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Urban planning and public health at CDC.

Urban planning, also called city and regional planning, is a multidisciplinary field in which professionals work to improve the welfare of persons and communities by creating more convenient, equitable, healthful, efficient, and attractive places now and for the future. The centerpiece of urban planning activities is a "master plan," which can take many forms, including comprehensive plans, neighborhood plans, community action plans, regulatory and incentive strategies, economic development plans, and disaster preparedness plans. Traditionally, these plans include assessing and planning for community needs in some or all of the following areas: transportation, housing, commercial/office buildings, natural resource utilization, environmental protection, and health-care infrastructure. Urban planning and public health share common missions and perspectives. Both aim to improve human well-being, emphasize needs assessment and service delivery, manage complex social systems, focus at the population level, and rely on community-based participatory methods. Both fields focus on the needs of vulnerable populations. Throughout their development, both fields have broadened their perspectives. Initially, public health most often used a biomedical model (examining normal/abnormal functioning of the human organism), and urban planning often relied on a geographic model (analysis of human needs or interactions in a spatial context). However, both fields have expanded their tools and perspectives, in part because of the influence of the other. Urban planning and public health have been intertwined for most of their histories. In 1854, British physician John Snow used geographic mapping of an outbreak of cholera in London to identify a public water pump as the outbreak's source. Geographic analysis is a key planning tool shared by urban planning and public health. In the mid-1800s, planners such as Frederick Law Olmsted bridged the gap between the fields by advancing the concept that community design contributes to physical and mental health; serving as President Lincoln's U.S. Sanitary Commission Secretary; and designing hundreds of places, including New York's Central Park. By 1872, the disciplines were so aligned that two of the seven founders of the American Public Health Association were urban designers (an architect and a housing specialist). In 1926, the U.S. Supreme Court, in validating zoning and land-use law as a legal government authority in Village of Euclid v. Ambler Realty, cited the protection of public health as part of its justification. Other connections have included 1) pioneering urbanist Jane Jacobs, who during the 1960s, called for community design that offered safe and convenient options for walking, biking, and impromptu social interaction; and 2) the Healthy Cities movement, which began in Europe and the United States during the 1980s and now includes projects in approximately 1,000 cities that in various ways highlight the role of health as much more than the presence of medical care.

Centers for Disease Control and Prevention, U.S.↗

Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison.

BACKGROUND: Urban and rural populations have different rates of psychotic illness. If psychosis exists as a continuous phenotype in nature, urban-rural population differences in the rate of psychotic disorder should be accompanied by similar differences in the rate of abnormal mental states characterized by psychotic or psychosislike symptoms. METHODS: A random sample of 7076 individuals aged 18 to 64 years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview. Approximately half of those with evidence of psychosis according to the Composite International Diagnostic Interview were additionally interviewed by clinicians. We investigated associations between a 5-level urbanicity rating and (1) any DSM-III-R diagnosis of psychotic disorder (sample prevalence, 1.5%), (2) any rating of hallucinations and/or delusions (sample prevalence, 4.2%), and (3) any rating of psychotic or psychosislike symptoms (sample prevalence, 17.5%). RESULTS: Level of urbanicity was associated not only with DSM-III-R psychotic disorder (adjusted odds ratio [OR] over 5 levels, 1.47; 95% confidence interval [CI], 1.25-1.72), but also, independently, with any rating of delusion and/or hallucination (adjusted OR, 1.28; 95% CI, 1.17-1.40; clinician-assessed psychotic symptoms only: OR, 1.30; 95% CI, 1.03-1.64) and any rating of psychosislike symptom (adjusted OR, 1.18; 95% CI, 1.13-1.24). Psychotic symptoms were strongly and independently associated with psychotic disorder, regardless of the level of urbanization. CONCLUSIONS: Community level of psychotic and psychosislike symptoms may be inextricably linked to the prevalence of psychotic disorder. The prevalence of abnormal mental states that facilitate development to overt psychotic illness increases progressively with level of urbanization.

Adolescent↗

Prevalence of glucose intolerance in urban and rural communities in Saudi Arabia.

