Environmental and health risks of cities: analyses of the Sustainable Healthy Urban Environments (SHUE) database

Authors: Paul Wilkinson1, James Milner1
Author Affiliations: 1London School of Hygiene & Tropical Medicine

In an increasingly urbanized world, cities are a key focus for action on health and sustainability. The Sustainable Healthy Urban Environments (SHUE) project aims to provide a shared information resource to support such action. Its aim is to test the feasibility and methods of assembling data about the characteristics of a globally-distributed sample of 309 cities and the populations within them for comparative analyses, and to use such data to assess how policies may contribute to sustainable urban development and human health. As an initial investigation, we present analyses of selected parameters on climate change and air pollution. Under a high greenhouse gas emissions trajectory (RCP 8.5), these analyses suggest damaging temperature rises in all regions of the world by 2100 based on the downscaled results of 15 global climate models. The mean of these models shows increases in the mean daily temperature for the hottest month of the year in the range 3 to over 8 °C, with some of the largest temperature rises (6 to >8 °C) occurring in cities in the World Health Organization (WHO) European, American and Western Pacific Regions, though with the future hottest cities (>35°C monthly mean temperature for the hottest month) being in South-East Asia and Eastern Mediterranean Regions. Air pollution levels are appreciably above the WHO guideline levels for annual average PM2.5 concentrations of 10 µg.m-3 for all but a handful of cities, with many exceeding 50 µg.m-3 and the highest exceeding 100 µg.m-3. Cities with both current very high PM2.5 levels and large potential temperature increases under climate change occur in cities in the South-East Asia, Western Pacific, and Eastern Mediterranean Regions. Such evidence underpins the need for urgent action on climate change (adaptation and mitigation) and the risks relating to air pollution.

Summarizing Factors Contributing to Partial or Non-utilization of Individual Household Latrine (IHHL) in Charutar Region of Gujarat, India

Authors: Kandarp Talati1, Somashekhar Nimbalkar2, Kishan Prajapati3, Bharat Joshi3, Shivani Mishra3, Heather Murphy4, A.G. Phatak5, A.R. Dongre6
Author Affiliations: 1Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, India; 2Head, Central Research Services, Charutar Arogya Mandal, Gujarat, India; 3Department of Social Work, Sardar Patel University, Vallabh Vidhyanagar; 4College of Public Health, Temple University, Philadelphia, USA; 5Central Research Services, Charutar Arogya Mandal, Karamsad, India; 6Head, Department of Community Medicine, Sri Manakula Vinayagar Medical College & Hospital, Pondicherry, India

Background: Sanitation campaign in India found renewed interest after Prime Minister Narendra Modi mentioned about it in his 2014 Independence Day speech which followed launch of “Swachh Bharat Abhiyan”(SBA). Construction of Individual Household Latrines(IHHL) is one of the key components under the mission to achieve ‘Open Defecation Free’(ODF) status. While IHHLs have been constructed in majority of villages in Gujarat, government is now campaigning for its increased utilization. The study assessed factors contributing non-utilization of IHHLs.

Methods: Four villages were randomly selected in Charutar region of Gujarat and 313 eligible respondents were surveyed after obtaining written informed consent. Trained surveyors collected socio-demographics and observational data using a structured questionnaire. In case of non-utilization, an open-ended question probed reasons for the same. The responses were summarized to report key findings.

Findings: Out of 313 respondents,85(27.16%) reported that not all the family members in their household are using IHHL. Review of responses revealed that elderly members were reluctant to use latrines constructed just outside the household. Higher number of family members was also reported as a barrier because one latrine couldn’t be sufficient for all the members. Structural limitations due to non-fitting of commodes (N=11), overhead tanks (N=121/39%), taps (N=163/52%), limited water storage capacity, inadequate drainage facility including shallow cesspool were identified as barriers to IHHL utilization.

Interpretation: Following fast-tracked construction of IHHL, now the challenge is to promote sustained utilization.Broadly, the barriers can be categorized as household- and structure-related. Participatory research involving IHHL beneficiaries and relevant stakeholders can help further investigate key barriers to non-utilization and list out locally adaptable, potential solutions. The findings can then be utilized to strengthen program planning & implementation, and design context-specific health promotion intervention to achieve ODF-status. Opportunities for resource sharing between IHHL beneficiaries and local self-government to fix-up structural barriers can also be investigated.

