Understanding the varied effects of urban environments on our health have arisen through centuries of observation and analysis. Various units of observation, when compiled spatially or linearly, have provided considerable understanding of the causal pathways between environmental exposures in cities and associated mortality and morbidity. With growing urban agglomerations and a digital age providing timely and standardized data, unique insights are being provided that further enhance the understanding of urban health. No longer is there a potential lack of urban data; over the 2010–2020 decade alone, the resolution and standardization of satellite and street imagery, for example, alongside methods of artificial intelligence such as self-supervision methods, have meant that technology and its capacity have surpassed the accuracy and resolution of many administrative data collections typically used for urban health research. From Bills of Mortality in 1665 to 20th century surveillance systems to the innovation and global reach in the period of “big data,” data has been the mainstay of decision support systems over the centuries. This new world of big data characterized by volume, velocity, variety, veracity, variability, volatility, and value is paramount to answering the significant urban health challenges of the 21st century.
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Big Data and Urban Health
Mark Stevenson, Jason Thompson, and Thanh Ho
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Digital Public Health: Quality, Interoperability and Capability Maturity
Siaw-Teng Liaw
Digitalization was accelerated to address the access, safety and quality needs of health professionals and citizens during care provision in the presence of human, animal and environmental vectors of pandemic infections. Digital transformation will harness cloud computing, artificial intelligence (AI), data networks and personalized digital agents, sensors, and visualization tools to monitor and enhance the care of individuals, populations and communities. A sociotechnical, multidisciplinary, and enterprise-wide approach is essential to improve the quintuple aims of cost-effectiveness, provider and patient well-being, and equity. Digitally competent health professionals and digitally mature health organizations are necessary to produce and use high-quality interoperable digital data and technologies to improve decisions and practice. The maturity of five essential digital health foundations (infrastructure, tools/agents, readiness to share information, enablers of trust and adoption, and quality improvement) is assessed across the micro–meso–macro continuum. The Digital Health Profile and Maturity Assessment Toolkit Maturity Model illustrates a sociotechnical capability maturity approach to assess how organizations manage, govern, improve, and sustain the ethical and safe production, use and sharing of digital health tools and data in the real world. The linkage and convergence of real-word data (RWD) from public health, clinical and managerial practice highlights potential cost-efficiencies in integrated data collection, reporting, aggregation, analysis, and use. Challenges include access, quality, and interoperability of RWD and tools. AI-driven data analytics is increasingly being used, despite misgivings about trustworthiness, biases and fairness of software agents, algorithms, and training data sets. The sociotechnical approach emphasizes leadership, inclusive governance, mutual trust, and reciprocity within a cocreation paradigm; communities of learning and practice operating within regulatory frameworks that promote quality, safety, and equitable access to digital tools and data; quality improvement and professional development programs aimed to improve digital health maturity; and science and digital health diplomacy to harmonize the multiplicity of actors and technology in digital public health ecosystems and global supply chains. Learning organizations that “think small and big simultaneously” within a standards-based cocreation paradigm will create the digital assets and social capital necessary for the national and global digital public health enterprise.
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Occupational Health Challenges for Immigrant Workers
Emily Q. Ahonen
Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.
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Priming Healthcare for Health Equity Management
Ebbin D. Dotson, Kimson E. Johnson, and Jada Irving
Health equity management (HEM) is defined as an actionable framework that supports the development of an industry-defining position for healthcare organizations and senior leaders to guide their business practices for investments in and financial gains from health equity. As healthcare leaders confront the disparate racial and ethnic burdens caused by the nation’s racialized societal history, making investments that increase health equity can help eliminate health disparities. To achieve health equity, leaders must cultivate a sense of interdependence among stakeholders and community members to effectively communicate the importance of collaboration, which is a shared understanding of the necessary actions that engage stakeholders around a central purpose. Achieving health equity forces healthcare systems to consider the notion that creating an equitable environment, where the costs of health inequity and barriers to achieving community and population health are shared with stakeholders and community members, might be addressed by the modification of certain management practices.
HEM encompasses an applied management model to help healthcare organizations maximize their efforts to increase health equity for vulnerable populations. It provides a stepwise approach to help frame the social, economic, and educational changes necessary for leaders to invest in health equity initiatives. The HEM involves the following actions: (a) redefining health equity, (b) identifying upstream inequalities, (c) realigning fiscal investments, and (d) leveraging community partnerships. Establishing and sustaining health equity initiatives through HEM ensures that both economic and social criteria are systematically considered, and financial investments are prioritized for sustained impact. Without addressing all four, the efforts of healthcare organizations will fall short of what it will take to effect lasting change.
Redefining health equity requires incorporating upstream and downstream inequities to offer a lens to align mission, assess capacity, and leverage profitable partnerships. The systematic approach to HEM goals and principles can be integrated at various organizational levels as a tool to successfully address health inequalities and social determinants of health.
