Capital. To address the continuous growing public interest in environmental concerns, the NCC developed in the 1990s an integrated approach using a strategic environmental assessment (SEA). This approach could be easily transferred to various urban-planning contexts worldwide. This paper aims to describe the NCC approach, in order to stimulate discussion on growing environmental health concerns and urban planning.     

社区卫生服务门诊统筹政策的成效与经验

在我国城镇居民基本医疗保险筹资水平较低而基本医疗保障需求较高的现实条件下,门诊统筹是提高保障水平、扩大受益面的关键。与社区卫生服务相结合,城镇居民基本医疗保险可以利用其方便价廉、安全有效的特征,充分发挥社区卫生服务的公益性及其高效率的服务优势来保障城镇居民的基本医疗和公共卫生服务。通过典型地区的实证分析,认为门诊统筹具有提高社区卫生服务公益性,提升医保资金使用效率等政策成效。试点地区的经验也表明,依托社区卫生服务的门诊统筹政策成功的原因在于典型地区都进行了服务模式转变的形态机制建设、强化公益性的运行机制建设以及提升能力的社区卫生服务内涵建设。     

Pennsylvania partners in pursuit of good health: building a shared-responsibility model for state health improvement.

Over the last decade, much attention has focused on the reorganization of the roles and functions of public health to improve the health of communities. The Pennsylvania State Health Improvement Plan (SHIP) offers one example of how national, state, and local components of the public health system can effectively integrate their strategies and resources to improve responsiveness to local public health needs. This article reviews the policy action and planning process used to develop a community partnership, shared-responsibility model and the strategies and implementation plans that have been adopted to achieve substantial, measurable improvement in community health status.     

Public Health, the APHA, and Urban Renewal

Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.THE PAST DECADE HAS SEEN a reemergence of efforts to connect public health and urban planning. Focusing on the health effects of the built environment, new research has shed light on the association between urban sprawl and obesity, the association between the physical form of neighborhoods and the physical activity levels of its inhabitants, and the role of housing in asthma. On the basis of this research, new programs are being developed, new building and design standards have been proposed, and there is new willingness to manipulate the built environment to promote and protect health. During this process, it will be important to remember the lessons of 20th-century program failures as public health seeks to intervene again in the built environment in this new century.     

Rapid appraisal in an urban setting, an example from the developed world

Rapid Appraisal has been used as a method to understand communities' own perceptions of their priority needs. It can be used as a tool for formulating joint action plans between communities and service planners and managers. It can also be used to complement quantitative methods of assessing needs by more in-depth qualitative understanding of socio-cultural perspectives. In the example described in this paper Rapid Appraisal is used both as action research and as a qualitative tool in order to define health and social needs of an urban, deprived community in England.     

Visual localisation of community health needs to rational decision-making in public health services

The objectives were to visualise the locations of community health needs and to develop a community health needs assessment geographic information system (GIS) for rational decision-making in public health services. We compiled census data, digital data of basic planning maps, digital data of topographic maps, contents of registers of medical and welfare facilities, and statistics of establishments into a geographical database; visualised geographical distributions of specific community health needs by integrating sets of indicators to reflect individual needs; and quantified their clustering by the nearest neighbour method. The database aggregated 3400 items of demographic, life and environmental factors. Thematic maps and clustering values showed different patterns of geographical distribution of the individual community needs. Means to match needs with services in smaller geographical units were discussed. This GIS will support appropriate resource allocation, intersectoral collaboration and greater transparency in planning and implementing services, by visualising locations of community health needs.     

Homes or hospitals? Contradictions of the urban crisis.

Medical expansion is threatening to eliminate many urban residential areas, despite criticisim that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of "medicalization." Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughtout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.     

Indicators of environmental health in the urban setting

The North American population is approximately 80% urbanized and spends almost 90% of the time indoors. Accordingly, the built environment is the most important--one might almost say "natural"--human environment. Urban settlements incorporate within their boundaries natural ecosystems of plant and animal life (often highly adapted to the urban environment), and are in turn incorporated within wider bioregions and global ecosystems. But urban settlements are not just built and natural physical environments, they are social, economic, cultural and political environments; the whole constitutes an urban ecosystem. These ecosystems have profound implications for the physical, mental, social, emotional and spiritual well-being of their human inhabitants, as well as for human beings remote from these urban ecosystems. Therefore, this paper discusses urban ecosystems and human health and presents a framework for indicators of environmental health in the urban setting based on such an understanding. The concepts of environmental viability, ecological sustainability, urban livability, community conviviality, social equity, and economic adequacy are discussed in relation to human health and are used to organize proposed candidate indicators for urban ecosystems and public health.     

