healthy city index - have we done enough
TRANSCRIPT
Healthy City IndexHave we done enough
Dr Rozlan IshakDr Masliha Harun
Urban Health UnitDisease Control Division
8th National Public Health Conference2016
MELAKA
CONTENT
i. Introductionii. Definitioniii. What’s is expected by the people?iv. Why there is a gap in services deliveries?v. How to solve the problems and gaps?vi. Actions and roles of Public Health Physicianvii. Conclusion
Introduction
Current situations• Healthy cities has been an important platform for improving
urban health in the Western Pacific Region.• Potential to cultivate cross-sectoral , political, financial and
social support for urban health• The impact has been highly appreciated at the local level
and encourage at the national level.• Approached and response included to address issues in
Sustainable Development Goals (SDGs)• The Regional Committee for the Western Pacific is
considered to draft Regional Framework for Urban Health in The Western Pacific 2016-2020.
Western Pacific Region• 54 % population lives in cities• 9 Megacities with more than 10 million populations• 212.3 million people live in slums in urban areas especially in Cambodia,
China, Lao PDR, Mongolia , Philippines and Viet Nam.• Air Pollution, water pollution, poor sanitation contributed to
communicable and non communicable diseases in urban areas.• Increase registered motor vehicles, noise, sedentary lifestyles and injuries
caused multi health problems• Easy access to tobacco, alcohol, unhealthy foods contributed to non
communicable diseases• Urban hazards flooding, storm and extreme weather events caused
suffering to the people.• This is resulted from unplanned urbanization and capability to response to
the rapid cities expansion and population migration to urban centers.
Global Cities, Present and Future2014 Global Cities Index and Emerging Cities Outlook
Where is Kuala Lumpur?
Index?
• So, do we still need an index?• What is the purpose? Why…• If yes, what are the variables to measures?• For Malaysia or regional or global…• If there is significant differences between
cities ..what can we do to change it?• Do we have the expertise, authority and
capability to make the differences?
What is a Healthy Cities ?
Healthy city
Index
1. A clean, safe physical
environment
2. A stable ecosystem now and the future
3. A strong, mutually supportive and non-
exploitive community
4. A high degree of Public participation
and control in decision makings
5. Meeting of basic needs of the people.
6. Access to a wide range of technology
7. Connectedness with the past , with
the cultural and biological heritage of
city
8. Urban layout compatible with
preceding characteristics
9. Optimum and appropriate health
services accessible to all
10. High health status and low levels of
disease
• The Sustainable Cities Index provides a platform for public and private decision-makers.
• Urban Heart indicators• Fundamentally, however, it provides guidance and allows
thoughtful decision-makers to….
“Measure what can be measured and make measurable what cannot be measured,” as per Galileo’s sage advice. Galileo Galilei Italian astronomer, physicist, engineer, philosopher, and mathematician
So, do we still need an index?What is the purpose? Why…
What is the purpose?• To improves the cities environment and expands its
resources so that people can support each other in achieving their highest potential
• To ensure cities will provide optimal infrastructural facilities to cater and support the creation of socially pleasant relationships between all strata of the society and
• the needs to promote the physical, social, mental and spiritual health of the Malaysian population through user friendly, cost effective, practical facilities developed through strong political will and community mobilization.
What to Measures?
1. Community satisfaction2. Comfortable living3. Accessibility to basic needs4. Efficient and timely services
deliveries5. Good Governance6. High health status
Whole of system approach
• Governance and coordination• Programme planning, management and
quality improvement• Information and surveillance system• Workforce and network capacities• Health system roles and functions
12 Urban HEART Core Indicators
Health outcomes
Infant mortality
Diabetes
Tuberculosis
Road traffic injuries
Who Should answer ?
• Mayors• Senior government
officers• Technical officers such
Engineers, Doctors, Urban Planners etc.
• NGO’s• General Public ( you
and me)
How to measures?Agreed or disagreed
• A clean, safe physical environment of high quality.
