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外文翻译(Urban Health Issues)


Urban Health Issues
Demographic trends suggest that there is an urgent need to consider the health of urbanpopulations. Cities are becoming the predominant mode of living for the world&#

39;s population. According to the United Nations, approximately 29% of the world's population lived in urban areas in 1950. By 2000, 47% lived in urban areas, and the United Nations projects that approximately 61% of the world's population will live in cities by 2030. Overall, the world's urban population is expected to grow from 2.86 billion in 2000 to 4.94 billion in 2030. As the world's urban population grows, so does the number of urban centers. The number of cities with populations of 500,000 or more grew from 447 in 1975 to 804 in 2000. In 1975, there were four megacities with populations of 10 million or more worldwide; by 2000, there were 18, and 22 are projected by 2015. Most cities are in middle to low-income countries; in 2000, middle to low income countries contained 72% of the world's cities. Epidemiology can play a central role in studying both health and disease in the urban context and how urban characteristics may influence the health of populations. Characteristics of the urban environment that may shape population health include features of the social and physical environment and features of the urban resource infrastructure. Features of the social and physical environment and the urban resource infrastructure in turn are shaped by municipal, national, and global forces and trends.

Defining Urban Areas
One of the key challenges that faces epidemiologic inquiry about health in cities and how city characteristics influence health is that there is little consensus about the definition of urban and what constitutes a city. The U.S. Bureau of the Census defines an urbanized area by specifying a minimum population (50,000 people) and a particular minimum population density (1,000 people per square mile). The Census Bureau thus provides a dichotomy whereby territory, population, and housing units within specific size and density parameters are designated as urban and those that are outside those parameters are nonurban. However, there are inherent limitations to these definitions; urban areas exist in contrast to rural or simply in contrast to nonurban areas. In the 21st

century, only a few cities, such as Las Vegas, exist in extreme isolation where what is not defined as city is rural. Most cities (e.g., New York City, London, Bangkok) are actually far-reaching densely populated areas, containing peri urban and suburban areas, which continue relatively uninterrupted for miles beyond the municipal city boundaries and the city center. To accommodate varying conceptions of what constitutes an urban area, alternative definitions have been developed. They vary in how they define rates of disease, risk, and protective behaviors. The definition of urban also varies widely between countries. Among 228 countries for which the United Nations had data in 2000, almost half (100) include size and density as criteria, 96 include administrative definitions of urban (e.g., living in the capital city), 33 include functional characteristics (e.g., economic activity, available services), 24 have no definition of urban, and 12 define all (e.g., Anguilla, Bermuda, the Cayman Islands, Gibraltar, the Holy See, Hong Kong, Monaco, Nauru, Singapore) or none (e.g., Pitcairn Island, Tokelau, and Wallis and Futuna Islands) of their population as urban. Official statistics (e.g., United Nations statistics detailed above) rely on country-specific designations and, as such, vary widely. In specific instances, definitions of urban in adjacent countries vary tremendously (e.g., Cambodia vs. Vietnam). Furthermore, definitions of urban have evolved in different ways in different countries. Therefore, global statistics are subject to country-level differences in the definition of urban that may be based on population density or specific urban features (e.g., proportion of agricultural workers, municipal services)

Urban ‘Exposure’ As a Determinant of Health
It may be heuristically and methodologically useful to conceptualize urban exposure in two main ways: urbanization and the urban environment. Epidemiologic inquiry can be guided by an understanding of how these different facets of urban exposure may influence population health. Urbanization refers to the change in size, density, and heterogeneity of cities and provides a perspective for public health planning. Factors such as population mobility, segregation, and industrialization frequently accompany urbanization. More simply stated, urbanization is the process that involves the emergence and growth of cities. Thus, the

