The indigenous peoples of Europe and Russia comprise the Inuit in Greenland, the Sami in northern Norway, Sweden, Finland and Russia and forty officially recognized ethnic minority groups in northern Russia plus a few larger-population indigenous peoples in Russia. While the health of the Inuit and Sami has been well studied, information about the health of the indigenous peoples of Russia is considerably scarcer. The overall health of the Sami is in many aspects not very different from that of their non-indigenous neighbors in northern Scandinavia; the health of the Inuit is similar across Greenland and North America and far less favorable than that of Denmark, southern Canada and the lower 48 American states, respectively; the health of the indigenous peoples of the Russian north is poor, partly due to poverty and alcohol.
Article
Regional Studies of Indigenous Health: Europe and Russia
Peter Bjerregaard
Article
Religion, Aging, and Public Health
Jeff Levin and Ellen Idler
Religion, in both its personal and institutional forms, is a significant force influencing the health of populations across the life course. Decades of research have documented that expressions of faith and the practice of spiritual pursuits exhibit significantly protective effects for physical and mental health, psychological well-being, and population rates of morbidity, mortality, and disability. This finding has been observed across sociodemographic categories, across nations and cultures, across specific disease outcomes, and regardless of one’s religious affiliation. A salutary religious effect on health and well-being is especially apparent among older adults, but is also observed across generations and age cohorts. Moreover, this association has been persistently found for various religious indicators, including attendance at worship services, prayer and other private practices, subjective feelings of religiosity, and numerous measures of religious behaviors, attitudes, beliefs, and experiences. Finally, a protective or primary preventive effect of religion has been observed in clinical, epidemiologic, social, and behavioral studies, regardless of research design or methodology.
Faith-based organizations also have contributed to the health of populations, in partnerships or alliances with medical institutions and public health agencies, many of these dating back many decades. Examples include congregational health promotion and disease prevention programs and community-wide interventions, especially targeting the health and well-being of older congregants and those in less well-resourced communities, as well as faith–health partnerships in healthcare delivery, public health policymaking, and legislative advocacy for healthcare reform. Religious denominations and institutions also play a substantial role in global health development throughout the world, individually and in partnership with national health ministries, transnational medical mission organizations, and established nongovernmental agencies. These efforts focus on a wide range of goals and objectives, including building public health infrastructure, addressing ongoing environmental health needs, and responding to acute public health challenges and crises, such as infectious disease outbreaks. Constituencies include at-risk populations and cohorts throughout the life course, and programming ranges from perinatal care to maternal and child healthcare to geriatric medicine.
Article
Risky Sexual Behaviors: Trends Among Young People (10–24 Years) in Four East African Countries
Fredrick E. Makumbi, Sarah Nabukeera, Justine N. Bukenya, and Simon Peter Sebina Kibira
The future of sub-Saharan Africa depends on the health of young people (10–24 years) who form about one-third of the region’s population. This large population of young people is a potential asset for social-economic development if appropriate investments and social empowerment can be provided. Despite the vast opportunities, young people are faced with enormous social, economic, and health challenges. Young people’s health increasingly remains important especially with the use and misuse of narcotics (drugs and alcohol) a key risk factor for risky sexual behaviors (RSBs).
RSBs are defined as behaviors that increase one’s risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) and unintended pregnancies. RSBs include multiple sex partners, sex without a condom, alcohol use with sex, sex initiation before age 15, nonuse of modern contraceptives, and early marriage (before age 18 years).
RSBs are reportedly influenced by a number of factors including lack of access to accurate, customized HIV information and prevention services, socioeconomic reasons, lack of parental control, peer pressure, and lack of youth-friendly recreational facilities. The consequences or impact of RSB, especially among the adolescents and young people, include poor health (STIs including HIV/AIDS, unintended pregnancies, unsafe abortions, maternal deaths, and mental health such as psychological distress), and negative social and economic challenges (nonenrollment and nonretention in school and early child marriage).