• Access to improve sanitation
• Effective sewerage system
• An ecosystem that is stable now and sustainable in the long term
• Air pollution, water pollution, solid waste disposal, sanitation and drainage system
How to measures?Agreed or disagreed
• A strong, mutually supportive and non-exploitive community
• Government spending on health and research grant
• Employment• Health facilities, clinics and
hospitals• Preventive, curative and
promotion including palliative and rehabilitative services
How to measures?Agreed or disagreed
• A high degree of participation and control by the public over decisions affecting their lives, health and wellbeing
• Children• Women• Youths involvement• Gender equality• Aging population
How to measures?Agreed or disagreed
• The meeting of basic needs
• Access to safe water• Basic needs of youths,
elderly, women’s and men’s needs, children and people with disabilities.
• Safety from crime and injuries
How to measures?Agreed or disagreed
• Access to a wide variety of experiences and resources, with the chance for a wide variety of contact, interaction and communication.
• Completion of primary, secondary and tertiary education
• Special skilled training institutions for youths, elderly, people with disabilities and women and child care.
How to measures?Agreed or disagreed
• The encouragement of connectedness with the past , with the cultural and biological heritage of city dwellers and other groups and individuals
• Aging population, handicaps and people with disabilities and displaced population
• Accessibility to place of interest for all
• Museum, welfare center, community center
How to measures?Agreed or disagreed
• Urban layout that is compatible with and enhance the preceding characteristics
• Flooding, traffic jams, urban slums, storms and extreme weather events
• Ease of mobility and transportation to important place of needs
• Disaster risk management, mitigation measures and responsiveness of public facilities and amenities
• Community resilient to disaster
How to measures?Agreed or disagreed
• An optimum level of appropriate public health and sick care services accessible to all.
• Skilled birth attendance• Fully immunized children• Basic health care and maternal
and child health care.• Efficient Emergencies Medical
Support services• Inventories of all public
inventories
How to measures?Agreed or disagreed
• High health status (high levels of positive health and low levels of disease)
• Infant mortality• Diabetes and hypertension• Cancer prevalence• Injuries and violence• Tuberculosis• Prevalence of tobacco smoke, alcohol,
obesity and substance abused.• Surveillance mechanism for
communicable and non communicable diseases
• Disease registries
How to measures?Agreed or disagreed
Social
Physical EnvironmentEconomy
HEALTHY City IndexGood Governance
LivableSuitableCivilizedHabitableConvenientComfortableAccessible
SUSTAINABILITY = HEALTHY
Equitable in wealthUnbiasedJustifiableRightfulBalancedAffordable
The People- Measures social performance including quality of life. These indicators can be broadly thought of as capturing ‘quality of life’ for the populace in the respective cities.
Here….is the Sub index
SOCIAL
COMMUNITY PARTICIPATION
EDUCATIONWORK LIFE BALANCE
PUBLIC OPINION AND PARTICIPATORY
DECISION MAKING
ENVIRONMENTAL
RENEWABLE ENERGY SHARE
WATER QUALITY
GREEN HOUSE GAS EMISSIONS
NATURAL CATASTROPHE RISK
DRINKING WATER AND SANITATION
AIR POLLUTION
Sub index
The Planet-Captures environmental factors like energy emissions and pollution.
The Use of Energy in Malaysia: Tracing Energy Flows from Primary Source to End Usewww.mdpi.com/1996-1073/8/4/2828/htm
ECONOMY
VIBRANT ECONOMY AND BUSINESS
INCOME INEQUALITY
TRANSPORT INFRASTRUCTURE
PROPERTY AND LIVING COSTS
THE CITY’S IMPORTANCE IN GLOBAL ECONOMIC
NETWORKS
EASE OF DOING BUSINESS
UNEMPLOYMENT RATE
Sub index
The Profit –(assesses business environment and economic performance) sub-index examines performance from a business perspective.
Healthy Cities Index or Urban Heart Assembling Data
• Urban HEART should rely as much as possible on use of existing, available datasets for your city from diverse policy sectors
• Extensive new data collection is often time consuming, financially burdensome and not sustainable– Teams that emphasize new surveys may lose momentum– In contrast, data sharing can foster intersectoral
responsibility for health and promote cooperative action later on
Assemble Relevant and Valid Data
• Assess the quality and validity of data sources
• Negotiate formal data-sharing agreements
• Set up a data-sharing repository
• Conduct general database management
• Conduct or commission new surveys, if necessary
1. Community satisfaction2. Comfortable living3. Accessibility to basic needs4. Efficient and timely services deliveries5. Good Governance6. High health status
Selecting an Indicator Set To measures ..