The prevalence and associated factors for glucose intolerance among Saudi populations in urban and rural communities were investigated among 13177 subjects, 15 years and over, from different regions of Saudi Arabia. The data were standardized using the known age structure of the Saudi population. The sample was randomly selected from subjects who participated in the National Epidemiological Household Study for Chronic Metabolic Diseases. Medical and social history was ascertained from all the study population during house visits. All subjects were then requested to attend a local primary care centre for physical examination and phlebotomy for measurement of random plasma glucose (RPG). A 75 g oral glucose tolerance test was employed for subjects with borderline values. WHO criteria for diagnosis of diabetes mellitus (DM) and impaired glucose tolerance (IGT) were applied. Mean RPG from the urban population was significantly higher than in the rural population. Age adjusted prevalence of DM was significantly higher in the urban population (males 12%, 95% CI 11-13 and females 14%, 95% CI 13-15) than in the rural population (males 7%, 95% CI 7-8 and females 7.7%, 95% CI 7-9) and is among the highest in the world. The prevalence of DM increased with age. The lowest and highest prevalences of DM in the urban population were 2% for subjects aged 15-20 years and 49% for female subjects aged 51-60 years. The lowest and highest prevalences of DM among rural population were 1% for subjects aged 15-20 years and 29% for female subjects over the age of 60 years. Fifty-six per cent of diabetic patients were newly diagnosed at the time of the study. Age adjusted prevalence of IGT was not significantly higher in the urban population. The highest prevalence of obesity, BMI>30, was among urban female subjects. Age, obesity, and family history of DM were associated with DM. Considering the young nature of Saudi population, the prevalence is expected to increase in the near future. There is a need to develop a multi-disciplinary approach for the general population with special attention to female subjects for prevention through controlling modifiable risk factors such as obesity and sedentary life style, improving glycemic control of the diabetic population, and early identification and treatment of diabetic complications.

Adolescent↗

Rural homes and urban dwellings? Gender, migration and the importance of tenure in Gaborone, Botswana.

"The issue of return migration has been widely debated in African migration literature in view of strong rural-urban ties and urban growth based largely on in-migration. On the basis of fieldwork in Botswana, it is argued that there are important gender differences in terms of the commitment to rural and urban areas. It has been postulated in past studies that the decision to remain in towns depends in part upon urban tenure and it is argued that home owners are more likely than tenants to be permanent urban dwellers. Again, there are important gender differences and women appear to be more committed to the urban dwelling than men."

Africa↗

Evaluating the environmental performance of urban parks in Mediterranean cities: an example from the Barcelona metropolitan region.

In a context of increasing urban sprawl and water scarcity common to other Mediterranean cities, this article focuses on the urban parks in the Region of Barcelona (Catalonia, Spain) to examine how these parks are distributed in this region and to assess whether their design and management follow criteria adapted to Mediterranean environmental conditions, especially in what concerns water use. In order to evaluate the environmental performance of these parks, we selected four factors possibly influencing the adoption of park management practices at the local scale: urban density, population size of the municipality, municipal income per capita, and political orientation of the city council. After determining the location and area of urban parks in the region, we correlated these four explanatory factors with several management tasks extracted from two different samples of parks (one of 315 parks and another of 125 parks) and a survey of 86 city councils. Results show that, in general, urban parks were more frequent in large, dense, and left/green municipalities but that environmentally sound practices were more common in small and low-density municipalities. We conclude that changes in certain practices (especially the substitution of high water demanding species) could improve significantly the environmental performance of public spaces in large urban areas with Mediterranean climates. Our observations may be pertinent for other cities interested in the provision of environmental public goods such as parks that necessitate water for irrigation.

Cities↗

Does women's literacy affect desired fertility and contraceptive use in rural-urban Pakistan?

The 1984-85 Pakistan Contraceptive Prevalence Survey showed that urban wives had more than twice the literacy rate of rural wives. The present study explored the relationship of the rural-urban gap in female literacy to differences in contraceptive use. In rural areas, literacy did not increase women's perceptions of having reached a 'sufficient' number of living children, although the opposite was true for urban areas. Yet rural women with an 'insufficient' number of living children were more likely to use contraception if they were literate, as did their urban counterparts. Thus, raising the literacy rate in rural Pakistan would not narrow the rural-urban gap in contraception to cease childbearing but would narrow the rural-urban gap in contraception used to space wanted births further apart. Recommendations for government policy are made.

Adolescent↗

Cities as harbingers of climate change: common ragweed, urbanization, and public health.

