healthy city index - have we done enough

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


• 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


• 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


• 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


• 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.


• 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


• 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


• 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


• 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


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


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


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


Cycling lanesJogging lanesMountain climbingPlay grounds

Town and Country PlanningLocal government


Historical sitesMuseumParks and greens

WelfareLocal government


HousingCommunity participationSecurity Crime ratesHousing Rentals

PoliceTown and Country Planning



Data sources Possible disaggregating

variables

Access to basic needs

Jobs availabilitySkilled workersIndustrial areaBusiness areas

Ministry of Labour


Food supplyMarketsOthers needs clothing apparel etc.

Local Government


Safe water supplyEfficient electricity supplyTelecommunication network

Utility companies


SchoolsHospital and clinicsRecreational parks and greenPolice and crime preventionFire stations

Health DepartmentLocal government



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


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


Disaster risk management and preparednessDisaster mitigation strategiesCommunity resilient and preparedness

PBTHealthMKN



Data sources Possible disaggregating variables

High health status

Infant mortalityMaternal mortalityUnder five mortality


Prevalence of tobacco smokeAlcoholObesity


Prevalence of Hypertension, Diabetes, Cardiovascular, Cancer and mental health


Injuries, MVA and crime and intentional injuries include homicide and suicidal rates

Ministry of HealthPolice


Incidence of infectious diseases , Tuberculosis, dengue, HIV, STI, food and water borne diseases, immunisable diseases


• 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.

healthy city index - have we done enough

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