Assessment of urban ecosystem health and its influencing factors: a case study of Zibo City, China.

Urban ecosystem health is the foundation of sustainable urban development. It is important to know the health status of urban ecosystem and its influencing factors for formulating scientific urban development planning. Taking Zibo city as the study area, the indicators were selected from five aspects: ecosystem vigor, structure, resilience, service function and population health to establish an assessment index system of urban ecosystem health. The health level of urban ecosystem was assessed, and its changing trend was analyzed from 2006 to 2018 in Zibo. Furthermore, obstacle degree analysis and sensitivity analysis were used to quantitatively analyze the main obstacle factors and sensitivity factors affecting urban ecosystem health, so as to provide references for improving urban ecosystem health. The results showed that the health level of urban ecosystem in Zibo showed an upward trend from 2006 to 2018. The poor structure and ecological environment quality were the main obstacle factors to urban ecosystem health. The impact of changes in a single indicator on urban ecosystem health gradually decreased, but the sensitivity index of indicators had obvious differences. Urban ecosystem health was sensitive to changes in ecosystem structure and resilience. In the future, Zibo should strengthen ecological construction, optimize the industrial structure, and develop green economy to promote urban ecosystem healthy.

The Urban Environment and Cardiometabolic Health.

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Multisectoral interventions for urban health in Africa: a mixed-methods systematic review.

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

Citizen science and social innovation as citizen empowerment tools to address urban health challenges: The case of the urban health citizen laboratory in Barcelona, Spain.

Urban health faces significant challenges due to the rapid growth of cities and the concentration of population in urban settings that have a strong impact on people's health. The approach to characterize and address these challenges requires increased societal involvement and interdisciplinary solutions to ensure their effectiveness and democratic nature. With this purpose, it is necessary to explore methodologies for citizen participation that foster a critical understanding of the environment and promote their active role in generating scientific knowledge and change. This article describes the creation of a collaborative space for experimentation and learning that, through the intersection of citizen science and social innovation, aims to engage citizens in the research and diagnosis of their local environment, as well as in the design and implementation of local solutions, while raising awareness about the main challenges to urban health. Through a collaborative and participatory framework, the community identified relevant challenges to urban health they wanted to investigate, co-designed and developed the methodology for data collection and analysis, and ultimately, they devised, designed, and implemented innovative solutions based on the scientific evidence obtained. The framework and results of this project hold potential interest for the scientific community, facilities, institutions, and society by offering an innovative and participatory approach to addressing the present and future urban health challenges.

Community perceptions of community health worker effectiveness: Contributions to health behaviour change in an urban health district in South Africa.

BACKGROUND: Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage. OBJECTIVE: These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes. METHODS: A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction. RESULTS: Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6%). CONCLUSION: As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions.

Identifying childhood malaria hotspots and risk factors in a Nigerian city using geostatistical modelling approach.

Malaria ranks high among prevalent and ravaging infectious diseases in sub-Saharan Africa (SSA). The negative impacts, disease burden, and risk are higher among children and pregnant women as part of the most vulnerable groups to malaria in Nigeria. However, the burden of malaria is not even in space and time. This study explores the spatial variability of malaria prevalence among children under five years (U5) in medium-sized rapidly growing city of Akure, Nigeria using model-based geostatistical modeling (MBG) technique to predict U5 malaria burden at a 100 × 100 m grid, while the parameter estimation was done using Monte Carlo maximum likelihood method. The non-spatial logistic regression model shows that U5 malaria prevalence is significantly influenced by the usage of insecticide-treated nets-ITNs, window protection, and water source. Furthermore, the MBG model shows predicted U5 malaria prevalence in Akure is greater than 35% at certain locations while we were able to ascertain places with U5 prevalence > 10% (i.e. hotspots) using exceedance probability modelling which is a vital tool for policy development. The map provides place-based evidence on the spatial variation of U5 malaria in Akure, and direction on where intensified interventions are crucial for the reduction of U5 malaria burden and improvement of urban health in Akure, Nigeria.