process of urbanization does not depend on definition of urban per se but rather on the dynamics of agglomeration of individuals. Although the pace of urbanization is independent of the base size of the population, the population size and density of surrounding areas may shape the pace of urbanization. For example, urbanization may include the establishment (or destruction) of new buildings or neighborhoods, development (or removal) of transportation routes and the in-migration and out-migration of people, and changing racial/ethnic composition of cities. How the dynamics of urbanization affect health can be considered with examples. An influx of impoverished peoples to a city (e.g., immigration driven by food or work shortages in nonurban or other urban areas) in search of jobs and services may tax available infrastructure, including transportation, housing, food, water, sewage, jobs, and health care. Overtaxed sanitary systems may directly lead to rapid spread of disease, as has been the case many times in North America during the past century and as continues to be the case in the developing world today. Also, the population strain on available jobs may result in devaluation of hourly wage rates, higher unemployment, and changing socioeconomic status for persons previously living in a given city. This lowering of socioeconomic status can result in more limited access to health care and may lead to poorer health. Therefore, characteristics of urbanization—including the intensity, rate, and duration of such changes as well as the response to these changes —may have health effects on urban residents. Common mechanisms may exist through which urbanization affects health independent of the size of the city in question. The urban context or environment can be defined as the specific characteristics or features of cities that influence health within a particular city. It is helpful to think of the urban environment as involving three distinct concepts: the social environment, the physical environment, and the urban resource infrastructure. The social urban environment comprises contextual factors that include social norms and attitudes, disadvantage (e.g., neighborhood socioeconomic status), and social capital (e.g., social trust, social institutions). The urban physical environment refers to the built environment, pollution, access to green space, transportation systems, and the geological and climatic conditions of the area that the city occupies. Features of the urban resource

infrastructure that influence health may include factors such as the availability of health and social services and municipal institutions (e.g., law enforcement). Features of the social and physical environment and infrastructural resources are all, in turn, shaped by municipal, national, and global forces and trends.

Studies of Health in Urban Populations
Three study designs—urban versus rural studies, interurban studies, and intra-urban studies—have been principally employed to consider both the health of urban populations and how characteristics of cities may influence the health of urban residents. Each has strengths and weaknesses, and these methods may lend themselves to addressing different questions. A multiplicity of methods, including qualitative and quantitative methods, may be employed within each of these designs.

Urban Versus Rural Studies
Urban versus rural studies typically contrast urban areas with rural areas in the same country or consider morbidity and mortality in urban versus nonurban areas. Essentially, these studies seek to determine whether morbidity and mortality due to a specific health outcome is different in specific urban areas as compared with specific nonurban areas. Urban versus rural (or nonurban) comparisons are useful in drawing attention to particular health outcomes that may be more or less prevalent in urban areas and merit further investigation to examine the specific features of the urban (or rural) environment that are associated with that outcome. Recognizing that urban-rural comparisons are too blunt, more recent work has refined distinctions such as urban core, urban adjacent, urban nonadjacent, and rural. However, such studies are limited in their ability to identify what those factors may be and the pathways through which they affect the health of urban dwellers. Features of cities change over time, and some factors may not be conserved between cities (e.g., racial/ethnic distribution). Thus, it is not surprising that different urban-rural comparisons have provided conflicting evidence about the relative burden of disease in urban and nonurban areas. At best, these studies reveal gross estimates of the magnitude and scope of health measures in broad areas by geographical areas typically defined by size and population density.

Interurban Studies

Interurban studies typically compare health outcomes between two or more urban areas between or within countries. Such studies can simply identify differences between cities or can examine specific features of cities that influence health. Examples of the former are numerous. For example, Vermeiren, Schwab-Stone, Deboutte, Leckman, and Ruchkin (2003) have compared mental health outcomes among adolescents in New Haven (United States), Arkhangelsk (Russia), and Antwerp (Belgium), providing insights into the cross-cultural, cross-urban similarities and differences in antisocial behavior, depression, substance use, and suicide. A study of Puerto Rican injection drug users in New York City (United States) and Bayamo? a (Puerto Rico) revealed several differences between the two ethnically similar populations; injection drug users in Puerto Rico injected more frequently and had higher rates of needle

sharing as compared with their New York counterparts. The authors pointed to similarities in drug purity and differences in the onset of the crack epidemic as city level factors that influenced injector risk behaviors. When using the city as the unit of analytic interest, one implicitly assumes that city-level exposures are equally important for all residents. Studying differences in drug use risk behaviors among two cities does not permit analysis of differences in behaviors within cities because of location of residence, intra urban variability in barriers to safer behaviors, or variations in access to key services (e.g., drug treatment, needle exchange) provided to different urban residents. However, interurban studies such as the examples mentioned here can help guide municipal and state policymakers when making decisions on service provision throughout a city.