BACKGROUND: Although controlled laboratory experiments have been conducted to demonstrate the sensitivity of allergenic pollen production to future climatic change (ie, increased CO(2) and temperature), no in situ data are available. OBJECTIVE: The purpose of this investigation was to assess, under realistic conditions, the impact of climatic change on pollen production of common ragweed, a ubiquitous weed occurring in disturbed sites and the principal source of pollen associated with seasonal allergenic rhinitis. METHODS: We used an existing temperature/CO(2) gradient between urban and rural areas to examine the quantitative and qualitative aspects of ragweed growth and pollen production. RESULTS: For 2000 and 2001, average daily (24-hour) values of CO(2) concentration and air temperature within an urban environment were 30% to 31% and 1.8 degrees to 2.0 degrees C (3.4 degrees to 3.6 degrees F) higher than those at a rural site. This result is consistent with most global change scenarios. Ragweed grew faster, flowered earlier, and produced significantly greater above-ground biomass and ragweed pollen at urban locations than at rural locations. CONCLUSIONS: Here we show that 2 aspects of future global environmental change, air temperature and atmospheric CO(2), are already significantly higher in urban relative to rural areas. In general, we show that regional urbanization-induced temperature/CO(2) increases similar to those associated with projected global climatic change might already have public health consequences; we suggest that urbanization, per se, might provide a low-cost alternative to current experimental methods evaluating plant responses to climate change.

Allergens↗

Evidence for a significant urbanization effect on climate in China.

China has experienced rapid urbanization and dramatic economic growth since its reform process started in late 1978. In this article, we present evidence for a significant urbanization effect on climate based on analysis of impacts of land-use changes on surface temperature in southeast China, where rapid urbanization has occurred. Our estimated warming of mean surface temperature of 0.05 degrees C per decade attributable to urbanization is much larger than previous estimates for other periods and locations. The spatial pattern and magnitude of our estimate are consistent with those of urbanization characterized by changes in the percentage of urban population and in satellite-measured greenness.

Biomass↗

Urbanisation and cariogenic food habits among 4-24-month-old black South African children in rural and urban areas.

OBJECTIVE: To determine if social class, education level and group environment (rural and urban) influence particular food habits commonly associated with dental caries incidence among 4-24-month-old black South African children. DESIGN, SETTING AND SUBJECTS: Information was collected by trained interviewers using a food-frequency questionnaire from mothers of children in two areas in South Africa: Ndunakazi, a rural area in KwaZulu/Natal (n = 105) and two urban areas in Gauteng - Soweto (low to middle socio-economic area) (n = 100) and the northern suburbs of Johannesburg and Sandton (middle to upper socio-economic area) (n = 101). Education level and occupation of the parents, which define social class, were also recorded. A linear logistic (Proc Catmod) analysis tested social class, education level and group environment as the independent variables and the food habits as the dependent variables. RESULTS: Group environment was significantly associated with nine of the 18 food habits investigated. More urban than rural mothers added sugar to their child's comforter. More mothers in urban Soweto than in urban Johannesburg were still breast-feeding their infants at 24 months. More rural than urban mothers were giving 'mutis' (common and traditional medicines). Together with group environment, education level was significantly associated with giving of 'mutis' and the frequency of giving them. Social class was significantly associated with the frequency of breast-feeding and when the child was breast-fed. Mothers from the upper social class breast-fed less frequently than mothers from the lower class. CONCLUSION: The study showed a strong influence of rural/urban environment on specific cariogenic food habits among young black South African children, enabling the development and implementation of a nutrition strategy.

Black or African American↗

Serum lipid peroxides and lipids in urban and rural Indian men.

Serum lipid peroxides, lipids, blood pressure, body mass index, and dietary intake in 190 urban men were compared with 190 age-matched rural men. Significantly higher levels of lipid peroxides, serum cholesterol, low-density lipoprotein cholesterol, and triglycerides were seen in urban men, compared with rural men. In rural men, serum lipid peroxides were related negatively to age; the same was observed in the 70 + y age group in the urban population. All the lipid constituents were related positively to age in both populations. There were statistically significant correlations between lipid peroxides and serum cholesterol and triglycerides in the urban men. The marked elevation of lipid peroxides and lipids in urban men may be the result of urbanization, including exposure to environmental pollutants.

Adult↗

Drug use, misuse, and the urban environment.