How do urban green spaces influence heat-related mortality in elderly? A realist synthesis.

BACKGROUND: An important consequence of climate change for urban health is heat-related mortality. Vulnerable groups, especially elderly, will be the most affected. A solution put forward in many reports and policy documents is the introduction or expansion of urban green spaces. While they have a proven effect in decreasing the ambient temperature and reducing heat related mortality, the causal pathways are far from clear. Moreover, results vary for different contexts, population types and characteristics of green spaces as they are 'complex systems thrusted into complex systems'. To our knowledge, there is no systematic synthesis of the literature that examines the mechanisms by which and the circumstances under which green spaces work to decrease heat-related mortality for elderly. METHODS: We performed a realist synthesis- a theory-driven review method- to develop a complexity- and context-sensitive program theory. As a first step, a causal loop diagram was constructed which describes the possible pathways through which urban green spaces influence heat-related mortality in elderly. In a second step, one of the pathways - how they may lead to a reduction of heat-related mortality by increasing social capital - was further explored for underlying mechanisms, the context in which they work and the differentiated patterns of outcomes they generate. Literature was searched for evidence supporting or contradicting the initial programme theory, resulting in a refined theory. RESULTS: Results show how urban green space can impact on heat-related mortality in elderly by its influence on their exposure to outdoor and indoor heat, by improving their resilience as well as by affecting their access to treatment. Urban green spaces and their interactions with social capital affect the access to health information, social support, and the capacity for effective lobbying. Several mechanisms help to explain these observed demi-regularities, among others perceived behavioural control, perceived usefulness, receptiveness, ontological security, and self-interest. If and how they are triggered depends on the characteristics of the urban green space, the population, and other contextual factors. CONCLUSION: Looking into the impact of urban green spaces on heat-related mortality in elderly, researchers and policy makers should take interest in the role of social capital.

Critérios para municípios, cidades e comunidades saudáveis da Região das Américas

Os critérios regionais para Municípios, Cidades e Comunidades Saudáveis ​​(MCCS) das Américas, adotados na Reunião de Prefeitos para MCCS da Região das Américas em 2022, apresentam um conjunto de diretrizes de referência para fortalecer políticas, planos e programas públicos voltados para melhorar a saúde e o bem-estar das populações atendidas pelos governos locais. Baseia-se no reconhecimento do papel fundamental dos municípios na promoção de políticas públicas saudáveis, tendo em conta que estas transcendem o sector da saúde e o papel que os outros sectores têm, dado o impacto de todas as políticas públicas na saúde. Estes critérios são o resultado de um trabalho colaborativo e interdisciplinar com a participação de diferentes pessoas e instituições da Região, incluindo governos locais. Algumas considerações fundamentais para o desenvolvimento destes critérios foram as experiências das redes nacionais e subnacionais de municípios saudáveis, os critérios existentes em vários países da Região e as diretrizes da Organização Mundial da Saúde para cidades saudáveis. Os critérios estão agrupados em seis áreas de atuação política e para a implementação de cada uma é incluído um conjunto de ações recomendadas, bem como uma proposta de meios de verificação e indicadores de cumprimento. Destinam-se às equipes gestoras municipais, redes e associações de municípios da Região e aos ministérios da Saúde, como apoio a políticas que fortaleçam a inclusão da promoção da saúde como prioridade da gestão local. É expressamente reconhecida a heterogeneidade existente entre os governos locais, onde diferentes formas organizacionais, competências e disponibilidade de recursos abordam realidades diversas. Por isso, os critérios são concebidos com caráter proposital para se adaptarem a esta diversidade e devem ser contextualizados e priorizados em cada território. Sem dúvida, a aplicação destas orientações conduzirá à identificação de diferentes desafios e oportunidades que enriquecerão esta proposta.

