The 21st century health challenge of slums and cities
The 21st century health challenge of slums and cities
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DOI：
10.1016/s0140-6736(05)71049-7
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发表时间：
2005-03-05
期刊：
影响因子：
168.9
通讯作者：
Carolini, G
中科院分区：
文献类型：
--
作者：
Sclar, ED;Garau, P;Carolini, G
千禧年计划在19世纪面临的挑战，当时第一波城市工业化浪潮给欧洲和美国不断增长的城市带来了令人不安的类似健康威胁。战略上有效的解决方案将不可避免地消除目前医疗服务、公共卫生和城市规划之间的专业界限。14.虽然抗逆转录病毒药物和抗疟疾治疗对于解决艾滋病毒/艾滋病和城市疟疾的迅速蔓延是必要的，但只有在健全的卫生系统中提供这些药物和治疗才能有效，该系统应具备强大和方便的公共卫生基础设施和健康的住房环境，包括通风良好和足够宽敞的住房，并提供安全饮用水和卫生设施。除非我们清楚地认识到，投资于加强世界穷人目前聚集的城市的公民和公共机构，不仅是对民主的投资，也是对全球健康的投资，否则这种局面就不会实现。帮助如何到达至少与期望的结果一样重要。把城市贫民当作被动的需要救助的对象是错误的。这种做法过去没有奏效，今后也不会奏效。在我们的调查中，我们目睹了世界上最贫穷城市中一些最贫穷的人所采取的减少城市健康问题的一些最有效的方法。在所有主要的成功案例中，基本的运作方式都是相似的：穷人有意义地参与改善他们所居住的贫民窟条件的进程。我们面临的挑战是帮助将这些参与性方法提高到可以显着改善城市环境和人口健康的规模。在经历了20年的私有化和国际金融机构决策者对政府的贬低之后，现在是时候改变方向，重新参与支持地方一级民主政府的进程，与城市贫民合作，明智地吸收和使用急需的外部援助。各国政府必须积极参与保健服务推广和公共保健基础设施的设计，明确打算让更多的城市穷人受益。保健教育方案必须针对与城市贫民特别相关的问题，包括伤害、暴力、心理健康问题、性传播疾病、艾滋病毒/艾滋病、结核病以及性健康和生殖健康问题。应系统地收集关于发病率和死亡率的城市内数据，因为目前一般无法获得这些数据。还需要更多的研究来了解更多
Millennium Project faced in the 19th century, when the first wave of urban industrialisation imposed uncomfortably similar health threats upon the growing cities of Europe and the USA. Strategically effective solutions will inevitably dissolve the present professional demarcations between medical services, public health, and urban planning. 14 While antiretroviral drugs and antimalarial treatments are necessary to address the rapid spread of HIV/AIDS and urban malaria, they are only effective if they are provided in the context of robust health systems with strong and highly accessible public health infrastructures and healthy housing environments, including well-ventilated and sufficiently spacious dwellings provided with safe drinking water and hygienic sanitation. This situation will not be achieved unless we clearly understand that investing in strengthening the civic and public institutions of the cities where the world’s poor are now congregating is more than an investment in democracy; it is also an investment in global health. How help arrives is at least as important as the desired outcome. It is a mistake to treat the urban poor as passive objects in need of rescue. That approach did not work in the past and it will not work in the future. In our investigations, we have witnessed some of the most effective approaches to reduction of urban health problems carried forward by some of the poorest people in the world’s poorest cities. Across the leading success stories, the underlying modus operandi is similar: the poor are meaningfully involved in the process of improving the slum conditions under which they live. The challenge we face is helping to bring these participatory approaches to a scale where they can measurably improve the urban environment and population health. After two decades of privatisation and disparagement of government by policymakers within international financial institutions, it is time to change direction and re-engage in the process of supporting democratic governments at the local level to work as partners with the urban poor to absorb and use sorely needed outside aid wisely.Specifically, governments must be actively involved in designing health-service outreach and public-health infrastructure with the explicit intention of reaching a greater share of the urban poor. Health education programmes must target issues particularly relevant to the urban poor, including injuries, violence, mental health issues, sexually transmitted diseases, HIV/AIDS, tuberculosis, and sexual and reproductive health issues. Intraurban data on morbidity and mortality should be systematically collected, as they are generally unavailable at present. More research is also needed to learn more