Understanding the trends in RSBs can provide insights in how well available interventions and policies have minimized their consequences among adolescents, and lay a basis to further develop more innovative and effective strategies especially in low-income countries.
Article
Social and Behavior Change Communication in Sexual and Reproductive Health
Suruchi Sood and Jose Rimon II
Social and behavior change communication (SBCC) is a core public health strategy not just for interventions designed to prevent, control, and treat disease but also for addressing the social determinants of health. Quality SBCC interventions are based on some common design, implementation, and evaluation best practices. The evidence base for using SBCC for sexual and reproductive health (SRH) includes, among other programs, family planning, maternal and neonatal health, and HIV/AIDS. Three global SBCC interventions—one on each of these topics—are presented as exemplars of best practices in public health communication programs designed to improve individual health behaviors and enable social change.
These SBCC programs employed cross-cutting approaches covering different levels of the social-ecological model while tackling multiple related health issues. While emphasizing individual roles and responsibilities, recognizing the importance of the cultural, social, and political context within which individuals live and work allowed these interventions to address social and gender norms. All three were theory-based and evidence-driven. They applied constructs from social and behavior change (SBC) theories to model causal pathways and stages or steps of behavior and community-level change. In addition, they relied on comprehensive, mixed-methods research throughout the project cycle. Other best practices included intersectoral collaboration and steps to ensure scale-up and sustainability.
Article
Social and Gender Norms Influencing Sexual and Reproductive Health: Conceptual Approaches, Intervention Strategies, and Evidence
Shaon Lahiri, Elizabeth Costenbader, and Jeffrey B. Bingenheimer
Research in diverse fields has examined how social and gender norms, broadly defined as informal rules of acceptable behavior in a given group or society, may influence sexual and reproductive health outcomes. One set of conceptual and empirical approaches has focused on perceptions of how commonly others perform a behavior and the extent to which others support or approve of the behavior. Another set of approaches has focused on how social norms emerge from structures of gender and power that characterize the social institutions within which individuals are embedded. Interventions intended to improve sexual and reproductive health outcomes by shifting social and gender norms have been applied across a wide range of populations and settings and to a diverse set of behaviors, including female genital mutilation/cutting, the use of modern contraceptive methods, and behavioral risk reduction for HIV. Norms-based intervention strategies have been implemented at multiple socioecological levels and have taken a variety of forms, including leveraging the influence of prominent individuals, using community activities or mass media to shift attitudes, and introducing legislation or policies that facilitate the changing of social norms.
Recent advances in social and gender norms scholarship include the integration of previously disparate conceptual and empirical approaches into a unified multilevel framework. Although challenges remain in measuring social and gender norms and studying their impacts on sexual and reproductive health-related behaviors across cultures, the research will continue to shape policies and programs that impact sexual and reproductive health globally.
Article
Social Medicine and the Social Sciences in Latin America: Conceptual Tensions for the Transformation of Public Health in the 20th Century
Arachu Castro
The development of public health in Latin America during the 20th century combined, early on, the social medicine framework on the social, political, and environmental origins of disease with the contributions of medical anthropological fieldwork. Despite the hegemony of the medical model, the surge of the preventive medicine framework further legitimized the involvement of social scientists in the study of the multicausality of disease. However, the limitations brought by the preventive medicine model’s lack of historical and political contextualization gave way to the Latin American social medicine movement, which was grounded in historical materialism, and the development of both critical epidemiology and critical medical anthropology.