Intra-Urban Studies
Intra-urban studies typically compare health outcomes within cities and are being widely used to investigate specific features of the urban environment. These studies often focus on neighborhoods, specific geographic areas within a city that are generally administrative groupings (e.g., census tracts in Canada, subareas or suburbs in South Africa). However, it is important to note that administrative groupings may not represent residents’ perceptions of their neighborhoods. Intra-urban studies may contribute important insights into the relations between specific urban features and health outcomes. However, it may be difficult to generalize from one city to another. For instance, the relation between collective efficacy and violence may be modified by different levels of policing or differential access to illicit substances within a given city. Furthermore, it is important to consider that neighborhood residence is a function of geographical location and other types of social ties that are facilitated or necessitated by the urban environment.

Defining and Quantifying Urban Exposures
When considering a complex and broad exposure such as urbanization or the urban environment, epidemiologic inquiry may fruitfully be guided by considering the elements of urban areas that mechanistically may shape the health of urban populations. It may be useful to consider how the social environment, the physical environment, and the urban resource infrastructure may influence population health.

Social Environment
The urban social environment includes features such as social norms and attitudes, social capital, and income distribution. This list is by no means exhaustive; the further readings provide a more comprehensive look at the urban social environment.

Social norms are patterns of behaviors that are considered accepted and expected by a given society. From the perspective of urban health, the multiple levels of societal and cultural norms are important considerations when thinking about the behavior of urban dwellers. Persons within the urban environment may be influenced by the social norms of their local, geographicallydefined community, with its unique physical and social structures and cultural characteristics. However, communities may not be limited to one geographic location. Persons in urban areas may also be influenced by the norms operating within the broader urban community. Social cohesion is typically defined as the connectedness among groups and includes both the presence of strong intra-group bonds and the absence of intragroup conflict. Social capital, a related construct, is thought to provide resources for collective action. Both may be particularly important in densely populated urban areas, where social interaction shapes daily living. There is evidence that the absence of social capital is associated with negative health outcomes such as increases in mortality, poor self-rated perception of health, higher crime rates, and violence. Income inequality is the relative distribution of income within a city or neighborhood and is typically operationalized with the Gini coefficient. Income inequality is thought to operate through material and psychosocial pathways to shape population health independently of absolute income. Income inequality has been associated with several health outcomes, including self-rated health, cardiovascular mortality, and consequences of illicit drug use. Additionally, emerging work suggests that intra-urban neighborhood income inequality is associated with adverse health outcomes.

Physical Environment
The urban physical environment refers to the built environment (e.g., green space, housing stock, transportation networks), pollution, noise, traffic congestion, and the geological and climate conditions of the area the city occupies. The built environment includes all human-made aspects of cities, including housing, transportation networks, and public amenities. Recent studies have suggested that poor quality of built environments is associated with depression, drug overdose, and physical activity. Green space (e.g., parks, esplanades, community gardens) has the potential to significantly

contribute to the health of urban dwellers. Living in areas with walkable green spaces has been associated with increased longevity among elderly urban residents in Japan, independent of their age, sex, marital status, baseline functional status, and socioeconomic status. Urban transportation systems include mass transit systems (i.e., subways, light rail, buses) as well as streets and roads. Urban transportation systems are key in the economic livelihoods of city residents as well as cities as a whole. On the other hand, there are significant health considerations for mass transit and roadways, including security and violence, noise, and exposure to pollutants. These exposures are relevant not only for transit workers but also for transit riders. Pollution is one of the well-studied aspects of the urban physical environment. Urban dwellers are exposed to both outdoor and indoor pollutants that include heavy metals, asbestos, and a variety of volatile hydrocarbons. For example, one study conducted by Ruchirawat et al. (2005) in Bangkok (Thailand) reported high levels of benzene and polycyclic aromatic hydrocarbons among street vendors and school children sampled from traffic-congested areas as compared with monks and nuns sampled from nearby temples.

