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A Comparative Analysis of Global Datasets and Initiatives for Urban Health and Sustainability.

ABSTRACT: Globally, urban populations are growing rapidly, and in most cases their demands for resources are beyond current limits of sustainability. Cities are therefore critical for achieving national and international sustainability objectives, such as greenhouse gas reduction. Improving sustainability may also provide opportunities for urban population health co-benefits by reducing unhealthy exposures and behaviours. However, there is currently sparse empirical evidence on the degree to which city characteristics are associated with variations in health-related exposures, behaviours and sustainability. This paper examines the feasibility of aggregating empirical data relating to sustainability and health for global cities. An initial scoping review of existing English-language datasets and networks is performed. Resulting datasets are analysed for data types, collection method, and the distribution of contributing cities across climates, population sizes, and wealth. The review indicates datasets are populated using inconsistent methodologies and metrics and have poor overlap of cities between them. Data and organisations tend to be biased towards larger and wealthier cities, and concentrated in Europe and North America. Therefore, despite vast amounts of available data, limitations of reliability, representativeness, and disparate sources mean researchers are faced with significant obstacles when aggregating data to analyse the sustainability and health of globally representative samples of cities.

SUBMITTER: Taylor J

PROVIDER: S-EPMC6614042 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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A Comparative Analysis of Global Datasets and Initiatives for Urban Health and Sustainability.

Taylor Jonathon J Haines Andy A Milner James J Davies Mike M Wilkinson Paul P

Sustainability 20181011 10

Globally, urban populations are growing rapidly, and in most cases their demands for resources are beyond current limits of sustainability. Cities are therefore critical for achieving national and international sustainability objectives, such as greenhouse gas reduction. Improving sustainability may also provide opportunities for urban population health co-benefits by reducing unhealthy exposures and behaviours. However, there is currently sparse empirical evidence on the degree to which city ch ...[more]

PMID: 31285859

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Project description:BackgroundWith much of the world's population residing in urban areas, an understanding of air pollution exposures at the city level can inform mitigation approaches. Previous studies of global urban air pollution have not considered trends in air pollutant concentrations nor corresponding attributable mortality burdens. We aimed to estimate trends in fine particulate matter (PM2·5) concentrations and associated mortality for cities globally.MethodsWe use high-resolution annual average PM2·5 concentrations, epidemiologically derived concentration response functions, and country-level baseline disease rates to estimate population-weighted PM2·5 concentrations and attributable cause-specific mortality in 13 160 urban centres between the years 2000 and 2019.FindingsAlthough regional averages of urban PM2·5 concentrations decreased between the years 2000 and 2019, we found considerable heterogeneity in trends of PM2·5 concentrations between urban areas. Approximately 86% (2·5 billion inhabitants) of urban inhabitants lived in urban areas that exceeded WHO's 2005 guideline annual average PM2·5 (10 μg/m3), resulting in an excess of 1·8 million (95% CI 1·34 million-2·3 million) deaths in 2019. Regional averages of PM2·5-attributable deaths increased in all regions except for Europe and the Americas, driven by changes in population numbers, age structures, and disease rates. In some cities, PM2·5-attributable mortality increased despite decreases in PM2·5 concentrations, resulting from shifting age distributions and rates of non-communicable disease.InterpretationOur study showed that, between the years 2000 and 2019, most of the world's urban population lived in areas with unhealthy levels of PM2·5, leading to substantial contributions to non-communicable disease burdens. Our results highlight that avoiding the large public health burden from urban PM2·5 will require strategies that reduce exposure through emissions mitigation, as well as strategies that reduce vulnerability to PM2·5 by improving overall public health.FundingNASA, Wellcome Trust.

Project description:BackgroundTo improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health systems of many industrialized countries trigger providers to optimize individual organizational goals rather than improve population health from a community perspective. Thus, a tension exists between the need to collaborate and the need to compete. Despite or because of this tension, community health partnerships are being promoted, and this should enforce a needs-based and integrated care delivery.MethodsIn this single case study, we retrospectively explored how local health-care providers in Amsterdam collaborated for more than 30 years, interacting with the changes to the national health-care system. In-depth analysis of interviews, documents and literature focused on the complex relationship between the activities of this health partnership, its nature and its changing context.ResultsThe findings revealed that the partnership itself was successful and sustainable over time, although the partnership lost its initial broad explorative nature and narrowed its strategic focus towards care of the elderly. Furthermore, the realized projects--although they enforced integrated care--lost their community-based character. This declining scope of community-based integrated care seems to have been influenced by the incremental introduction of regulated competition in Dutch health care. This casts doubts on the ability of health partnerships to apply a vision of community-based integrated care within the context of competition.ConclusionCollaborating health-care providers can build seamless continuums of care in a competitive environment, although these will not automatically maximize community health with limited resources. Active policies with regard to health system design, incentive structures and population-based performance measures are warranted in order to insure that community-based integrated care through health partnerships will be more than just policy rhetoric.

Project description:BackgroundTo date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in two cities: Ilorin, where the program ended in March 2015 and Kaduna where the program continued.MethodsData come from three time periods: 2011, before program implementation; 2014, near Phase 1 completion; and 2017, two-years post Phase 1. In 2011, we undertook a facility audit and provider surveys in all public sector facilities in each city as well as all private facilities mentioned as the source for FP or maternal, newborn, and child health services in a 2010 women's household survey. In 2014 and 2017, we returned to the same facilities to undertake the facility audit and provider surveys. Quality is measured from principal component analyses of 30 items from the facility audit and provider surveys. Service use outcomes are measured as the ratio of FP clients (total and new) to the number of reproductive health staff members. Multivariate random effect models are estimated to examine changes in the outcomes over time, between NURHI and non-NURHI facilities and by city.ResultsWe demonstrate that NURHI facilities had better quality and higher service use than non-NURHI facilities. Further, while quality of services was higher in Ilorin in 2011, by 2014 and three years later (2017), the quality was better in Kaduna where the program continued. In addition, while no difference was found in service utilization between Ilorin and Kaduna in 2014, by 2017, Kaduna had significantly more new FP users than Ilorin.ConclusionsIn Ilorin, quality of services did not continue its strong upward trend after the program ended. Programs need to consider long-term strategies that support continuation of program components post program implementation. This may include ensuring continued training of providers and addressing equipment and commodity stock-outs through system changes rather than specific facility-level changes. The findings from this study can be used to inform future programs seeking to improve quality of FP services in a sustainable manner.

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Dataset Information

A Comparative Analysis of Global Datasets and Initiatives for Urban Health and Sustainability.

Publications

A Comparative Analysis of Global Datasets and Initiatives for Urban Health and Sustainability.

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