Article
Street Science: Community Knowledge for Global Health Equity
Jason Corburn
Street science is the processes used by community residents to understand, document, and take action to address the environmental health issues they are experiencing. Street science is an increasingly essential process in global urban health, as more and more people live in complex environments where physical and social inequalities create cumulative disease burdens. Street science builds on a long tradition of critical public health that values local knowledge, participatory action research, and community-driven science, sometimes referred to as “citizen science.” Street scientists often partner with professional scientists, but science from the street does not necessarily fit into professional models, variables or other standards of positivist data. Street science is not one method, but rather an approach where residents are equally expert as professional scientists, and together they co-produce evidence for action. In this way, street science challenges conventional notions in global health and urban planning, which tend to divorce technical issues from their social setting and discourage a plurality of participants from engaging in everything from problem setting to decision-making. Street science does not romanticize local or community knowledge as always more accurate or superior to other ways of knowing and doing, but it also recognizes that local knowledge acts as an oppositional discourse that gives voice to the often silent suffering of disadvantaged people. At its best, street science can offer a framework for a new urban health science that incorporates community knowledge and expertise to ensure our cities and communities promote what is already working, confront the inequities experienced by the poor and vulnerable, and use this evidence to transform the physical and social conditions where people live, learn, work, and play.
Article
Surveys in Low- and Middle-Income Countries
Madeleine Short Fabic, Yoonjoung Choi, and Fredrick Makumbi
Sexual and reproductive health (SRH) surveys around the world, especially in low- and middle-income countries, have been and continue to be the primary sources of data about individual-, community-, and population-level sexual and reproductive health. Beginning with the Knowledge, Attitudes, and Practices surveys of the late 1950s, SRH surveys have been crucial tools for informing public health programming, healthcare delivery, public policy, and more. Additionally, major demographic and health modeling and estimation efforts rely on SRH survey data, as have thousands of research studies. For more than half a century, surveys have met major SRH information needs, especially in low- and middle-income countries. And even as the world has achieved impressive information technology advances, increasing by orders of magnitude the depth and breadth of data collected and analyzed, the necessity and importance of surveys have not waned.
As of 2021, four major internationally comparable SRH survey platforms are operating in low- and middle-income countries—the Demographic and Health Surveys Program (DHS), Multiple-Indicator Cluster Survey (MICS), Population-Based HIV Impact Assessment (PHIA), and Performance Monitoring for Action (PMA). Among these platforms, DHS collects the widest range of data on population, health, and nutrition, followed by MICS. PHIA collects the most HIV-related data. And PMA’s family planning data are collected with the most frequency. These population-based household surveys are rich data sources, collecting data to measure a wide range of SRH indicators—from contraceptive prevalence to HIV prevalence, from cervical cancer screening rates to skilled birth delivery rates, from age at menarche to age at first sex, and more.
As with other surveys, SRH surveys are imperfect; selection bias, recall bias, social desirability bias, interviewer bias, and misclassification bias and error can represent major concerns. Furthermore, thorny issues persist across the decades, including perpetual historic, measurement, and methodological concerns. To provide a few examples with regard to history, because the major survey programs have historically been led by donors and multilateral organizations based in the Global North, survey content and implementation have been closely connected with donor priorities, which may not align with local priorities. Regarding measurement, maternal mortality data are highly valued and best collected through complete vital registration systems, but many low- and middle-income countries do not have complete systems and therefore rely on estimates collected through household surveys and censuses. And regarding methods, because most surveys offer only a snapshot in time, with the primary purpose of monitoring key indicators using a representative sample, most analyses of survey data can only show correlation and association rather than causation. Opportunities abound for ongoing innovation to address potential biases and persistent thorny issues.
Finally, the SHR field has been and continues to be a global leader for survey development and implementation. If past is prelude, SRH surveys will be invaluable sources of knowledge for decades to come.
