Journal of urban health : bulletin of the New York Academy of Medicine
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Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. ⋯ In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.
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The years 2020-2021 during the COVID-19 pandemic witnessed increases in firearm violence in many cities across the USA. We present data from Sacramento, Stockton, and Richmond, California that suggests firearm homicides during the pandemic did not increase in all communities or disproportionately burden the African American community. More specifically, we found that in these cities, there was a 5-52% decrease in gun homicides during the 2020/2021 period compared to the 2018/2019 period for neighborhoods with a gun violence prevention program operating there. ⋯ Advance Peace is a program that engages those at the center of gun violence, frequently young, Black men under 35 years old, and offers them the Peacemaker Fellowship, an intensive, 18-month program of 24/7 mentorship, social services, and life opportunities. The program is delivered by community resident "credible messengers," who conduct the mentorship and interrupt conflicts in the streets. While these findings are descriptive and preliminary, we know of no other program that was in operation before and during the pandemic in each of these cities that engaged the hard-to-reach but highly influential population at the center of gun violence.
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In Indore, India, BHC engaged 247 multi-sector stakeholders through a systems mapping approach to gather qualitative data across three workshops and four citizen town halls from 2018 to 2020. These data were synthesized with results from BHC's 18 other city activities to build a systems map and identify high-impact areas for engagement. Contextual findings showed a tension at the heart of Indore's growth-Indore's great success as a city has spurred rapid population growth. ⋯ These opportunities are: (1) improving data quality, use, and integration; (2) supporting accountability to, and enforcement of, policies and regulations; and (3) increasing community engagement. Brought together through a better understanding of the key patterns driving system behavior from the context map and leverage opportunities, BHC was able to co-create, with stakeholders, seven "coherent actions" to move Indore to a healthier, more equitable state. When COVID-19 regulations ease, BHC and city officials will reconvene to finalize an implementation plan for these actions.
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The USAID-funded Building Healthy Cities (BHC) work in Da Nang, Vietnam, engaged 108 multi-sector stakeholders to gather qualitative data across two workshops and three citizen town halls from 2019 to 2021. These data were synthesized with the results from BHC's seven other activities in Da Nang to build systems maps. Contextual findings showed that multi-sector, multi-level participation and collaboration have been the key to moving the city toward their smart and livable city goals. ⋯ Stakeholders found four key leverage points within this context that, if included in every action, could help overcome barriers. These leverage opportunities are: (1) investing at all levels; (2) improving function and innovation of information technology; (3) increasing participation and feedback; and (4) creating more responsive policy. As BHC concludes activities in Da Nang, local university students will be trained on systems mapping techniques to embed systems thinking skills into the next generation of workforce, and a set of recommendations will be developed to share with the government to act on these findings.