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Highlights of the online course on urban health in low- and middle-income countries
URBANIZATION AND HEALTH: historical trends, demographic, epidemiological, and nutritional transitions; the global policy agenda.
DESCRIBING HEALTH AND ANALYSING SOCIAL DETERMINANTS AND INEQUALITIES: health status of urban populations; inequities and inequalities in urban context.
HEALTH SYSTEM: issues regarding the organization, financing, and delivery of health services and public health systems; access, quality and coverage.
PHYSICAL ENVIRONMENT: incl. water, sanitation & waste management; housing and land tenure; pollution; traffic injuries; natural disasters.
SOCIAL AND SOCIO-CULTURAL ENVIRONMENT: incl. social cohesion; (informal) employment; sex work, STIs/HIV; mental health, substance abuse; crime and violence; nutrition and the ‘double burden’; ‘lifestyles’.
CITY GOVERNANCE & COMMUNITY PARTICIPATION: city development plans, policy process; healthy cities projects; slum upgrading; rights based approaches; participation and accountability.
ADVOCACY & MULTI-SECTORAL ACTION FOR URBAN HEALTH: stakeholder analysis; effective communication and designing policy solutions.

Since 2007, more than half of the world population has lived in an urban environment. Urban citizens live in environments that offer both opportunities and threats for health. The poor in expanding urban slums often suffer from worse health indicators than the rural poor, with ‘urban averages’ hiding considerable inequalities between the poor and rich city dwellers.

Background

In February 2005 the late Dr. Lee Jong-Wook, Director-General of the WHO, created the Commission on Social Determinants of Health, in order to analyse and propose solutions to address the fundamental causes of poor health, especially those of the ‘bottom billion’ of this globe. The commission recognized the importance of urban health problems: one of the 9 working groups (knowledge networks) that advised the Commission was the Knowledge Network on Urban Settings (KNUS). The final report of this KNUS working group was entitled: ‘Our cities, our health, our future: Acting on social determinants for health equity in urban settings’ (WHO, 2008).

It is this background and the complexity of the pathways and causal chains through which social determinants impact on health that make urban health a particularly challenging topic for public health professionals. In response to urban health becoming more and more important on the policy agenda internationally, KIT organized a refresher course for her alumni in 2009 on urban health challenges, with participants from Ghana, Kenya, Nepal, Indonesia, Yemen, Egypt, Malawi, Uganda and Zambia. The course was held in Nairobi, and during the second week, a short 2 day field visit was made to a few of the less ‘famous’ slums of Nairobi, namely Dagoretti, Mukuru and Kawangware. (Kibera is the best known slum, having become almost a touristic place.)

Field visit

Armed with boots, cameras, interview guides and issue lists, that were elaborated with the help of an urban health conceptual framework, participants mapped the slums that they visited, held interviews with multiple stakeholders, and visited some of the homes of the slum dwellers.

Participants learned new vocabularies, like ‘flying toilets’, and at the end of the field visits, they were literally shocked by what they had heard, seen, smelled and experienced: even the Kenyan participants were so impressed by the visit, that one of them sighed: ‘We just know the names of the slums.’

A year later, KIT organized another course related field visit to urban health, this time in Jinja, Uganda. The course had as its title: ‘Health’ needs more than health care.

Diagnosed public health problems

In the follow-up of the first course, participants felt a need for public health officials to improve their communication skills in order to advocate for this broader and multi-sectoral approach related to the social determinants of health, developing contacts with politicians, press, opinion leaders and population networks; using media, message design strategies and other technologies. The course in Jinja therefore was aimed particularly at improving communication, advocacy and leadership skills, in order to enable public health alumni to play a more ‘passionate’ role in advocacy, and engaging with a diversity of stakeholders on a range of health issues.

Participants inventoried problems related to the following clusters of public health problems in Jinja:

  1. Traffic injuries and other injuries
  2. Unhealthy lifestyles – problems of overweight, diabetes, cardiovascular disease, related to unhealthy food, lack of physical exercise, smoking etc.
  3. Sanitary/environmentaland water problems
  4. Mental and social problems -including drug and alcohol abuse, STIs/HIV, mental distress, related to social support networks, churches and religion, mobility and migration.

They discussed these problems with various stakeholders relevant for each cluster: municipality, schools, police, health office, hospital, shop keepers, etc. to look at their awareness and involvement around that particular problem. The quick group assessments around the above four themes resulted in journal articles on each of the topics, meant for advocacy to the general public on the importance of social determinants of health. At the end of the course, participants made feedback presentation to the stakeholders whom they had contacted earlier.

Since these two short courses were held, KIT has integrated sessions on urban health in its regular Masters Programmes, and since 2013 a short online course on Urban Health in low-income countries is offered. Some highlights of this short course are given below. (More information on the KIT website: http://bit.ly/XeHEvp)