Urban Resource Infrastructure

The urban resource infrastructure can have both positive and negative effects on health. The urban infrastructure may include more explicit health-related resources such as health and social services as well as municipal structures (e.g., law enforcement), which are shaped by national and international policies (e.g., legislation and cross-border agreements). The relation between availability of health and social services and urban living is complicated and varies between and within cities and countries. In wealthy countries, cities are often characterized by a catalog of health and social services. Even the poorest urban neighborhood often has dozens of social agencies, both government and nongovernmental, each with a distinct mission and providing different services. Many of the health successes in urban areas in the past two decades, including reductions in HIV transmission, teen pregnancy rates, tuberculosis, and childhood lead poisoning, have depended in part on the efforts of these groups. For example, social and health services may be more available in cities than in nonurban areas, contributing to better health and well-being among urban residents. Despite wider availability of social and health services in cities, many cities experience remarkable disparities in wealth between relatively proximate neighborhoods. This variance is often associated with disparities in the availability and quality of care. Low-income urban residents face significant obstacles in finding health care both in wealthy and less wealthy countries.

Municipal, National, and Global Forces and Trends
Municipal, national, and global forces and trends can shape the more proximal determinants of the health of urban populations. For example, legislation and governmental policies can have substantial influence on the health of urban dwellers. Historically, municipal regulations regarding sanitation in the 19th and 20th centuries facilitated vast improvements in population health and led to the formation of national groups dedicated to improving population health such as the American Public Health Association. A contemporary example of the power of legislation to influence health has been ongoing in New York State since the early 1970s. In 1973, the New York State Legislature, with the encouragement of then Governor Nelson Rockefeller, enacted some of the most stringent state drug laws in the United States. Characterized by mandatory

minimum sentences, the Rockefeller Drug Laws have led to the incarceration of more than 100,000 drug users since their implementation. Those incarcerated under the Rockefeller Drug Laws overwhelmingly are New York City residents (78%) and Black or Hispanic (94%). Ernest Drucker (2002) estimated the potential years of life lost as a result of the Rockefeller Drug Laws to be equivalent to 8,667 deaths. Regional and global trends can affect not only urban living but also the rate and process of urbanization or deurbanization. Changes in immigration policies or policy enforcement can affect urban dwellers in a variety of ways, including, but not limited to, changes in access to key health and social services for some subpopulations, changes in community policing practices, and changes in social cohesion and levels of discrimination. Terrorist attacks in urban centers (e.g., Baghdad, Jerusalem, London, Madrid, and New York City) are associated not only with morbidity and mortality among those directly affected by the event but also with significant psychological distress for other residents of the cities. Armed conflicts have resulted in mass displacement of individuals, some of whom have fled cities for other cities, regions or countries, or camps for displaced individuals (e.g., Darfur。

