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Urban Health & Environment |
Programming Considerations of Urban Health & Environment
Identify At-Risk Populations
Health interventions cannot be appropriately designed and implemented without a clear understanding of the health challenges facing the target population. Unfortunately, policymakers at all levels typically lack reliable information on the health conditions of the urban poor. Where data exists, it often suffers from two weaknesses. First, health data is usually aggregated for all urban residents--blurring differences between the wealthy and the poor. Second, the urban poor are often overlooked altogether because public health authorities do not collect data in informal or illegal settlements and miss the homeless.
Obtaining accurate health data on these "invisible" urban residents requires innovative application of traditional data collection tools or new tools altogether. An example is USAID-supported work using remote sensing to locate and estimate the size of slums populations in Bangladesh to construct accurate sampling frames and allow targeted surveys. For more information, click here: Slums of Urban Bangladesh: Mapping and Census 2005
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Help Overcome Barriers
In almost all countries, the best healthcare facilities are concentrated in urban areas. However, the urban poor face numerous barriers to accessing services from these facilities. Beyond the common difficulty of paying for services, social factors play an important role in restricting access by the poor. Such factors include lack of culturally appropriate services, language/ethnic barriers, and prejudices among providers. These same factors also act as barriers to effective health promotion among the urban poor. Even if appropriate health promotion materials are designed, health outreach workers may be afraid to deliver them in slums because of security concerns. Recent research on such barriers in two cities in India and the Philippines is reported in this USAID report.
To effectively connect the urban poor with health education and improved services, these barriers must be understood and appropriate interventions designed to overcome them. Much more needs to be learned about the effectiveness of various approaches, however, several themes have emerged from developing country efforts in the past two decades:
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Prioritize Environmental Health
The urban poor often live in poor quality housing with few if any formal municipal services. The environmental conditions in these "slum" settings play an important role in the prevalence of infectious disease. Diarrhea, caused by unsafe water, inadequate sanitation and poor hygiene, accounts for 15 to 18 percent of child deaths annually. Poor drainage contributes to increased malaria prevalence - responsible for 2.5 million deaths each year. In many cities, exposure to indoor smoke from cooking with biomass fuels in cramped housing is associated with acute lower respiratory infections (ARI) - the leading cause of death for children under five years of age.
Comprehensive urban health programming should include targeted preventive measures to reduce the adverse impact of environmental factors on health. Much can be gained by designing health programs that compliment infrastructure, energy, and local government strengthening programs in a synergistic fashion to address environmental health concerns. USAID aims to provide global leadership in the development of such innovative interventions to prevent illness and death associated with environmental factors, and to take these interventions to scale. For more information, click here: Environmental Health at USAID
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