Urbanization is probably the single most important demographic shift world-wide throughout the past and the new century and represents a sentinel change from how most of the world's population has lived for the past several thousand years. As urban living becomes the predominant social context for the majority of the world's population, the very ubiquity of urban living promises to shape health directly and to indirectly affect what we typically consider risk factors or determinants of population health. Although a growing body of research is exploring how characteristics of the urban environment may be associated with health (e.g. depression) and risk behaviours (e.g. exercise patterns), relatively little research has systematically assessed how the urban environment may affect drug use and misuse. In this paper we will propose a conceptual framework for considering how different characteristics of the urban environment (e.g. collective efficacy, the built environment) may be associated with drug use and misuse, summarize the existing empiric literature that substantiates elements of this framework, and identify potential directions for future research.

Health Services Accessibility↗

GIS-based urban modelling: practices, problems, and prospects.

"This paper reviews the practices, problems, and prospects of GIS-based urban modelling. The author argues that current stand-alone and various loose/tight coupling approaches for GIS-based urban modelling are essentially technology-driven without adequate justification and verification for the urban models being implemented. The absolute view of space and time embodied in the current generation of GIS also imposes constraints on the type of new urban models that can be developed. By reframing the future research agenda from a geographical information science (GISci) perspective, the author contends that the integration of urban modelling with GIS must proceed with the development of new models for the informational cities, the incorporation of multi-dimensional concepts of space and time in GIS, and the further extension of the feature-based model to implement these new urban models and spatial-temporal concepts according to the emerging interoperable paradigm."

Demography↗

Urban-rural differences in cancer incidence in The Netherlands 1989-1991.

BACKGROUND: Differences in cancer incidence have been observed between urban and rural communities for many decades. These differences have been attributed for the most part to lifestyle aspects. In Western populations, however, differences in lifestyle have diminished. This study addressed the question: For which cancer sites can differences in cancer occurrence still be demonstrated between urban and rural communities in the Netherlands? METHODS: Cancer incidence data from 1989 to 1991 inclusive, were obtained from the Netherlands Cancer Registry. Age-adjusted, site-specific incidence rates were calculated for five classes of municipalities classified by address density. RESULTS: With increasing urbanization, slightly higher incidence rates were observed for all cancer sites combined (rate ratio [RR] = 1.08 in males and 1.12 in females). Statistically significant RR of > 1.4 were observed for Kaposi's sarcoma (m), mesothelioma (m), cancer of the liver (m), mouth/pharynx (m + f), oesophagus (f), larynx (f), lung (f), other respiratory organs (f), cervix (f) and Hodgkin's disease (m). Significantly lower incidence rates were found in urban areas for non-melanoma skin (m + f) and lip cancer (m). CONCLUSIONS: In males, the urban excess of tobacco-related cancer has largely disappeared. However, urban-rural differences in cancer incidence still exist for other cancer sites and for tobacco-related cancer in females. Apparently, differences in the prevalence of lifestyle factors are still large enough to cause variation in cancer incidence.

Female↗

Increased female drinking in accordance with post-industrial urbanization in Japan.

We studied the relationship between living in an urban area and the alcohol-consumption habits of young mothers in light of the recent increase of the female drinking population in Japan, particularly among those from 20 to 39 years of age. We conducted a survey in four areas in and around Tokyo, each area representing a different level of urbanization. The study population consisted of 6418 mothers of 3-year-old children; an 84.9% response rate was obtained. Thirty-eight per cent of the respondents had drunk at least four units of alcohol (about 44 g of pure ethanol) during the most recent month. The proportion of current drinkers in a more-urbanized area was greater than that in a less-urbanized area, and this tendency was significant (P < 0.001). Current workforce participation was significantly positively associated with current drinking (P < 0.01). Younger age significantly increased chances of current drinking (P < 0.05). Effects of living in a more-urbanized area on current drinking of mothers of 3-year-old children after excluding the effects of workforce participation and age was significantly positive (P < 0.001). An increase in female drinking in Japan was considered to be due to acculturation associated with urbanization in a post-industrial society.

Adult↗

Urban asthma.