城市卫生问题
人口趋势表明, 有一个迫切需要考虑城市人口的健康。城市正在成为世界人 口的主要居住方式。根据联合国 1950 年,约 29%的世界人口居住在城市地区。 到 2000 年,47%居住在城市地区,联合国项目中,约 61%的世界人口将居住在 城市,到 2030 年。 总体而言,世界城市人口从 2.86 亿至 4.94 亿美元,在 2000 年到 2030 年预计将增长。随着世界城市人口的增长,使城市中心区的数量。人 口超过 50 万的城市的数量从 1975 年的 447 增长到 2000 年的 804。在 1975 年, 有四个大城市, 人口 10 万以上的世界各地, 到 2000 年, 有 18 和 22, 预计到 2015 年。大多数城市都在中低收入国家,2000 年,中低收入国家 72%的世界城市。 流行病学方面可以发挥核心作用, 在城市中的健康和疾病研究和城市特色如 何影响人民的健康。 特性可能塑造人口健康的城市环境,包括社会和物理环境的 功能和特点的城市资源基础设施。 特点的社会和物理环境和城市基础设施资源反 过来塑造的城市,国家,全球的力量和趋势。 定义市区 面临着关于健康流行病学调查, 在城市和城市特色如何影响健康的主要挑战 之一是,很少有关于城市的定义达成共识,什么构成了城市。 美国人口普查局 定义一个城市化地区,通过指定的最低人口(50,000 人)和一个特定的最低人 口密度(每平方英里 1000 人)。 因此,人口普查局提供了一个二分法,即在特 定的大小和密度参数的领土, 人口和住房单位被指定为城市和那些这些参数之外 的非都市。但是,也有固有的局限性这些定义;城市地区中存在的农村或仅仅在 对比非都市区。在 21 世纪,只有少数几个城市,如拉斯维加斯,存在于什么地 方没有被定义为城市是农村的极端孤立的境地。大多数城市(如纽约,伦敦,曼 谷)实际上是深远的人口稠密地区,包含近郊城区和郊区,继续不间断英里以外 的市级城市边界和市中心。什么构成市区,以适应不同的概念已被开发,替代定 义。他们在不同的他们是如何定义率疾病,风险和保护行为。 城市的定义也各不相同的国家之间广泛。 在 228 个国家, 联合国的数据, 2000 年,几乎一半(100)包括大小和密度为标准,96 的定义包括行政城市 (例如, 生活在省会城市),33 个包括功能特性(例如,经济活动,提供的服务),24 城市没有定义,12 定义(例如,安圭拉,百慕大,开曼群岛,直布罗陀,罗马 教廷,香港,摩纳哥,瑙鲁,新加坡)或没有(如,皮特凯恩岛,托克劳,瓦利 斯群岛和富图纳群岛)为城镇人口。官方统计数据(例如,联合国统计详述依赖 特定国家的名称,因此,有很大的不同。 在相邻国家在特定情况下, 城市的定 义千差万别(例如,柬埔寨与越南)。. 此外,对城市的定义已经发展以不同的 方式在不同的国家。因此,全球的统计数据是国家水平的差异,在城市的定义, 可根据人口密度或特定的城市功能(如农业劳动者的比重,市政服务)。 城市“曝光”作为一项健康决定因素 它可能是, 启发式和方法论有用概念化城市暴露在两个主要方面:城市化和 城市环境。 流行病学调查可以了解如何将这些不同层面的城市暴露可能会影响 人口健康指导。

