The current disconnection between access to increasing amounts of data about urbanization, health, and other global changes and the conflicting meanings and values of that data has created uncertainty and reduced the ability of people to act upon available information which they do not necessarily understand. We see a disconnection between increasing data availability and data processing capability and capacity. In response to this disconnection, modeling has been attributed an important role in international and national research programs in order to predict the future based on past and recent trends. Predictive models are often data heavy and founded on assumptions which are difficult to verify, especially regarding urban health issues in specific contexts. Producing large volumes of data warrants debate about what data are prerequisites for better understanding human health in changing urban environments. Another concern is how data and information can be used to apply knowledge. Making sense of empirical knowledge requires a new transdisciplinary knowledge domain created by a commitment to convergence between researchers in multiple academic disciplines and other actors and institutions in cities. Disciplinary-based researchers are no longer the sole producers of empirical knowledge. Today, diverse kinds of knowledge are becoming an emergent product of multiple societal stakeholders acting collectively to address challenges that impact on their habitat, their livelihood, and their health. Insights from complexity science also require a fundamental rethinking of the role and responsibility of human agency while admitting rather than denying complexity and radical uncertainty.
Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.
Cities are complex adaptive systems whose responses to policy initiatives emerge from feedback interactions between their parts. Urban policy makers must routinely deal with both detail and dynamic complexity, coupled with high levels of diversity, uncertainty and contingency. In such circumstances, it is difficult to generate reliable predictions of health-policy outcomes. In this paper we explore the potential for low-order system dynamics (LOSD) models to make a contribution towards meeting this challenge. By definition, LOSD models have few state variables (≤5), illustrate the non-linear effects caused by feedback and accumulation, and focus on endogenous dynamics generated within well-defined boundaries. We suggest that experience with LOSD models can help practitioners to develop an understanding of basic principles of system dynamics, giving them the ability to 'see with new eyes'. Because efforts to build a set of LOSD models can help a transdisciplinary group to develop a shared, coherent view of the problems that they seek to tackle, such models can also become the foundations of 'powerful ideas'. Powerful ideas are conceptual metaphors that provide the members of a policy-making group with the a priori shared context required for effective communication, the co-production of knowledge, and the collaborative development of effective public health policies.
The term "co-benefits" refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.
This case study investigates the connections among urban planning, governance and dengue fever in an emerging market context in the Global South. Key informant interviews were conducted with leading figures in public health, urban planning and governance in the planned city of Putrajaya, Malaysia. Drawing on theories of urban political ecology and ecosocial epidemiology, the qualitative study found the health of place - expressed as dengue-bearing mosquitoes and dengue fever in human bodies in the urban environment - was influenced by the place of health in a hierarchy of urban priorities.
The local Chow Kit market is the largest wet market in the city of Kuala Lumpur. It is very close to the biggest government hospital in the city centre. However, the level of cleanliness in this area is always questionable and a matter of concern. The aim of this study was to identify the prevalence of T. gondii oocyst in water samples used by hawkers in that market and tissue cysts in rats' brains captured from the same area. Water samples were taken to the parasitology laboratory at the National Universtiy of MalaysiaUniversity and a sugar flotation concentration method was used. Supernatant microscopical examination was then performed. A total of 752 slides were screened for the presence of T. gondii oocyst. A hundred rats wandering in the same area were also captured by the hawkers using mousetraps. After each animal was sacrificed, and an electric microtome was used to cut out serial sections 5 microm thick from the rat brains. The de-waxed tissue sections were stained by the progressive Haematoxylin and Eosin (H&E) stain for microscopical examination. A total of 1000 slides were screened under a light microscope to detect the presence of T. gondii brain cysts. All the water samples were found to be negative for T. gondii oocyst. Out of the 100 rats captured, three rats were found to possess T. gondii cysts in their brains. Water samples reflect minimal or no solid food contamination, while the 3% of positive brain cysts influence the researchers to broaden their investigations for future projects.
Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.
