Urbanization and Slums Infectious Diseases in the Built Environment: Proceedings of a Workshop (2018) / Chapter Skim
Currently Skimming:
5 Achieving Sustainable and Health-Promoting Urban Built Environments
5 Achieving Sustainable and Health-Promoting Urban Built Environments
Pages 61-88
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 61... ...
In his presentation, Siddharth Agarwal, director of the Urban Health Resource Centre in India, explored how to build an investment case for slum upgrading and health-promoting urban environments and outlined several methods for infectious disease mitigation that have been implemented in slum environments in India. Daniele Lantagne, associate professor of civil and environmental engineering at Tufts University, discussed examples of context-specific water, sanitation, and hygiene (WASH)
|
From page 62... ...
He warned: "We are so ignorant about the true distribution of this mosquito, this fantastic vector of arboviruses." Lindsay also expressed serious concern about the ability to control a disease such as yellow fever if it moves into one of the megacities in South America. Global Initiatives to Mitigate the Risk of Infectious Diseases in Urban Environments After outlining some of the major infectious disease threats to urban built environments, Lindsay turned to global initiatives aimed at mitigating the risk of such diseases.
|
From page 63... ...
-- but the global Zika pandemic, coupled with the SDGs, caused WHO to reexamine global vector control and to produce its Global Vector Control Response 2017–2030, which provides a new strategy to strengthen vector control worldwide through increased capacity, improved surveillance, better coordination, and integrated action across sectors and diseases (WHO, 2017a)
|
From page 64... ...
He said that addressing those two pillars is a challenge because the function of intersectoral committees is contingent on commitment at the highest national or FIGURE 5-1 Response framework in the World Health Organization's (WHO's) Global Vector Control Response 2017–2030 to reduce the burden and threat of vector-borne diseases affecting humans.
|
From page 65... ...
Making intersectoral collaboration sustainable is one of the biggest challenges of the century, according to Lindsay, but he suggested that effectively controlling infectious disease in urban environments will need to include collaborating and gleaning lessons learned from organizations outside the health sector. He further suggested that turning policy into action will require "breaking the mold" within the health sector by engaging with communities and with nonhealth sectors.
|
From page 66... ...
Lindsay explained that the Sudan National Intersectoral Committee for Vector Control had full political support, some financing, and an effective and dynamic person in charge and running the committee. He explained that they searched for and eliminated the location of the aquatic habitats; for example, they replaced leaking pipes that were relics of poor and aged British engineering.
|
From page 67... ...
He clarified that he is not trying to oversell Aedes-borne diseases, but to encourage people to reflect about what can be done in urban centers to reduce that risk as well as addressing other locally determined priorities. BUILDING AN INVESTMENT CASE FOR HEALTH-PROMOTING URBAN ENVIRONMENTS To explore strategies for building an investment case for upgrading slums and promoting health in urban environments, Siddharth Agarwal drew upon his work as director of the Urban Health Resource Centre in India.
|
From page 68... ...
In the first method described by Agarwal, representatives from local women's groups are engaged to assess living conditions across several slums using a qualitative adaptation of WHO's Urban Health Equity Assessment and Response Tool (Urban HEART) .3 With this tool, the women use color-coded dots to denote their assessment of each indicator.
|
From page 69... ...
Agarwal reported that India now has an urban health policy in place, but its ongoing implementation has been slow. He noted that the policy encourages intersectoral coordination at both the municipal and community levels to promote overall well-being and health and to reduce the risk of infectious disease.
|
From page 70... ...
Treating water to remove all three of these organism types generally involves combined treatment of filtration plus chlorination, Lantagne said. She explained that combined treatment was the strategy used to successfully reduce infectious disease transmission across the United States and Europe during the "sanitation revolution" (approximately between 1890 and 1930)
|
From page 71... ...
. Lantagne noted that China is managing its urban growth through a top-down centralized scientific approach that includes rolling out identical water and wastewater treatment plants on a daily basis.
|
From page 72... ...
3. Easy access to safe water in sufficient amounts at an affordable price.
|
From page 73... ...
Water, Sanitation, and Hygiene Interventions in Slums Lantagne provided some specific examples of WASH programming and interventions in slums that have been successful in addressing water supply, water treatment, and the sanitation chain. She also described an example of a WASH intervention carried out in an emergency response context.
|
From page 74... ...
She cautioned that there are no silver-bullet interventions in WASH, only interventions that are appropriate for a specific context and that must be implemented well to be successful. Sanitation Chain Interventions To discuss successful sanitation chain interventions, Lantagne explained that people with access to modern sewage systems have the benefit of not having to deal with their own waste -- it is flushed down a toilet and passes through a treatment plant and is shipped away.
|
From page 75... ...