城市化 是指到的变化的大小,密度,和城市的异质性,并提供了一个立体 的公共健康规划。经常伴随着城市化的因素,如人口流动,隔离和工业化。更简 单地说,城市化的过程,涉及到城市的出现和成长。 因此,城镇化的过程中, 不依赖于城市本身的定义,而是个人结块的动态。 虽然城镇化的步伐,是独立 的基础的人口规模,人口规模和密度的周边地区可能塑造城市化的步伐。例如, 城市化可能包括建立新的建筑物或居民区,开发(或删除),运输路线和在迁移 和人口迁移(或破坏),改变种族/族裔组成的城市。 城市化的动态如何影响健康的例子, 可以考虑。 一个贫困的人民涌入城市 (例 如, 移民带动非都市或其他城市地区的食物或工作短缺)在寻找工作和服务征税 提供基础设施,包括交通,住房,食物,水,污水,作业,医疗保健。不堪重负 的卫生系统可能直接导致疾病的迅速蔓延, , 一直多次在北美, 在过去一个世纪, 仍然是今天发展中世界的情况。此外,人口可供工作的压力,可能会导致贬值, 每小时的工资率, 较高的失业率,以及不断变化的社会经济地位的人以前住在一 个给定的城市。 这种社会经济地位下降可能会导致较为有限获得医疗保健,并可 能导致健康状况较差。 因此,城市化的特点,包括的强度,速度和持续时间等 的变化,以及这些变化的响应,可能对城市居民的健康影响。公共机制可能存在 通过城市化影响健康城市问题的大小无关。 可以被定义为在一个特定的城市影响健康的具体特征或功能的城市的城市 环境下或环境 。认为涉及三个不同的概念:社会环境,物理环境和城市资源基 础设施,城市环境是很有帮助的。城市环境包括社会环境因素,包括社会规范和 态度,缺点(例如,邻里社会经济地位),和社会资本(如,社会信任,社会机 构)。城市物理环境是指内置环境,污染,绿色空间,交通系统,城市占据的区 域的地质和气候条件。 Features of the urban resource 城市资源的特点基础 设施,可能包括影响健康的因素,如健康和社会服务的可用性和市政机构(如执 法)。 反过来,社会和物理环境和基础设施资源的特点是所有塑造的城市,国 家,全球的力量和趋势。 在城市人群健康的研究 三个研究设计, 城市与农村的研究,城市间的研究和城市内部的研究主要考 虑的健康城市人口和城市的特性,可能会影响到城市居民的健康。 每个人都有 长处和短处,这些方法可能借给自己解决不同的问题。 在每个这些设计方法, 包括定性和定量方法,可采用多重。 城市对战农村研究 城市与农村的研究通常是对比城市地区与农村地区在同一个国家或考虑在 都市与非都市地区的发病率和死亡率。从本质上讲,这些研究的目的,以确定是 否与特定的非都市区相比, 发病率和死亡率,由于特定的健康结果是在特定的市 区不同。 城市与农村(或者非都市)比较适用于特定的健康结果,可能是或多或少普 遍存在,在市区和值得进一步调查研究城市(或农村),结果都与环境的具体特 点, 提请注意。 认识到城乡的比较是太钝了, 最近的工作已经细化如城市核心区, 城市相邻,不相邻的城市和农村的区别。 然而,这些研究只限于在自己的鉴别 能力,这些因素可能是什么途径,通过他们的影响城市居民的健康。. 城市特点 的变化随着时间的推移, 一些因素可能不守恒城市 (如, 种族/民族分布) 之间。 因此, 这并不奇怪, 不同的城乡比较的相对的疾病负担在城市和非都市地区提供