Urban Planning and Health Equity

Although the fields of urban planning and public health share a common origin in the efforts of reformers to tame the ravages of early industrialization in the 19th century, the 2 disciplines parted ways in the early 20th century as planners increasingly focused on the built environment while public health professionals narrowed in on biomedical causes of disease and disability. Among the unfortunate results of this divergence was a tendency to discount the public health implications of planning decisions. Given increasingly complex urban environments and grave health disparities in cities worldwide, urban planners and public health professionals have once again become convinced of the need for inclusive approaches to improve population health and achieve health equity. To make substantive progress, intersectoral collaboration utilizing ecological and systems science perspectives will be crucial as the solutions lie well beyond the control of any single authority. Grounded in the social determinants of health, and with a renewed sense of interconnectedness, dedicated and talented people in government agencies and communities who recognize that our future depends on cultivating local change and evaluating the results can come to grips with the enormous challenge that lies ahead to create more equitable, sustainable, and healthier cities worldwide.     

Toward a Research and Action Agenda on Urban Planning/Design and Health Equity in Cities in Low and Middle-Income Countries

The importance of reestablishing the link between urban planning and public health has been recognized in recent decades; this paper focuses on the relationship between urban planning/design and health equity, especially in cities in low and middle-income countries (LMICs). The physical urban environment can be shaped through various planning and design processes including urban planning, urban design, landscape architecture, infrastructure design, architecture, and transport planning. The resultant urban environment has important impacts on the health of the people who live and work there. Urban planning and design processes can also affect health equity through shaping the extent to which the physical urban environments of different parts of cities facilitate the availability of adequate housing and basic infrastructure, equitable access to the other benefits of urban life, a safe living environment, a healthy natural environment, food security and healthy nutrition, and an urban environment conducive to outdoor physical activity. A new research and action agenda for the urban environment and health equity in LMICs should consist of four main components. We need to better understand intra-urban health inequities in LMICs; we need to better understand how changes in the built environment in LMICs affect health equity; we need to explore ways of successfully planning, designing, and implementing improved health/health equity; and we need to develop evidence-based recommendations for healthy urban planning/design in LMICs.     

Public housing, public health: health needs of public housing tenants

OBJECTIVES: To determine the health needs of public housing tenants, measured in terms of self-reported health status, health risk factors and expressed need for health risk reduction intervention. METHOD: Face-to-face interviews were conducted with a randomly selected sample of public housing tenants in the Hunter Region of New South Wales. RESULTS: Of 463 contactable tenants, 329 consented to participate in the study. Participants were 2.5 times more likely to rate their health as fair or poor relative to the community generally, and visited a doctor twice as often. The prevalence of smoking was more than twice that of the community generally, and the prevalence of falls was approximately three times greater. Risk of injury due to domestic violence was approximately six times greater, and the risk of injury due to violence in other locations was more than double that in the community. Between a quarter and a half of the participants requested support to reduce their health risks. CONCLUSIONS: The findings suggest that public housing tenants are one of the more severely health-compromised groups in the Australian community. IMPLICATIONS: An urgent need exists for public health initiatives that are directed at improving not only the current markedly poorer health status of public housing tenants, but also the greater prevalence of health risk factors that predict a likely continuation of such differentials into the future.     

The U.S. Department of Housing and Urban Development BUILD Las Vegas 2019 Event: Lessons Learned in Public Health Community Engagement

The U.S. Department of Housing and Urban Development (HUD) BUILD Las Vegas 2019 event brought together Las Vegas Lead Hazard Control and Healthy Homes Program (LVLHCHHP) staff, community leaders, and volunteers from multiple organizations for a neighborhood clean-up and community resource fair in a low-income, historic west Las Vegas neighborhood. In preparation for the event, LVLHCHHP staff encountered a lack of published guidance regarding past BUILD events or planning of community-based public health events. To address this gap in the literature, this brief report offers lessons learned from the process of planning and evaluating the HUD BUILD Las Vegas 2019 event. These include taking early planning measures, centering the focus on community needs, and forming strategic partnerships, which can provide a valuable foundation for future events that want to integrate community engagement with public health.

     

Health impact assessments are needed in decision making about environmental and land-use policy

The importance to public health of environmental decisions-including those about land use, transportation, power generation, agriculture, and environmental regulation-is increasingly well documented. Yet many decision makers in fields not traditionally focused on health continue to pay little if any attention to the important health effects of their work. This article examines the emerging practice of health impact assessment and offers real-world examples of its effective implementation, including studying the impact of nearby highways-a major source of air pollution-on proposed new housing for seniors. The article argues that officials at the federal, state, and local levels should consult health experts and consider using health impact assessments when their decisions on such issues as urban planning, land use, and environmental regulation have the potential to directly affect the conditions in which people live and work.     