Influence of Brazil's public health policies on physical activity promotion in urban areas

The research aims to determine the influence of Brazil's public health policies on promoting physical activity in urban areas. An overview of the impact of Brazilian public health initiatives on encouraging physical exercise in metropolitan areas is given in the study. Brazil has put in place a wide range of regulations to combat non-communicable disease and promote healthy living. The cornerstone of the approach is the National Health Promotion Policy, which highlights the incorporation of physical exercise into everyday activities. Research used smart PLS software to measure the research and generated informative results, including descriptive statistics, correlation coefficient, and smart PLS Algorithm model. The goal of infrastructure development, urban planning, and educational initiatives is to provide settings that support active living. Campaigns for health promotion and community involvement support these initiatives by raising awareness and encouraging behavioral change. These policies will only be successful if they are implemented well, are continuously assessed, and are flexible. Overall result found the positive and significant influence of Brazil's public health policies on physical activity promotion in the urban areas. Brazil's dedication to encouraging physical exercise indicates the global recognition of the significance of preventative health measures. Sustained endeavors towards this end might foster a more robust and engaged urban populace in Brazil (AU)

Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh.

INTRODUCTION: Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. METHODS: This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. RESULTS: Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. CONCLUSION: While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.

Implementing a social work care coordination model for children and youth with special health care needs in a rural-urban health system.

This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization. This model of pediatric outpatient care coordination provides a flexible and highly targeted approach for stratification of care and services based on the needs of the individual patient.

Criteria for Healthy Municipalities, Cities, and Communities in the Region of the Americas

The regional criteria for healthy municipalities, cities and communities (MCCS) of the Americas, adopted at the Meeting of Mayors for MCCS of the Region of the Americas in 2022, present a set of reference guidelines to strengthen public policies, plans and programs aimed at improving the health and well-being of the populations served by local governments. It is based on the recognition of the key role of municipalities in promoting healthy public policies, taking into account that these transcend the health sector and the role that other sectors have, given the impact of all public policies on health. These criteria are the result of collaborative and interdisciplinary work with the participation of different people and institutions in the Region, including local governments. Some key considerations for the development of these criteria were the experiences of national and subnational networks of healthy municipalities, the existing criteria in several countries in the Region and the World Health Organization guidelines for healthy cities. The criteria are grouped into six areas of political action and for the implementation of each one a group of recommended actions is included, as well as a proposal for means of verification and compliance indicators. They are addressed to municipal management teams, networks and associations of municipalities in the Region, and ministries of Health, as support for policies that strengthen the inclusion of health promotion as a priority of local management. The existing heterogeneity among local governments is expressly recognized, where different organizational forms, competencies and availability of resources address diverse realities. For this reason, the criteria are conceived with a purposeful nature to adapt to this diversity and must be contextualized and prioritized in each territory. Undoubtedly, the application of these guidelines will lead to the identification of different challenges and opportunities that will enrich this proposal.

Mouvement des municipalités, des villes et des communautés en santé des Amériques

Reconnaissant le rôle clé que jouent les gouvernements locaux dans la promotion de la santé et du bien-être de leurs populations, cette brochure présente le Mouvement des municipalités, villes et communautés saines (MCCS) des Amériques, une plateforme régionale de gouvernements locaux de la région, engagée avec la gouvernance locale pour la santé et le bien-être. Il s'adresse aux maires des Amériques et montre le contexte du Mouvement des municipalités, villes et communautés en santé, comment le Mouvement des municipalités, villes et communautés en santé est organisé, comment y adhérer et quelles opportunités il offre. Ce Mouvement dirigé par les maires se constitue comme une plateforme globale et intégratrice dans laquelle ont leur place les différentes initiatives de santé mises en œuvre en synergie au niveau local, y compris les réseaux existants. En même temps, il offre une excellente opportunité de nouer des alliances et des partenariats stratégiques avec d’autres acteurs engagés dans la santé et le bien-être. Toutes les gouvernements locaux engagés dans la santé et le bien-être peuvent rejoindre ce Mouvement. Les ministères de la Santé des pays de la Région ont joué un rôle central dans la promotion de municipalités, de villes et de communautés saines, avec la formation et le renforcement de réseaux nationaux et infranationaux de municipalités saines. De plus, la mise en réseau favorise l'échange d'expériences et la contribution aux politiques nationales et régionales.