PURPOSE OF REVIEW: To review the possible reasons why the prevalence and morbidity of asthma are greater in those living in an urban setting. RECENT FINDINGS: Urban asthma is associated with exposure to air pollution, urban allergens, and violence. Outdoor air pollution is a particular problem in urban areas and affects children more than adults. Asthma has been shown to be exacerbated by ozone, respirable particulates, and nitrogen dioxide. Exposure to high point sources of pollutants such as heavy traffic is of particular concern. Urban allergens include cockroach, mouse, and rat. Cockroach exposure increases the risk of asthma exacerbations and may increase the risk of developing asthma. Although mouse allergen is also found in suburban homes, the concentration is a log-fold higher in inner-city homes at levels known to elicit symptoms in workers in animal facilities. Rat allergen is found in a third of inner-city homes and is associated with asthma morbidity. A recent interventional study showed that comprehensive environmental control of cockroach allergen reduced asthma morbidity. Finally, stress elicits asthma symptoms and exposure to violence is associated with greater asthma morbidity. SUMMARY: The increase in prevalence and morbidity of asthma associated with urban living is associated with at least three plausible causative factors each of which is amenable to intervention, raising the issue of environmental justice issues: controlling air pollution in general and exposure to point sources in particular; reducing cockroach, mice, and rat infestations; and preventing violence.

Air Pollution↗

Basic amenities and health in urban India.

We have examined the findings from various studies and corroborated other evidence that the large and continuous increase in India's urban population, and the concomitant growth of the population residing in slums and shanty towns, has resulted in over-straining of infrastructure and a deterioration in public health. Inadequate civic amenities, lack of purchasing power, and lack of knowledge and awareness among the urban poor have resulted in urban poverty which is very different from its rural counterpart. While a few policies have specifically targeted the urban poor, these have been neither sufficient nor effective. Also, the deteriorating health status of urban people needs urgent attention because many of the recent health problems can take an epidemic form if neglected. A resurgence of malaria, dengue and tuberculosis indicates that much of the poor health emanates from a lack of basic amenities such as sanitation, clean water and housing, coupled with a lack of awareness about the need to take precautionary measures against preventable and infectious diseases. To tackle these problems effectively, it is important for policy-makers to recognize that certain groups are more susceptible to ill health than others; they are vulnerable to the severe impact of illnesses and also the likely sources of infection for the population at large. There is an urgent need for research on the factors that prevent the urban poor from availing the services provided to them. It is possible that this is due to the lack of awareness-generating policies which should accompany any supply-side policies such as the provision of basic facilities (e.g. Sulabh Sauchalaya). To reduce the private costs as well as the negative externalities of ill health, it may be necessary to target such populations by cost-effective strategies based on holistic research on all the factors that determine well-being.

Health Status↗

Urban planning in metropolitan areas of Asia: the challenge of accomodating the informal sector.

One paradox in the recent pattern of urbanization in Asia is 'metropolisation' and 'informalization'. This is paradoxical since growth and development of a metropolis is expected to reduce its traditional or informal sector. From available evidence, this paper shows that metropolisation in Asia, instead of reducing the size of informal sector, is rather providing new impetus to its growth. After revealing the nature and content of these growth patterns, the paper argues the case for making changes in the urban planning paradigms for accommodation of the informal sector in metropolitan development. The concurrent expansion of a metropolis and the informal sector within it will not appear paradoxical, the author believes, once the traditional urban planning paradigms of land use, zoning, and standards, mostly evolved from the Western experience of urban-industrial development, are modified in light of the socio-economic realities of the Asian metropolises. The huge population base of the respective countries relative to capital and other material resources, and vast qualitative change in the production structure of urban metropolitan economies have made the presence of the informal sector rather functionally relevant in the very heart of their metropolises. The paper provides some directions, citing examples from several cities, as to how to make the necessary accommodation. The paper further contends that mere physical accommodation by legal acceptance and provisions will not be enough. The other major direction of change in urban planning ought to be for integrating the physical, economic, and social dimensions of planning for ensuring better quality of life for all instead of a small proportion of people.

Adolescent↗

Matching community need with physician training: the OSU Urban Family Medicine Program.

There continues to be a shortage of primary care physicians practicing within urban, Iower-socioeconomic and minority communities despite the fact that many of the 125 allopathic and 19 osteopathic medical schools are located within the affected urban cities. Recognizing a need to better train and recruit primary care physicians to serve in urban settings and provide care to those underserved. The Ohio State Department of Family Medicine established an Urban Family Medicine Residency Program headquartered in Near East Columbus, OH. Starting in 2003, the Urban Family Medicine Residency Program began training up to two residents each academic year. The mission, vision and (curriculum have attracted residency applicants and faculty who have displayed sincere interest and commitment to practicing in urban lower socioeconomic communities.

Competency-Based Education↗