Article
Ten Lessons From a Career in Global Health: Guidance to Those Considering a Life Working With the Poor Countries of the World
Jon Rohde
Global health, defined by the World Health Organization as “priority on improving health and achieving equity in health for all people worldwide,” is an expanded view of traditional public health. While utilizing many of the tools widely taught in schools of public health, its emphasis is both on reaching the poorest and most isolated populations and transferring knowledge and skills for their benefit. Extensive and continuous field interactions and collaboration with the populations for whom health interventions are intended to benefit are very important. Thus, immersion in local culture and society, language skills, and active listening are key attributes for a global health professional to acquire. These apply to local health workers as well as expatriates. A broad array of disciplinary insights, ranging from clinical medicine to social sciences, communication strategies, and team building, are often more valuable than a single technocentric expertise, enabling a more holistic approach to health problems. The ability to simplify suggested techniques and interventions and especially the ability to create a culturally understood logic behind biomedical explanations go a long way to establishing acceptance of health messages and advice. Introducing new ideas, habits, and procedures incrementally rather than in one large dose of instructions or training has more lasting impact on both trainees and the targeted population. Invariably, delegating both authority and responsibility to “lower-level” workers—that is, those closer to the people through tradition, familiarity, and geographic access—results in greater acceptability and uptake of desired behaviors. Learning in the field is best accomplished from observing and emulating mentor figures—those who best exemplify the attributes of a widely accepted and respected health leader. In time, one’s own role as a mentor for new recruits facilitates the transfer of attitudes and approaches that embody these important principles of global health work. In the end, one’s impact on communities will be measured by the people and institutions that one inspires and leaves to carry on the work into the future.
Article
The Investment Case for Strengthening Primary Healthcare and Community Health Worker Programs in Low- and Lower-Middle-Income Countries
Henry B. Perry and Jeffrey D. Sachs
Universal health coverage is within reach of even the poorest countries if these countries are helped to expand their systems of primary healthcare (PHC). The overriding theme is that PHC (with a strong community outreach component) is the best bargain on the planet—alongside spending on primary and secondary education. Investing in PHC, both from domestic revenues and international grants and loans as necessary, can save millions of lives per year at a remarkably low cost. Many low- and middle-income countries (LMICs) direct too many resources to tertiary care rather than PHC. Community outreach programs, notably those that include community health workers, are chronically underfunded, even disproportionately relative to overall funding government for healthcare. In many or most LMICs, the political pressure on national policymakers is, strangely enough, to expand investments in higher level health facilities and specialized care—especially for hospitals. As a result, the underfunding of PHC leads to a vicious cycle. Because PHC services are underfunded, the quality of these services is weak, and patients bypass these facilities to obtain urgent PHC services they need at hospitals. Underutilization of PHC services at PHC facilities and provision of PHC services at hospitals leads to increased funding for hospitals, at leading to progressively lower levels of funding for PHC facilities and for strong community outreach. There is an immediate need to recognize community-level health programs as a permanent feature of effective health systems (even in high-income countries). Additional funding is needed to enable the concerted strengthening and expansion of PHC services in low- and lower-middle-income countries. This would enable, among other things, community health workers to reach their full potential and provide a broad range of life-saving and life-improving services by allocating the skills, supplies, supervision, salaries, and career opportunities that are needed.
Article
The People’s Health Movement
Ravi Narayan, Claudio Schuftan, Brendan Donegan, Thelma Narayan, and Rajeev B. R.
The People’s Health Movement (PHM) is a vibrant global network bringing together grass-roots health activists, public interest civil society organizations, issue-based networks, academic institutions, and individuals from around the world, particularly the Global South. Since its inception in 2000, the PHM has played a significant role in revitalizing Health for All (HFA) initiatives, as well as addressing the underlying social and political determinants of health with a social justice perspective, at global, national, and local levels.