Movimento de Municípios, Cidades e Comunidades Saudáveis das Américas

Este folheto apresenta o Movimento de Municípios, Cidades e Comunidades Saudáveis (MCCS) das Américas, uma plataforma regional de governos locais da Região, comprometidos com a governança local para a saúde e o bem-estar. Destina-se a prefeitos e prefeitas, e mostra como o Movimento MCCS é organizado, como se juntar e quais oportunidades ele oferece.

Assessing the contributions of an urban population health initiative to shift political priority towards cardiovascular health: three case studies from Brazil, Mongolia and Senegal.

BACKGROUND: The urban population health initiative was designed as a multidisciplinary, multisector programme to address cardiovascular (CV) disease, specifically hypertension and its underlying causes in the cities of Ulaanbaatar, Mongolia; Dakar, Senegal; and São Paulo, Brazil. This article aims to provide an overview of the history and dynamics of CV disease policy making in the three countries, to present the policy reform contributions of the initiative and its role in the policy agenda-setting framework/process in each country and to identify the enablers and challenges to the initiative for doing so. METHODS: A qualitative case study was conducted for each setting from November 2020 to January 2021, comprised of a document review, semi-structured in-depth interviews and unstructured interviews with stakeholders involved in the initiative. The literature review included documents from the initiative and the peer-reviewed and grey literature with a total of 188 documents screened. Interviews were conducted with 21 stakeholders. Data collection and thematic analysis was guided by (i) the Kingdon multiple streams conceptual framework with the main themes being CV disease problems, policy, politics and the role of policy entrepreneurs; and (ii) the study question inquiring on the role of the urban population health initiative at the CV disease policy level and enabling and challenging factors to advancing CV disease policy. Data were thematically analysed using the Framework Method. RESULTS: Each setting was characterized by a high hypertension and CV disease burden combined with an aware and proactive political environment. Policy outcomes attributed to the initiative were updating the guidelines and/or algorithms of care for hypertension and including revised physical and nutritional education in school curricula, in each city. Overall, the urban health initiative's effects in the policy arena, were most prominent in Mongolia and Senegal, where the team effectively acted as policy entrepreneur, promoting the solutions/policies in alignment with the most pressing local problems and in strong involvement with the political actors. The initiative was also involved in improving access to CV disease drugs at primary health levels. Its success was influenced by the local governance structures, the proximity of the initiative to the policy makers and the local needs. In Brazil, needs were expressed predominantly in the clinical practice. CONCLUSIONS: This multi-country experience shows that, although the policy and political environment plays its role in shaping initiatives, often the local priority needs are the driving force behind wider change.

Health and well-being for all: celebrating 35 years of the Healthy Cities Movement: WHO European Healthy Cities Network Annual Business Meeting and Technical Conference, 21–23 November, Utrecht, Netherlands (Kingdom of the): meeting report

This report provides a comprehensive overview of the proceedings and key discussions held during the 2023 WHO European Healthy Cities Annual Business Meeting and Technical Conference in Utrecht, Netherlands (Kingdom of the). It covers the opening session, plenary sessions, roundtable discussions, workshops, abstract presentation sessions, and business meetings, highlighting themes such as the transformative power of intersectoral collaboration, navigating challenges brought by the COVID-19 pandemic, and reflections on 35 years of the Healthy Cities Movement. Key topics addressed include climate change, health inequalities, the well-being economy, and youth engagement. The report also includes 12 practical recommendations from a political statement adopted by the network on advancing health in the well-being economy.

Political statement of the WHO European Healthy Cities Network: towards thriving societies - advancing health in the well-being economy

Cities are drivers of innovation across public and private sectors towards enabling an economy that works for everyone. The following Political Statement has been developed through consultation with member cities and WHO European Office for Investment for Health and Development and reflects commitment to the Health and Well-Being Economy Pilot initiated by the WHO European Healthy Cities Network. The pilot aims to bring expertise together to support action in cities towards well-being economies.