Indicator Suggested benchmarks and targets Data sources Possible disaggregating variables
CommunitySatisfaction
SanitationWater qualityAir QualityNoise pollution
Department of Environment
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
FloodingStormsHeat waveslandslides
Department of meteorological
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Primary EducationSecondary EducationTertiary educationSpecial training institutionNumber of Schools
Ministry of Education Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Skilled trainingProductivityGood governanceHousingJobs availabilityFood availability and price
Consumers
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Welfare homesElder services centreChild care centre
Ministry of Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Indicator Suggested benchmarks and targets
Data sources Possible disaggregating
variables
Comfortable living
Food and restaurantEntertainmentShopping mallsChild care
Local government Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Sport complexesGamesPlaying fieldsschools
Local governmentTown and Country Planning
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Cycling lanesJogging lanesMountain climbingPlay grounds
Town and Country PlanningLocal government
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Historical sitesMuseumParks and greens
WelfareLocal government
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
HousingCommunity participationSecurity Crime ratesHousing Rentals
PoliceTown and Country Planning
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Indicator Suggested benchmarks and targets
Data sources Possible disaggregating
variables
Access to basic needs
Jobs availabilitySkilled workersIndustrial areaBusiness areas
Ministry of Labour
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Food supplyMarketsOthers needs clothing apparel etc.
Local Government
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Safe water supplyEfficient electricity supplyTelecommunication network
Utility companies
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
SchoolsHospital and clinicsRecreational parks and greenPolice and crime preventionFire stations
Health DepartmentLocal government
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Indicator Suggested benchmarks and targets
Data sources Possible disaggregating variables
Efficient and timely services deliveries
TransportationBusesTaxiTrains
Ministry of Transport Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Basic UtilitiesWater supplyElectricity Telecommunication
Utilities Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Solid wasteDrainagesSeweragesRoad services
Local Government Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Health services such quit smoking clinic, maternal and child health care, out patient care Enforcement activities for tobacco control, vector control
Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Traffic controlTraffic jamsTime to work
JKRLocal Government
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Indicator Suggested benchmarks and targets Data sources Possible disaggregating variables
Good Governance Public transportation servicesHousing and human settlementRoad management Central business districtLand use planningParks and recreational areas
Ministry of Transport Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Provision of basic utilitiesWater supplyElectricity Telecommunication
Utilities Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Solid waste and sanitation servicesSolid wasteDrainagesSewerages
Local Government Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Health care financing and spendingEducational financing for higher educationFinancing for the poor and disadvantage groups
HealthWelfare
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Disaster risk management and preparednessDisaster mitigation strategiesCommunity resilient and preparedness
PBTHealthMKN
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Indicator Suggested benchmarks and targets
Data sources Possible disaggregating variables
High health status
Infant mortalityMaternal mortalityUnder five mortality
Ministry of Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Prevalence of tobacco smokeAlcoholObesity
Ministry of Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Prevalence of Hypertension, Diabetes, Cardiovascular, Cancer and mental health
Ministry of Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Injuries, MVA and crime and intentional injuries include homicide and suicidal rates
Ministry of HealthPolice
Strongly disagreed, disagreed, unsure, agreed and strongly agreed
Incidence of infectious diseases , Tuberculosis, dengue, HIV, STI, food and water borne diseases, immunisable diseases
Ministry of Health Strongly disagreed, disagreed, unsure, agreed and strongly agreed
• The whole-of-system approach to urban health encompasses actions on policy frameworks, regulations, accountability, financing, performance of workforce, information system and service delivery.
• These have been organized into five action domains:
(1) governance and coordination infrastructure, (2) programme planning, management and quality improvement, (3) information and surveillance system, (4) workforce and network capacities, and (5) health system roles and functions.
Identifying challenges & problems
Thank you
Conclusion The Regional Framework for Urban Health in the Western Pacific 2016–2020 envisions “healthy and resilient cities and urban communities” and presents a proactive whole-of-systemapproach to urban health.
The goal is to improve health, and promote equity and sustainable urban development.
A healthy city is one that enables people to have affordable and equitable access to health and social services and economic opportunities; empowers people; nurtures natural environments;constantly creates and improves physical and social environments; and expands community resources to support people in developing their optimal potential.