The PHM is part of a global social movement—the movement for health. For more than a century, people across the world have been expressing doubts about a narrowly medical vision of health care, and calling for focus on the links between poor health and social injustice, oppression, exploitation, and domination. The PHM grew out of engagement with the World Health Organization by a number of existing civil society networks and associations. Having recognized the need for a larger coalition, representatives of eight networks and institutions formed an international organizing committee to facilitate the first global People’s Health Assembly in Savar, Bangladesh, in the year 2000. The eight groups were the International People’s Health Council, Consumer International, Health Action International, the Third World Network, the Asian Community Health Action Network, the Women’s Global Network for Reproductive Rights, the Dag Hammarskjold Foundation and Gonoshasthaya Kendra. All these groups consistently raised and opposed the selectivization and verticalization of Primary Health Care (PHC) that followed Alma Ata leading to what was called Selective PHC (i.e., not the original comprehensive PHC). These groups came together to organize the committee for the first People’s Health Assembly and then to form the Charter Committee that led to the People’s Health Charter, which finally led to the actual PHM.
Within PHM, members engage critically and constructively in health initiatives, health policy critique, and formulation, thus advancing people’s demands. The PHM builds capacities of community activists to participate in monitoring health-related policies, the governance of health systems, and keeping comprehensive PHC as a central strategy in world debate. The PHM ensures that people’s voices become part of decision-making processes. The PHM has an evolving presence in over 80 countries worldwide, consisting of groups of individuals and/or well-established PHM circles with their own governance and information-sharing mechanisms. It additionally operates through issue-based circles across countries.
Article
The Politics of Primary Health Care
David Sanders and Louis Reynolds
The global project to achieve Health for All through Primary Health Care (PHC) is a profoundly political one. In seeking to address both universal access to health care and the social determinants of health (SDH) it challenges power blocs which have material vested interests in technical approaches to health and development.
The forces that have shaped PHC include Community Oriented Primary Care and the Health Centre Movement, the “basic health services approach,” and nongovernmental and national initiatives that exemplified comprehensive and participatory approaches to health development. The 1978 Alma-Ata Declaration codified these experiences and advocated Health for All by the year 2000 through PHC. It emphasized equitable and appropriate community and primary-level health care as well as intersectoral actions and community participation to address the social and environmental determinants of health. This would need the support of a new international economic order.
The concept of “Selective Primary Health Care” emerged soon after Alma-Ata, privileging a limited set of technical interventions directed at selected groups, notably young children. This was soon operationalized as UNICEF’s Child Survival Revolution. The visionary and comprehensive policy of PHC was further eroded by the 1970s debt crisis and subsequent economic policies including structural adjustment and accelerated neoliberal globalization that deregulated markets and financial flows and reduced state expenditure on public services. This translated, in many countries, as “health sector reform” with a dominant focus on cost efficiency to the detriment of broad developmental approaches to health. More recently this selective approach has been aggravated by the financing of global health through public-private partnerships that fund specific interventions for selected diseases. They have also spawned many “service delivery” NGOs whose activities have often reinforced a biomedical emphasis, supported by large philanthropic funding such as that of the Gates Foundation.
Educational institutions have largely failed to transform their curricula to incorporate the philosophy and application of PHC to inform the practice of students and graduates, perpetuating weakness in its implementation.
Revitalizing PHC requires at least three key steps: improved equity in access to services, a strong focus on intersectoral action (ISA) to address SDH and prioritization of community-based approaches. The third sustainable development goal (SDGs) focuses on health, with universal health coverage (UHC) at its center. While UHC has the potential to enhance equitable access to comprehensive health care with financial protection, realizing this will require public financing based on social solidarity. Groups with vested interests such as private insurance schemes and corporate service providers have already organized against this approach in some countries. The SDGs also provide an opportunity to enhance ISA, since they include social and environmental goals that could also support the scaling up of Community Health Worker programs and enhanced community participation.
However, SDG-8, which proposes high economic growth based substantially on an extractivist model, contradicts the goals for environmental sustainability. Human-induced environmental degradation, climate change, and global warming have emerged as a major threat to health. As presciently observed at Alma-Ata, the success of PHC, and Health for All requires the establishment of a new, ecologically sustainable, economic order.