Reprint of: “I'm always entirely happy when I'm here!” Urban blue enhancing human health and well-being in Cologne and Düsseldorf,Germany

Water is one of the most important landscape elements. In settled areas, planners rediscovered urban blue in the form of rivers as a soft location factor in post-industrial times. Although the recognition of the need for recreational or ‘healthy’ places like urban green or urban blue in cities is increasing, current urban planning is mostly conducted without taking beneficial health issues into account. In this paper an extended concept of therapeutic landscapes is used to analyse two promenades on the river Rhine in the centres of two German cities (Cologne and Düsseldorf). A complex of qualitative and quantitative methods from diverse disciplines is applied to obtain a multi-dimensional image of salutogenic health processes. The results show that the promenades are favourite places to spend leisure time and to engage in recreational activities, in addition to providing restoration from everyday stresses. Water is a strong predictor of preference and positive perceptive experiences in urban environments. Users of the promenades also report strong emotional attachments to the place. Urban blue space may be interpreted as a therapeutic landscape in various ways. The study forms a contribution to planning issues, particularly considering benefits for human health, and enhances current research concerning therapeutic landscapes.     

“I'm always entirely happy when I'm here!” Urban blue enhancing human health and well-being in Cologne and Düsseldorf,Germany

Water is one of the most important landscape elements. In settled areas, planners rediscovered urban blue in the form of rivers as a soft location factor in post-industrial times. Although the recognition of the need for recreational or ‘healthy’ places like urban green or urban blue in cities is increasing, current urban planning is mostly conducted without taking beneficial health issues into account. In this paper an extended concept of therapeutic landscapes is used to analyse two promenades on the river Rhine in the centres of two German cities (Cologne and Düsseldorf). A complex of qualitative and quantitative methods from diverse disciplines is applied to obtain a multi-dimensional image of salutogenic health processes. The results show that the promenades are favourite places to spend leisure time and to engage in recreational activities, in addition to providing restoration from everyday stresses. Water is a strong predictor of preference and positive perceptive experiences in urban environments. Users of the promenades also report strong emotional attachments to the place. Urban blue space may be interpreted as a therapeutic landscape in various ways. The study forms a contribution to planning issues, particularly considering benefits for human health, and enhances current research concerning therapeutic landscapes.     

Using geographic information systems to match local health needs with public health services and programs

Local health departments (LHDs) play an important role in ensuring essential public health services. Geographic information system (GIS) technology offers a promising means for LHDs to identify geographic gaps between areas of need and the reach of public health services. We examined how large LHDs could better inform planning and investments by using GIS-based methodologies to align community needs and health outcomes with public health programs. We present a framework to drive LHDs in identifying and addressing gaps or mismatches in services or health outcomes.     

Integrating health and social services for older adults: a case study of interagency collaboration

As public housing residents age in place, they require health and social services outside of those traditionally offered by housing authorities. A promising response to these emerging needs is for housing authorities to collaborate with local public health departments to deliver coordinated services to older adult residents. Aging residents' health needs include health promotion activities, preventive health services, health education, and mental health services, among others. From 2001-2004 the New York City Department of Health and Mental Hygiene (DOHMH) and the New York City Housing Authority (NYCHA) collaborated to implement the Senior Wellness Project. This outreach program integrated health and social services provided by DOHMH and NYCHA, and delivered these services to older adult residents on site in 21 New York City public housing developments. Services were rendered at senior centers located in the housing developments and in residents' apartments. The program also referred residents to community healthcare providers to address special needs such as addiction. This article retroactively applies a formal model for interagency collaboration, the Stages of Collaboration, to describe and analyze the process of collaboration between DOHMH and NYCHA. It identifies the successes and shortcomings of the collaborative process, and explores the theory that successful collaboration leads to inherent challenges for implementation. Recommendations are then made for other public housing and public health agencies that have considered collaborating to address the needs of public housing residents who are aging in place.     

Ethnography of individuals in psychological distress

OBJECTIVE: To asses how people with mental disorders experience their special needs and interact with the community in public urban places. METHODOLOGY: The research was performed in the city of Passo Fundo, Rio Grande do Sul, Brazil, using ethnography as the theoretical methodological approach. As of the study of one subject, the objective was to understand what characterizes people as mentally sick and how the adversities of their mental picture do not prevent them from building circuits, paths, and social networks with the urban space. RESULTS AND CONCLUSIONS: It was identified the subjectivity processes of subjects in the spaces of the city. Since health services recognized these individuals, it is possible to create interventions which are more suitable to their special needs.