Healthy Cities: What will it take?

Healthy Cities: What will it take?

Leah Steimel, MPHUrban Health PartnersUNM Health SciencesCenter Office for Community HealthApril 12 2013

Leah Steimel, MPHUrban Health PartnersUNM Health SciencesCenter Office for Community HealthApril 12 2013

Social Exclusion and inclusion as a means to health

Social Exclusion and inclusion as a means to health

Partici-pation Access Health

Social Exclusion:Social Exclusion:“… a multi-dimensional process in which various

forms of exclusion are combined:

• participation in decision making and political process;

• access to employment and material resources;

• integration into common cultural processes. When combined, they create acute forms of exclusion that form a spatial representation in particular neighborhoods.” (Madanipour, Cars, & Allen, 1998)

“… a multi-dimensional process in which various forms of exclusion are combined:

• participation in decision making and political process;

• access to employment and material resources;

• integration into common cultural processes. When combined, they create acute forms of exclusion that form a spatial representation in particular neighborhoods.” (Madanipour, Cars, & Allen, 1998)

Link between social exclusion & health

Link between social exclusion & health

• Prime social determinant of individual & community health

• Societal factors- not lifestyle choices- primary determinants of cardiovascular disease

~ Dennis Raphael

• Prime social determinant of individual & community health

• Societal factors- not lifestyle choices- primary determinants of cardiovascular disease

~ Dennis Raphael

Low Income

Unhealthy Behaviors

Excessive Psychosocial

Stress

Material Deprivatio

n

Cardiovascular Disease

How the process of Social Exclusion contributes to the mechanisms by which low income causes Cardiovascular Disease

Major Driver of Health InequityMajor Driver of Health Inequity

“the empowerment of individuals to challenge and change the unfair and steeply graded distribution of social resources to which everyone has an equal claims and rights.”

“the empowerment of individuals to challenge and change the unfair and steeply graded distribution of social resources to which everyone has an equal claims and rights.”WHO Commission on SDOH 2008

“The best local governance can help produce 75 years or more of life expectancy;

with bad urban governance, life expectancy can be as low as 35 years.”

“The best local governance can help produce 75 years or more of life expectancy;

with bad urban governance, life expectancy can be as low as 35 years.”Report of Knowledge Network on Urban

Settings, WHO Commission on Social Determinants of Health, 2008

What facilitates social inclusion?What facilitates social inclusion?

Healthy Governance ANDCommunity organization and participation for problem definition and community empowerment

Identifying interventions based on scientific-technical evidence

↓

Availability of financial resources to draw upon for implementation

↓Implementation for and with community

↓

Monitoring and evaluation of health and social impact

21st century participation21st century participation

Pathologies of legally required participation methods

___achieves genuine participation?___satisfies members of public?___improves decisions made?___involves broad spectrum of public?

Pathologies of legally required participation methods

___achieves genuine participation?___satisfies members of public?___improves decisions made?___involves broad spectrum of public?

Arnstein, 1969

Collaborative ParticipationCollaborative Participation

• One way talk dialogue• Elite or self-selected diverse

participants• Reactive involved at the outset• Top-down education mutually

shared knowledge• One-shot activities continuous

engagement• Controversial choices routine

activities

• One way talk dialogue• Elite or self-selected diverse

participants• Reactive involved at the outset• Top-down education mutually

shared knowledge• One-shot activities continuous

engagement• Controversial choices routine

activities

Research QuestionsResearch Questions• What are prominent indicators of social exclusion in our city and where are the “hot spots” for taking action?

• Participation is a building block for the City of the Future. What are the competencies for Participationand how do we build them?

Other Disciplines to Collaborate with @ UNM

Other Disciplines to Collaborate with @ UNM

• Architecture & Planning• Economics & Business• Sociology• Political Science • Public Administration

• Architecture & Planning• Economics & Business• Sociology• Political Science • Public Administration