Article
The Use of Appropriate Sanitation Technology in Low-Income and Informally Occupied Areas: A Case Study of EMBASA’s Experience With the Condominial Sewerage System in Salvador da Bahia, Brazil
Júlio Mota and Ivan Paiva
This article describes how the State of Bahia Water and Sanitation Company (Empresa Baiana de Águas e Saneamento [EMBASA]) expanded sewerage coverage in the city of Salvador, in the state of Bahia, Brazil. In 2021, the city had a sewerage network that served over 80% of its population, despite the fact that at least 70% of the city was composed of informal settlements. To overcome the enormous challenges of installing sewerage systems in areas with informal settlements, EMBASA decided to use the condominial sewerage model, a methodology that combines technical changes in the design of the collection systems coupled with a strong community participation component. The principal technical changes in the collection system were adapting the solution to local circumstances in each neighborhood, universalization of service, the use of the concept of microsystems (subbasins), and the use of the urban block as the basic collection unit. The methodology was first used during a program to expand the sanitary sewerage system of Salvador between 1995 and 2004, when household connections to the sanitary sewage system increased from 26% to 60% in the municipality. The condominial sewerage methodology was adopted because it was the only system capable of solving the enormous problems of informal occupation, community participation, and social inequality, among other things. With the success of the program, investments in sanitary sewerage were continued, and in 2021, the connection rate was 81%. Many challenges to increasing coverage remained, especially those related to the occupation of urban land, which continued in a disorderly manner; social inequalities; and changes in the sanitation regulatory framework.
Article
Traditional Chinese Medicine and Public Health
Paul Unschuld
In many countries, Traditional Chinese Medicine has acquired a status similar to other historical healthcare systems that are not at all or only partially legitimated by modern science, such as Ayurveda and homeopathy. They all contribute in one way or another to the health of the public. And yet, Chinese medicine eludes inclusion in modern, global public health concepts. Its focus on the individual patient-healer relationship, its diverse non-Chinese terminologies, often developed by individuals regardless of the historical meaning of the original Chinese terms, and an increasingly uncoordinated development of TCM in China and the rest of the world, with heterogenous educational standards resulting in very different skill levels of practitioners, make it impossible to draw far-reaching conclusions and contribute generalizable suggestions for the continued improvement of global public health.
Article
Traditional Medicine and Indigenous Health in Indigenous Hands
Gerard Bodeker and Kishan Kariippanon
An estimated 370 million Indigenous people reside in 90 countries and make up 5% of the global population. Three hundred million Indigenous people live in extremely disadvantaged rural locations. Indigenous people have suffered from historic injustices due to colonization and the dispossession of their lands, territories, and resources, thus preventing them from exercising their right to development according to their own needs and interests. Across the board, Indigenous people have poorer health outcomes when compared to their non-Indigenous fellow citizens.
Cancer, respiratory disease, endocrine, nutritional, and metabolic disorders, primarily diabetes, affect Indigenous people disproportionately. Newborns of Indigenous women are more than twice as likely to be of low birth weight as those born to non-Indigenous women. Indigenous rates of suicide are the highest in the world.
For public health to be effective, a social determinants approach, along with health interventions, is insufficient to create lasting health impact. Partnerships with Indigenous organizations, Indigenous researchers, and the professionalization of health workers is essential. Integration of traditional medicine and traditional health practitioners can enable the Western biomedical model to work in partnership with Indigenous knowledge systems and become more locally relevant and accountable.
The Indigenous health workforce is increasingly using evidence-based, innovative approaches to address the shortage of health professionals as they move toward universal health coverage. Internet, mobile, and communication technologies are enhancing the mobilization of Indigenous health efforts and the support for health workers in rural locations. Presented are country examples of integrated medicine and Indigenous partnerships that effectively implement health interventions.