Health has been the main driver for many urban environmental interventions, particularly in cases of significant health problems linked to poor urban environmental conditions. This paper examines empirically the links between climate change mitigation and health in urban areas, when health is the main driver for improvements. The paper aims to understand how systems of urban governance can enable or prevent the creation of health outcomes via continuous improvements in the environmental conditions in a city. The research draws on cases from two Indian cities where initiatives were undertaken in different sectors: Surat (waste) and Delhi (transportation). Using the literature on network effectiveness as an analytical framework, the paper compares the cases to identify the possible ways to strengthen the governance and policy making process in the urban system so that each intervention can intentionally realize multiple impacts for both local health and climate change mitigation in the long term as well as factors that may pose a threat to long-term progress and revert back to the previous situation after initial achievements.
Prehypertension is one of the most common conditions affecting human beings worldwide. It is associated with several complications including hypertension. The blood pressure between normal and hypertension is prehypertension as per the Seventh Report Joint National Committee (JNC-7) classification. The current study was done to measure the magnitude of prehypertension and to study their sociodemographic correlates in the urban field practice area of Kasturba Medical College, Mangalore, India, among 624 people aged ≥20 years. The measurements of blood pressure were done (JNC 7 criteria) with the anthropometric measurements and lifestyle factors. Data analysis was done using Statistical Package for Social Sciences version 16. Adjusted odds ratios were calculated. Overall, 55% subjects had prehypertension and 30% had hypertension. Prehypertension was higher among males. Those from the higher age groups, those from upper socioeconomic status, obese individuals, and those with lesser physical activity had significantly higher association with prehypertension, and it was least among those who never used tobacco and alcohol.
The influence of soil texture (silt, sand and laterite) and flotation solutions (saturated NaCl, sucrose, NaNO3, and ZnSO4) upon the recovery of Toxocara ova from seeded soil samples with the centrifugal flotation technique was investigated. Soil samples of different texture were artificially seeded with Toxocara spp. ova and subjected to a centrifugal flotation technique which used various flotation solutions. The results showed significant (P < 0.001) interactions between the soil types and the flotation solutions. The highest percentage of ova recovery was obtained with silty soil (34.9-100.8%) with saturated NaCl as the flotation solution (45.3-100.8%). A combination of washing of soil samples with 0.1% Tween 80, and flotation using saturated NaCl and a 30 min coverslip recovery period was used to study the prevalence of contamination of soil samples. Forty-six soil samples were collected from up to 24 public parks/playgrounds in urban areas of Petaling Jaya and suburban areas of Serdang. The prevalence of Toxocara species in the urban and suburban areas was 54.5% and 45.8% respectively.
In a study of mild to significant malnutrition in an urban squatter settlement, the weights for age of 297 children between birth and ten years, and the heights for age and weights for height of 197 children between two to ten years were analysed. Using NCHS standards, the overall prevalence of underweight was found to be 18.9%, stunting 15.2%, and wasting 11.2%. Age and ethnicity were significantly associated with the prevalence of underweight and stunting. The growth achievement of children below the age of two years were significantly better off than the older children, and Chinese children significantly better off than Malay and Indian children.
Sixty three and fifty nine non-insulin dependent diabetes mellitus (NIDDM) patients in rural (land resettlement scheme) and urban areas respectively were studied to determine factors associated with diabetic control. The anthropometric and metabolic data (HbA1 and fructosamine levels) were analysed. After adjusting for gender, age, body mass index (BMI) and food intake, the fructosamine level which correlates with short term diabetic control, was significantly lower among patients in urban areas compared to patients in rural areas (p < 0.05). However, for longer term diabetic control (HbA1 level) the difference was not statistically significant (p > 0.05). The socio-economic status, level of education, BMI and types of food did not correlate with diabetic control in either group of patients. More diabetes education is needed together with socio-economic development and changes in lifestyles to enhance compliance towards health and dietary regimens and to achieve better metabolic control.
A study was carried out to determine the distribution of cockroaches in two different housing areas with central sewerage or individual septic tanks in an urban area in Kuala Lumpur, Malaysia. Six species of cockroaches were present and of these Periplaneta americana and Periplaneta brunnea were found in greater abundance. Seventeen species of bacteria were isolated and of these Escherichia coli and Klebsiella p. pneumoniae were isolated in greatest numbers. Control measures carried out using lambda cyhalothrin showed that there was no significant difference between treated and control sites.