了相互矛盾的证据。 在最好的情况下,这些研究揭示估计总额按地区划分的通 常定义的大小和人口密度的程度和范围的卫生措施,在广泛的领域。 市际研究 市际研究通常比较健康结果之间的两个或两个以上的国家之间或在市区。 这样的研究可以简单地识别城市之间的差异,或影响健康的城市,可以检查特定 的功能。 例如,卫美恒,施瓦布石,Deboutte,Leckman,Ruchkin(2003)比 较了纽黑文(美国),阿尔汉格尔斯克(俄罗斯),安特卫普(比利时)在青少 年的心理健康成果,提供洞察跨文化,跨城市的相似性和反社会行为,抑郁,物 质的使用,和自杀的差异。波多黎各在纽约市(美国)和 Bayamo'a(波多黎各) 的注射吸毒者的研究发现一些差异的两个种族相近的人群, 注射吸毒者在波多黎 各更加频繁,注射针率较高。作者指出,在药物纯度的相似性和差异在城市层面 的因素,影响喷油的危险行为的破解流行发病。. 当使用城市为单位解析兴趣, 一个隐含的假设,市级风险是同样重要的,对所有居民。研究使用毒品的危险行 为两个城市之间的差异,不允许在城市内的行为差异分析,因为户籍所在地的, 更安全的行为障碍,城市内变异或变化的关键服务(如药物治疗,针具交换)提 供不同的城镇居民。然而,这里提到的例子,如市际研究可以帮助指导市政和国 家的政策制定者提供服务的决策时,整个城市。 城市内研究 城市内部的研究通常比较健康结果在城 市之内,并正在广泛用于研究城市 环境的具体功能。 这些研究往往侧重于社区,特定的地理范围内的城市,一般 都是行政分组(例如,在加拿大,人口普查子区域或郊区在南非)。 然而,重 要的是要注意,管理分组可能并不代表他们的社区居民感知。 进入特定的城市功能和健康结果之间的关系, 城市内部的研究可能很重要的 贡献。 但是,它可能难以一概而论从一个城市到另一个。 例如,集体效能和暴 力之间的关系可能会被修改, 在一个给定的城市不同程度的治安或差分访问非法 物质。此外,重要的是要考虑到附近居住的地理位置和其他类型的社会关系,是 促进城市环境的需要,是一个功能。 定义和质量考虑 当考虑一个复杂和广泛的接触,如城市化或城市环境,流行病学查询可能卓 有成效指导下考虑市区机制可能塑造城市人群的健康元素。这可能是有用的,要 考虑社会环境,物理环境,以及城市资源的基础设施可能会影响人口健康。 社会环境 城市社会环境包括社会规范和态度,社会资本,收入分配等功能。此列表并 不详尽;进一步读数提供了一个更全面的了解城市社会环境。 社会规范的行为被 认为是由给定的社会接受和预期的模式。从城市卫生的角度,多层次的社会和文 化规范是重要的考虑因素时,考虑城市居民的行为。在城市环境中的人,可能会 受到社会规范的地方.地理定义的社区,有其独特的物理结构和社会结构和文化 的特点。. 然而,社区可能不局限于一个地理位置。在市区的人可能也将受到更 广泛的城市社区内经营的规范。 社会凝聚力通常被定义为群体之间的连通, 包括强大的集团内公司间债券存 在的内部冲突和缺乏。社会资本,相关构造,被认为集体行动提供资源。 既有 可能是在人口稠密的城市地区尤为重要,,社会互动形状日常生活。 有证据表 明,由于缺乏相关的社会资本对健康的负面结果,如死亡率增加,贫困自测健康 的看法,更高的犯罪率和暴力。

收入不平等是收入在一个城市或附近的相对分布的基尼系数通常可操作性。 收入不平等被认为是通过塑造独立的绝对收入人群健康的物质和心理途径。 收入 不平等一直伴随着一些健康结果,包括自测健康,心血管疾病的死亡率,以及使 用非法药物的后果。此外,新兴的工作表明,城市街道内的收入不平等是与不良 健康结果。 物理环境 城市物理环境是指建筑环境(例如,绿地,存量住房,交通网络),污染, 噪音,交通拥堵,城市占据的面积和地质和气候条件。. 内置环境包括城市所有 的人为方面,包括住房,交通网络和公共设施。最近的研究表明,抑郁症,药物 过量和身体活动是与内置的环境质量较差。 绿色空间(例如,公园,散步路, 花园小区)有潜力显着城市居民的健康做出贡献。 生活在绿地与步行地区一直 伴随着增加老年城镇居民,在日本,他们的年龄,性别,婚姻状况,基线功能状 态,社会经济地位之间的长寿。 城市交通系统包括大众运输系统(即,地铁, 轻轨,公共汽车)以及街道和道路。城市交通系统是城市的居民以及作为一个整 体的城市在经济生活的关键。另一方面,也有显着的健康考虑公共交通和道路, 包括安全性和暴力,噪音,接触污染物。这些风险不仅为运输工人,也为过境乘 客有关。 污染是城市的物理环境的充分研究的方面之一。 城市居住者暴露在室外和室 内的污染物,包括重金属,石棉,和各种挥发性烃。例如,由 Ruchirawat 等人 进行的一项研究中。(2005 年),曼谷(泰国)高浓度的苯和多环芳烃之间的 交通挤塞的地区摊贩和采样学童相比,取样来自附近寺庙的僧尼。 城市资源基础设施 城市资源的基础设施, 可以对健康有正面和负面的影响。城市基础设施可能 包括更明确的健康相关的资源, 如卫生和社会服务, 以及城市结构 (例如, 执法) , 这是塑造国家和国际政策(例如,立法和跨境协议)。 卫生和社会服务的可用性和城市生活之间的关系是复杂的, 城市和国家之间 和内部的变化。在富裕国家,城市的特点往往是由卫生和社会服务的目录。即使 是最贫穷的城市社区往往有几十个社会机构,政府和非政府组织,每一个独特的 使命,并提供不同的服务。在城市地区,在过去的二十年中,包括艾滋病毒的传 播,减少青少年怀孕率,肺结核,儿童铅中毒,许多方面的成功一直依赖这些团 体的努力的一部分。例如,社会和卫生服务可提供比非都市区的城市,城镇居民 之间的更好的健康和福祉。 尽管在城市社会和卫生服务的广泛可用性,许多城市 的经验相对较近的邻里之间的财富差距显着。 这种差异往往是相关的可用性和护 理质量的差距。 城镇低收入居民面临着重大障碍,无论是在富裕和较富裕的国家 在寻找保健。 城市,全国和全球的力量和趋势 城市, 国家和全球的力量和趋势, 可以塑造更近的城市人群的健康决定因素。 例如,立法和政府政策可以对城市居民的健康有很大的影响力。从历史上看,市 政促进了广大改善人口健康,并导致形成的民族群体,致力于改善人民健康,如 美国公共健康协会在 19 世纪和 20 世纪的卫生法规。 立法权影响健康的一个当代 的例子,20 世纪 70 年代初以来,在纽约州一直持续。当时的州长纳尔逊·洛克 菲勒的鼓励,1973 年,纽约州立法机关颁布了一些在美国最严格的国家药品法 律。特点是强制性最低刑期,洛克菲勒毒品法已经导致监禁超过 10 万吸毒者, 因为它们的实现。 洛克菲勒毒品法下被关押压倒性的纽约市居民(78%)和黑