Article
Urban Guerrilla Gardening and Health
Alec Thornton
The benefits of gardening for mental and physical health are well known. Gardening is also recognized as a local-level or grassroots response to the negative effects of climate change and global warming. In urban areas, dense neighborhoods, limited green spaces, contaminated brownfield sites, and, at times, restrictive council regulations on the public use of parks and verges can act as barriers to gardening. In the 1970s, guerrilla gardening emerged as a clandestine, environmentally conscious, grassroots activity to reclaim and transform neglected or derelict urban spaces into healthy green spaces. Although not as subversive since its inception, guerrilla gardening in cities is as much a recreational activity as it is an ecological statement of urban activism, which effectively provides urban dwellers an entry point to engage with the outdoors for the planting of edible and nonedible plants in artificial places and spaces where natural life struggles to exist. Guerilla gardening has been impactful to city life through its contributions and controversies in improving urban ecosystems, educating neighbors on nutrition and food production where gardens crop up, and broadly to the health of humans (and other creatures) who live there.
Article
Urban Health and Disaster Resilience
David Sanderson, Ronak Patel, and Kelsey Gleason
As cities and towns across the world continue to grow to accommodate most of the world’s population increase, so too are they increasingly and often disproportionately exposed to the threat of natural hazards—including those worsened by climate change—such as floods, earthquakes, windstorms, and fires. Efforts that aim to enhance and safeguard urban health are those that seek to build the resilience of people and systems before, during, and after disasters. Yet where these efforts fail or fail to exist, components of vulnerability and urban diversity inform disaster risk. Taking a systems approach is especially essential to recognize the interconnected, complex, and dynamic issues that include and impact on the spectrum of urban health.
Article
Urban Health and Healthy Cities Today
Evelyne de Leeuw, Jean Simos, and Julien Forbat
The authors of this article purport that for current understanding of Healthy Cities it is useful to appreciate other global networks of local governments and communities. In a context where the local level is increasingly acknowledged as decisive in designing and implementing policies capable of tackling global threats such as climate change and their health-related aspects, understanding how thousands of cities across the world have decided to respond to those challenges appears essential. Starting with the concept of “healthy cities” in the 1980s, the trend toward promoting better living conditions in urban settings has rapidly grown to encompass today countless “theme cities” networks. Each network tends to focus on more or less specific issues related to well-being and quality of life. These various networks are thus not limited to more or less competing labels (Healthy Cities, Smart Cities, or Inclusive Cities, for instance), but entail significant differences in their approaches to the promotion of health in the urban context. The aim of this article is to systematically typify these “theme cities.” A typology of “theme cities” networks has several objectives. First, it describes the health aspects that are considered by the networks. Are they adopting a systemic perspective on all health determinants, such as Healthy Cities, or are they focusing on “hardware” determinants like Smart Cities? Second, it highlights the key characteristics of the networks. For instance, are they pushing for technological solutions to health problems, like Smart Cities, or are they aiming at strengthening communities in order to mitigate their detrimental effects, like Creative Cities? Third, the typology has the potential to be used as an analytical tool, for example, in the comparison of the results obtained by different types of networks in urban health issues. Finally, the typology offers a tool to enhance both transparency and participation in the policymaking process taking place when selecting and engaging in a network. Indeed, by clarifying the terms of the debate, decisions can be made more explicit and achieve a greater level of congruence with the overall objectives of the city. Indeed, Healthy Cities today need to make alliances with other theme networks, and this typology gives the keys to find which networks are the “natural best allies,” avoiding mutually harmful antagonisms. In that sense, the typology developed should be of interest to any actor involved in health promotion at the city level, whether in an existing “theme cities” policy process or as willing to participate in such a program, and to scholars interested in better understanding the main drivers of “theme cities” networks, a rapidly growing field of study.
Article
Urban Health in Latin America and the Caribbean
Luiz Galvão, Waleska Teixeira Caiaffa, Solimar Carnavalli Rocha, and Bernhard Liese
Urbanization can enhance the quality of life in cities and promote healthy living conditions. Unfortunately, according to the World Health Organization, 24% of urban populations live in unhealthy slums, making early intervention and public policies imperative. While urban areas have the advantage of access to essential services like transportation and healthcare, inadequate planning can lead to health issues.