People who join the program receive a type of home toilet and have their waste collected from the home regularly, she said, and the waste is treated using ultraviolet light and heat to transform it into briquettes sold as affordable fuel for cooking. Emergency Response Interventions Lantagne described emergency response work carried out with a WASH cluster in Syria, where more than 95 percent of the population had access to pipe-treated safe drinking water and sanitation in 2009.
|
From page 76... ...
ENGAGING COMMUNITIES: FROM SURVEILLANCE TO POLICY Eva Harris, professor of infectious diseases and director of the Center for Global Public Health at the University of California, Berkeley, offered her vision of the concept of engaging communities in addressing Aedes-borne arboviral diseases, such as dengue and Zika. Her presentation focused on an experience with community engagement in a pilot program that led to a large-scale trial, but she began by discussing the particular threat posed by Aedes-borne diseases.
|
From page 77... ...
The Pan American Health Organization's EGI-Dengue concept6 promotes an integrated approach that includes a social communication component, she added. In Cuba, she reported that researchers used a structured format to investigate a more vertical approach to community involvement in dengue vector control using randomized controlled trials, which they found effective in embedding community empowerment strategies into routine vector control programs (Castro et al., 2012; Vanlerberghe et al., 2009)
|
From page 78... ...
, which was then applied to the dengue problem in Nicaragua. Socializing Evidence for Participatory Action Harris explained that in Camino Verde's SEPA strategy, small community teams formed groups called health brigades (Brigadas SEPA)
|
From page 79... ...
Harris reported that the lessons learned from the pilot phase formed the basis of a large cluster randomized controlled trial in two countries that quantified the effectiveness of community mobilization for dengue 8 Pairedsamples gathered before and after the epidemic were used to examine the increase in antibody titers.
|
From page 80... ...
Camino Verde Cluster Randomized Controlled Trials Harris explained that the parallel cluster randomized controlled trials were carried out among 85,000 total residents from two sites in Nicaragua and Mexico,9 and the study included double randomization, interventions, and impact measurements. She said that the primary outcomes were incidence (antidengue antibodies in saliva)
|
From page 81... ...
Dengue is the banner, Harris said, but the ability to mobilize on other issues is actually more important to the communities. DengueChat for Real-Time Capture and Use of Data Harris reported that they have taken the concepts learned from the Camino Verde and added a technological tool that captures real-time data:
|
From page 82... ...
DengueChat pilots and programs are ongoing in Brazil, Mexico, Nicaragua, and Paraguay, she said. Harris highlighted the role of community action and community participation in research and data generation in moving toward sustainable models of community engagement.
|
From page 83... ...
Lantagne also mentioned that when behavior research was conducted, common responses to the reason for behavior change included statements that denote aspirational thinking, such as, "I have a good family, I am going to take care of my children, and I want to provide my guests something nice." She also provided an example from Haiti where people like the tap on the safe water storage container because it makes them look as if they have flowing water in the household. However, she noted that the triggers for aspiration-motivated behavior change will vary for different cultures and interventions.
|
From page 84... ...
He said that after extensive meetings over time, they were able to help shift some of the thinking at the government level, which has now become part of the National Urban Health Mission. Lantagne remarked that, in her experience, governments are resistant to reporting to WHO diseases such as cholera, regardless of the population affected.
|
From page 85... ...
In the San Francisco Bay Area, she said, there are efforts to engage communities in mosquito abatement, and she reported that there has been receptivity on the local domestic side for incorporating some elements from global health that make sense in this domestic environment. Lantagne said that work done in decentralized WASH in emergencies in developing countries has been brought back to the United States when there is an emergency, such as the necessary use of household water filters in Flint, Michigan, caused by infrastructure problems.
|
From page 86... ...
Lantagne replied that emergency response and development are both moving in the direction of conditional or unconditional cash transfers, because giving cash is efficient and it stimulates the local economy. Emily Gurley, associate scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, asked whether technology could help facilitate communities in collecting their own data and in monitoring their own exposure and health status, noting that some communities are already monitoring their own air pollution.
|
From page 87... ...
He remarked that the problems at hand are too complex and challenging to be addressed by a priori models and solutions; he added that community engagement can be integrated with building robust monitoring, tracking, and data feedback systems to allow for continuous adjustment. Finally, Corburn suggested that linkages between policy and local, urban, and community-scale projects appear to be a critical piece in moving to health equity.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.