人或西班牙裔(94%)。欧内斯特·德鲁克(2002)估计的潜在寿命损失年的洛 克菲勒毒品法相当于 8,667 人死亡的结果。区域和全球的发展趋势,不仅会影响 城市生活,但城市化的速度和过程或 deurbanization。移民政策的变化或政策 的执行会影响城市居民的各种方式,包括,但不限于访问关键的卫生和社会服务 的变化对某些亚群, 在社区警务实践的变化, 社会凝聚力和水平的变化歧视。 (例 如,巴格达,耶路撒冷,伦敦,马德里和纽约市)城市中心的恐怖袭击不仅与那 些直接受影响的事件, 但也具有显着的心理困扰城市的其他居民之间的发病率和 死亡率。 有导致大规模流离失所个人的武装冲突,其中一些人已经逃离城市, 其他城市,地区或国家,或为流离失所的个人(例如,达尔富尔)的阵营。 未来的研究 全球人口发展趋势表明, 已经成为城市生活的规范,有一个迫切需要考虑城 市生活如何可能会影响人民的健康。卓有成效地从事流行病学研究城市特色,包 括社会和物理环境的特点和功能的城市资源基础设施如何影响健康和疾病在市 区范围内。城市卫生的研究需要多学科的角度,可以考虑不同类型的研究,包括 间和城市内的研究和城乡比较。 流行病学家在该地区的工作,可以补充公共健康 从业者,城市规划者,以及社会,行为,临床和环境健康科学家在社区居民和公 民,企业,和政治领导人的积极参与配合的工作。


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particularly in urban areas, such as slums and illegal settlements, where the...(partial) alleviation of the state from environmental care issues and have ...
毕业论文外文翻译(中英文)
urban transportation system that is economically, ...“a range of other human health effects, from ...Economic equity issues resulting from congestion ...
外文翻译
吉林化工学院毕业设计外文翻译 Ergonomics and Design ...urban planning, infrastructure construction, factory ...health and safety, ergonomic office environment; 2...
外文翻译
These survey results have already been included in the World Health ...Household water filters are increasingly used in urban areas of China. ...
外文翻译
数学的外文翻译 11页 5财富值如要投诉违规内容,请到...When these urban-specific fiscal and credit ...pension and health care arrangements, and high costs...
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