Rural populations also face challenges accessing safe drinking water and sanitation, leading to unequal distribution of drinking-water quality. Climate change exacerbates these issues, resulting in conflicts, social and economic instability, and adverse environmental and public health effects. Additionally, population growth and improved water access have intensified wastewater treatment problems, and waste generation remains a significant issue in Latin America. Homeless communities in urban areas are particularly vulnerable to crises like COVID-19 and climate change. Access to healthcare is crucial for urban health, but half of the population lacks this access, leading to poverty due to healthcare expenses. Promoting social equity through healthcare access is vital.
The United Nations recognizes the devastating impact of COVID-19 and calls for a transformative approach to rebuild economies that prioritize social equity and environmental sustainability. Sustainable development policies can combat poverty, hunger, climate change, and environmental degradation. The Barcelona Institute for Global Health has developed a framework that connects healthy urban development to the sustainable development goals, emphasizing intersectoral work, health equity, and data quality. However, COVID-19 has severely affected the implementation of the 2030 Agenda.
Research in Brazil and Latin America reveals that economic segregation and inequality contribute to higher homicide rates and lower life expectancy. Effective urban policies can improve population health, and understanding the factors that impact elderly health can lead to better planning for active aging and reducing health disparities.
Successful approaches to research and addressing urban health issues involve interdisciplinary collaboration among academia, public and private sectors, and communities. Policies that impact health, with particular attention to the social, economic, and urban determinants of health in urban areas, are essential. The aim of the authors of this article, as public health researchers, is to identify targets for large-scale policy interventions in these areas.
The Belo Horizonte Observatory for Urban Health was founded in 2002 through a process led by the local university and health services to bring together academics and public sector services as part of a broader agenda to strengthen local and national health systems. This model could be a modern approach to Urban Health and play a central role in the current global health challenges.
Article
Urban Homelessness Policy in OECD Nations
Charley E. Willison and Amanda I. Mauri
Homelessness is a public health challenge for modern governments. Homelessness emerged as a formal policy problem for rich nations in the mid- to late 20th century as nations developed stable economies and democracies, including housing and job markets, and social welfare mechanisms to protect citizens from disenfranchisement. In early 21st-century Organisation for Economic Co-operation and Development (OECD) nations, homelessness arises most often among at-risk or vulnerable populations, such as historically marginalized groups and/or persons with constrained access to welfare state mechanisms, such as immigrants or refugees. Thus, homelessness in OECD nations is very different from informal housing or mass poverty in poor nations and/or non-democratic regimes.
Homelessness affects individual and population health, requiring complex policy solutions across multiple domains of health, as well as intergovernmental coordination. Policy responses to homelessness vary across OECD nations in their approach and efficacy. There are four key factors influencing how OECD nations respond to homelessness: (a) the strength and inclusivity of the welfare state; (b) degrees of decentralization in homeless policy governance; (c) the strength, capacity, and inclusivity of the health and behavioral healthcare systems; and (d) the role of federated structures in health and welfare state policy. Overall, nations with weaker welfare states and health/behavioral healthcare systems face greater risks of homelessness. The inclusivity of these systems also shapes who may be eligible for protection or experience homelessness. Local governments, especially those in large metropolitan areas, are the frontline providers of homelessness services. Yet local governments are constrained at both ends: Policies designed, delivered, and funded at larger units of government—such as welfare state provisions—influence many of the determinants of homelessness, such as housing, and the resources available to subnational actors to combat homelessness. Local actors are also constrained by the degree of decentralization. Devolution of homelessness policy to smaller units of government or even solely to nongovernmental actors, through federated mechanisms or decentralization, may create barriers to locally tailored solutions by perpetuating disparities across jurisdictions and/or constraining authority and resources necessary to design or deliver homeless policy.
