NETWORKED DISEASE; EMERGING INFECTIONS IN THE GLOBAL CITY Edited by Harris Ali a
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Question
NETWORKED DISEASE; EMERGING INFECTIONS IN THE GLOBAL CITY Edited by Harris Ali and Roger Keil (Wiley-Blackwell, 2008): CHAPTER 2 – VICTOR RODWIN: HEALTH AND DISEASE IN GLOBAL CITIES: A NEGLECTED DIMENSION OF NATIONAL HEALTH POLICY
1. What are the four health risks that world cities confront?
2. Why is the evidence on health advantages and health penalties so confusing?
3. Is health policy typically made with careful systematic analysis of health systems in cities?
4. How does Manhattan compare to Tokyo , Paris and London when it comes to disparities between the health of residents in different neighborhoods?
5. The author says that NY does better in the area of tuberculosis than other indicators of health. Why?
6. How much authority does the NY Department of Health and Mental Hygiene (DHMH) have?
7. What is the burden on NY of uninsured “Americans, children living below the poverty line and recent immigrants” compared to other cities in the USA?
8. What are some of the dangers NYC has to face regarding health?
9. What are some of the ways that the DHMH has intergrated with other agencies to protect the health of its citizens?
10. England has a national health service. Is London’s Dept. of Health and Social Security centralized?
11. How does the health of citizens of Tokyo compare to the other global giant cities?
12. How is NYC prepared for carrying out health surveillance compared to the other global cities?
13. In all four cities how important is the “neighborhood” as far as targeted interventions goes?
14. Some cities are “hard and some are “soft” when it comes to protecting their citizens from some of the forces of globalization. Which one’s are hard, and which soft?
15. What areas of NYC has the Health Department targeted most in its attempt to deal with health problems?
Explanation / Answer
1. What are the four health risks that world cities confront:
While urban living continues to offer many opportunities, jobs and services, today’s urban environments can concentrate health risks and introduce new hazards.
Urban health risks are distributed unequally among social groups, with most of the burden concentrated among vulnerable segments, particularly those living in slum areas, where some 40% of urban population growth is occurring.
WHO estimates 63% of global mortality, about 36 million deaths per year, is due to noncommunicable diseases (NCDs). A large proportion of these deaths are attributable to risks related to the urban built environment. These risks include: physical inactivity and obesity, cardiovascular and pulmonary diseases from transport-generated urban air pollution, ischemic heart disease and cancers from household biomass energy use, asthma from indoor air pollution, and heat-related strokes and illnesses. Outdoor air pollution alone is responsible for 3.7 million deaths annually, mainly attributed to NCDs. Furthermore, physical inactivity is responsible for 3.2 million deaths annually, and traffic injuries cause some 1.3 million deaths annually – both health risks are likely to be much larger among urban populations.
Communicable diseases also are associated with an unhealthy urban environment. They include: airborne diseases such as tuberculosis resulting from crowding and lack of adequate ventilation; waterborne and vector-borne diseases such as dengue linked to unsafe water storage and poor waste management; acute respiratory diseases from indoor air pollution and mouldy housing interiors; and diarrhoeal diseases from unsafe drinking water and sanitation.
Importantly, cities are responsible for a large amount of air and climate pollutants emissions, such as CO2, black carbon and methane.
Despite the complicated and inefficient nature of its oversight, American health care has flourished over the past hundred years. Rather than hindering its progress, the complex system of regulation, for all of its flaws, may actually have served to support and nurture the overall enterprise.
Consider, for example, the public confidence that is engendered in the competence of physicians through licensure requirements and in the safety and efficacy of prescription drugs through the FDA approval process. These programs enhanced overall respect for major elements of the health care system and greatly expanded markets for the goods and services that they provide. Regulatory programs that include major funding components, such as Medicare and research support administered by the National Institutes of Health (NIH), serve an additional role of creating a financial base for key sectors of the industry.
Viewing the system in this way may help to provide perspective for those who have to navigate it. It is also important to consider the underlying nature of the system, with both its positive and negative elements, in evaluating proposals for reform.
A more thorough presentation of the regulatory structure of the health care industry and the themes that drive it can be found in my book.
2.Why is the evidence on health advantages and health penalties so confusing
Health and Human Services
When families move into urban areas, they automatically place themselves in closer proximity to basic services such as hospitals and schools -- urbanization often brings health care and educational opportunities to those who might not have had access to them in rural areas. Cities also offer public transportation, government run sanitation services and social programs such as libraries, health clinics and children's programs. For many people, especially in developing countries, access to these services offers many advantages in terms of creating opportunities.
Job Opportunities
As large-scale agriculture displaces many traditional farmers from the rural lifestyle, the tremendous growth of modern industry in large urban areas attracts people with the promise of employment. In general, urban wages are significantly higher, so moving to the city is an opportunity to earn that was impossible in rural areas. However, the wage difference is often offset by the higher cost of living and absence of self-produced goods, including subsistence farming.
Inequality, Crime and Poverty
Those who move from rural areas to urban ones sometimes find themselves living in shanty towns or slum areas. These new city residents are faced with problems that do not exist in the countryside: street crime, including gangs, as well as social inequality and discrimination. The urban poor struggle to make a living, even if they do earn more than they did in rural areas, because the cost of city life is significantly higher and the opportunities to produce their own food and other basic necessities is greatly reduced.
Pollution and Contamination
Traffic congestion and industrial manufacturing, prominent features of the urban landscape, also take their toll on the natural environment and those who depend on it. Lack of clean water is a major problem among the urban poor in major cities around the world, as is air pollution from both cars and factory emissions. In fact, according to an article in the "British Medical Journal," almost 10 percent of the world's disease burden is now caused by pollution and contamination, and the number is significantly higher among the poor in developing countries. For many, and especially those who moved to urban areas for opportunity, city living proves deadly in ways not known in the countryside.
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