Journal of urban health : bulletin of the New York Academy of Medicine
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To improve population health, one must put emphasis on reducing health inequities and enhancing health protection and disease prevention, and early diagnosis and treatment of diseases by tackling the determinants of health at the downstream, midstream, and upstream levels. There is strong theoretical and empirical evidence for the association between strong national primary care systems and improved health indicators. The setting approach to promote health such as healthy schools, healthy cities also aims to address the determinants of health and build the capacity of individuals, families, and communities to create strong human and social capitals. ⋯ This synergistic effect would help to strengthen human and social capital development. The model can then combine the efforts of upstream, midstream, and downstream approaches to improve population health and reduce health inequity. Otherwise, health would easily be jeopardized as a result of rapid urbanization.
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An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cities and their suburbs for the years 1996, 1999, and 2002, we examined a number of measures of use and capacity, including staffed beds, admissions, outpatient and emergency department visits, trauma centers, and positron emission tomography scanners. Over the 6-year period, the number of for-profit, nonprofit, and public hospitals declined in both cities and suburbs, with public hospitals showing the largest percentage of decreases. ⋯ However, the results demonstrate for the first time, a highly disproportionate share of hospital resources and use among suburbs with a low poverty rate compared to suburbs with a high poverty rate. High poverty communities represented the greatest proportion of suburban population in 2000 but had the smallest proportion of hospital use and specialty care capacity, whereas the opposite was true of low poverty suburbs. The results raise questions about the effects of the expanding role of private hospitals as safety net providers, and have implications for poor residents in high poverty suburban areas, and for urban safety net hospitals that care for poor suburban residents in surrounding communities.
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Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. ⋯ We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.
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In the fall of 2004, the FDA and British authorities suspended the license of one of only two manufacturers that provided the US supply of inactivated influenza vaccine. With a 50% reduction in supply, a severe vaccine shortage resulted. This situation necessitated the development of priority groups for vaccination including those > or =65 years, when ordinarily, influenza vaccine is recommended for those > or =50 years old. ⋯ A significantly larger proportion of patients 50-64 years of age were unvaccinated due to the shortage (73%) compared to those who were vaccinated during both seasons (36%, P < 0.001), but there were no racial disparities in vaccination rates. Compared with patients who were vaccinated during both seasons, those who were unvaccinated due to the shortage were more frequently employed, self-reported their health positively, saw their physician less frequently, rated the US government's response to the shortage as "terrible," and blamed the US government for the shortage. Vaccination during the influenza vaccine shortage appears to have followed preferential vaccination of the CDC-established priority group (> or =65 years) and did not result in racial disparities in inner-city health centers.
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This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. ⋯ The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.