Housing in Nairobi’s informal settlements – a complex urban system

Authors: Michael Davies1, Balazs Csuvar2, Kaveh Dianati3, Alex Ezeh4, Henry Fletcher2, Catherine Kyobutungi4, Blessing Mberu4, James Milner5, Kanyiva Muindi4, Marcella Ucci1, Paul Wilkinson5, Nicole Zimmermann1
Author Affiliations: 1University College London; 2BuroHappold; 3UCL; 4African Population and Health Research Center; 5London School of Hygiene & Tropical Medicine

58% of Nairobi’s population live in informal settlements in extremely poor conditions that limit health and the fulfilment of human potential. Narrow focus policies have so far failed to address the complex environmental challenges faced by the inhabitants – including the vital issue of indoor/outdoor air pollution, one of the top five causes of childhood deaths in the Nairobi slums. Holistic and transformative solutions are needed that are developed through participation of the local population and stakeholders, including the city administration and NGO groups. The role of built environment and service delivery models is particularly important in enabling progress towards achievement of the Sustainable Development Goals in Nairobi in the face of significant local and global challenges. To respond to this need, we have begun innovative research based on principles of ‘co-generation’ and stakeholder engagement using system dynamics processes, supported by the expertise and input of a transdisciplinary research team.

In ongoing work we have used participatory system dynamics to map the complex systems involved via a series of workshops with stakeholders in Nairobi. We have applied building physics principles to understand the housing related exposures to pollutants implied by policy options resulting from the workshops. We then used health impact modelling to quantify population burdens, based on assessment of the population exposures and published exposure-response relationships. This then enabled a comparison of the impacts on health, wellbeing and sustainability objectives of alternative development options to inform policy, thus offering a full process pilot towards a multi-sectoral plan to reduce severe and avoidable health impacts on the urban poor.  Via the enthusiastic participation of a wide spectrum of stakeholders, the outputs from the initial workshops in Nairobi have highlighted the value of such a process in the development of relevant evidence based policy.

Drone Observed Therapy System (DrOTS): A Pathfinder for healthcare provision in remote villages

Authors: Gouri Sadananda1, Peter Small1
Author Affiliations: 1Institutional Studies Assistant, Stony Brook Global Health Institute

Globally, more than one billion people lack access to all-weather roads. This lack of infrastructure has a direct impact on health outcomes. When inhabitants of such areas become ill, they must run a gauntlet of challenges on their pathway to care. These include arduous walks to reach health clinics, health facilities staffed by poorly trained health workers equipped with limited diagnostic tests, and a need to return frequently to clinics for continued health monitoring. Such challenges are particularly problematic for finding and treating tuberculosis in in countries such as Madagascar.

We are embarking upon Drone Observed Therapy System (DrOTS), which uses unmanned aerial vehicles (UAVs) to eliminate travel and deliver a quiver of technology to overcome each of these challenges. The solution is based on four core innovative technologies: 1) UAVs to transport diagnostic and treatment materials from healthcare facilities to villages; 2) Medication event recording monitors (MERMs) to provide visual and sound reminders for patients in order to improve medication adherence; 3) Cough counters to monitor the improvement of symptoms associated with tuberculosis; and 4) A Malagasy video-based training curriculum that will provide targeted instruction for patients and community health workers. While highly innovative, this DrOTS Program will be fully integrated and compliant with Madagascar’s National TB Program (NTP). We are currently focusing on villages in the Ifanadiana district of Madagascar, where sputum samples will be collected from suspected patients and sent via drone to a diagnostic facility for molecular testing. Patient-centric and differentiated treatment will be provided to the anticipated 110 TB-positive patients using the four core technologies.

This proof-of-concept program aims to create a paradigm for using drones and innovative technology to overcome the burdens of accessing healthcare in rural areas and is a pathfinder for improving human and ecosystem health in remote settings.

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