46 Human Health and Global Environmental Change
Individual effects Although the health of a population is determined by a large number of factors (Table 1), we place more emphasis on individual level determinants such as age, education, marital status, behaviours and health competencies. The effects of individual factors are stronger than other level determinants. KHAN & KRÄMER (2010) found that cigarette smoking and smoking inside the home were significantly lower among people with better health knowledge and education. Slum dwellers with better health knowledge also reported better environmental management (e.g. garbage was collected regularly in their areas) and better living conditions (e.g. living in a house getting sufficient light and air) than slum dwellers with poor health knowledge. Public health interventions and research One of the fundamental purposes of public health intervention is to promote living environment conditions and healthy lifestyles through environmentally friendly behaviour, health education and improved personal hygiene. Such interventions are particularly necessary for slum dwellers because such people experience a higher burden of diseases, mainly attributable to poor socio-economic and environmental conditions, poor governance, and limited basic and health care resources. Communitybased public health interventions thus need to be at the centre of our interest. Several studies have reported on the effectiveness of interventions in developing countries including Dhaka (LUBY 2001; RANA ET AL. 2009; SHAHID ET AL. 1996). For instance, after one study, the incidence of diarrhoea was 62% lower in the intervention community (who twice a week received half a bar of soap and a pitcher
IHDP Update Issue 1, 2011
to facilitate hand washing) than in the non-intervention community. Through this intervention study, participants were encouraged to wash their hands with soap before eating or handling food and after urination or defecation (SHAHID ET AL. 1996).
P. Hostert Geography Department, Humboldt-Universität zu Berlin, Germany References Ahmed, R. & Falk, G.C. 2008. Bangladesh: environment under pressure. Geographische Rundschau, 4:12-18. Ahmed, S.M., Hossain, M.A. & Chowdhury, M.R. 2009. Informal sector providers in Bangladesh: How equipped are they to provide rational health care? Health Policy and Planning, 24: 467-478.
Conclusions
Alberti, M. 2009. Advances in Urban Ecology: Integrating
Conceptualising urban health not only requires analysis of current health determinants, but should include consideration of the dynamic nature of the cause-consequence chain which underlies the strong effects of, for instance, global climate change. Conceptual frameworks for urban health need to be further extended to consider informal processes and environmental exposures of poor population groups in the megacities of developing countries. Multiple determinants and interacting factors at different scale levels need to be addressed when megacity urban health is investigated. We described urban exposures and the reality of complexity within an extended framework for urban health in megacities of developing countries, in order to support intervention strategies for slum improvement in Dhaka and other megacities in comparable settings worldwide.
Barton, H. & Grant, M. 2006. A health map for the local
Humans and Ecological Processes in Urban Ecosystems. Springer-Verlag: New York.
Oliver Gruebner Geography Department, Humboldt-Universität zu Berlin, Germany. +49 30 2093 6905 oliver.gruebner@geo.hu-berlin.de
R. Staffeld Geography Department, Humboldt-Universität zu Berlin, Germany M.M.H. Khan Department of Public Health Medicine, University of Bielefeld, Germany K. Burkart Geography Department, Humboldt-Universität zu Berlin, Germany A. Krämer Department of Public Health Medicine, University of Bielefeld, Germany
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