Bell DM, Weisfuse IB, Hernandez-Avila M, del Rio C, Bustamante X, Rodier G.

Pandemic influenza as 21st century urban public health crisis, IN: Emerg Infect Dis. 2009 Dec.

Full-text: http://www.cdc.gov/eid/content/15/12/pdfs/09-1232.pdf (pdf, 689KB)

The percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012.

Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide.

SINGAPORE — Asia’s urban poor are worst-hit by spiking food prices, according to a report released Tuesday by a regional think tank which tipped rising volatility in commodity prices.

Impoverished families in the region’s teeming cities are more vulnerable than rural folk to swings in food costs, according to the Pacific Economic Cooperation Council (PECC).

Food price increases’ greatest impact is on the urban poor who are more dependent on a money-based economy and spend a large share of the household budget on food,” said Walter Armbruster from the PECC taskforce which authored the report.

“The rural poor may have greater access to food through family relationships or the capacity to produce their own food.”

The report, released at the Asia-Pacific Economic Cooperation (APEC) forum in Singapore, said that food price volatility was set to worsen as trade in commodities became more interlinked with other markets.

“Real agricultural prices increased in the 2000s, as they became more closely linked to non-agricultural commodity and energy prices. Some of these price increases — such as fertilizer and transportation costs — changed the cost structure of agriculture,” he said.

Protectionist policies by major agricultural producers coupled with “the psychology of scarcity and propensity to hoard” were other factors behind volatility, Armbruster said.

“Policy intervention played a significant role in raising agricultural commodity prices, especially in the case of rice,” he said.

Describing swings in rice prices as “the single most important phenomena affecting the region’s food system in recent years,” Armbruster said that a major factor was slim trading volumes in the grain.

An important lesson from this volatility was that the rice market intervention, if left unchecked, can be more destructive than economic events,” he said.

Commodities prices soared before the global downturn struck last year, causing serious concerns over food prices and food security.

The UN food agency said this week that although prices have fallen significantly since their peaks a couple of years ago, wheat and maize prices are rising and rice export prices are still way above pre-crisis levels.

Armbruster urged regional nations to adhere to the APEC Open Food System of liberalising trade and developing rural regions in agricultural economies in order to cushion the impact of food price volatility.

“We may be entering a higher volatility future in commodities prices, but there are some things that can offset that volatility,” he said.

Source – Nov. 11, 2009, AFP

It was around 15 years ago that Rajendra Joshi, Schwab Foundation for Social Entrepreneurship winner for this year, woke up to the power of social entrepreneurship.

Joshi’s NGO had been working on an Integrated Slum Development project in Ahmedabad since 1989, and that year, it tied up with the city municipal corporation to provide basic infrastructure — water, drainage, sewerage — to seven slums.

The slum-dwellers would pay Rs 2,000, a one-time fee, and in exchange the municipality would give a guarantee that it would not evict them.

In no time, 5,000 families had come on board.

For me, that was an indication that the urban poor could be viewed as a market. What NGOs and the government sector needed to do was take the private sector approach. Innovations will come if there is money to be made,” says Joshi who is one of three winners of the Schwab Foundation.

It’s a lesson that Joshi has applied to Umeed-Udaan, the training programme in data-entry, hospitality, retail, spoken English, computers and other technical skills that Saath has been running in the slums of eight cities in Gujarat and Rajasthan.

In just four years, 15,403 youth, one-third of them female, have been placed, with eighty per cent of them in companies such as ICICI Bank, Vodaphone, and Reliance Fresh.

Joshi is now looking for an angel investor who will allow him to scale up Saath’s Urmila project. This is for the women from slums, who are trained to be ‘home managers’ and then be placed in households. Joshi says he hopes to take this to other metro cities.

Also in the works is a hand-held solar light for vegetable vendors, which will save them the Rs 10 they pay everyday to recharge their batteries.

Source – Nov. 12, 2009, Top News

peruvian-fog-catcherIn Lima, Peru, more than 1.3 million people have no access to drinking water. The citizens without it are in the poorest areas, where water trucked in can cost nine times as much as it does in richer areas. So, citizens have had to either make do without running water, or, with the help of a German NGO, make dew into drinking water.

The Telegraph reports on one slum in particular, Bellavista del Paraiso. With 200 residents in need of water, the mayor of the slum stated, “We are the very first to have fog-catchers in Lima’s poor neighborhoods…We have five panels that are eight metres by four metres (26 feet by 13 feet),” perched on the mountaintop above, he explained. “With them we are able to collect up to 60 litres per night in wintertime.”

The water is used for drinking and cooking, but also to irrigate small vegetable gardens. So the fog nets are bringing a much needed resource right to the kitchen steps of the citizens. While the nets cost around $800 each, and water purifying tabs are also required, the pay-off is far greater with citizens able to drink and raise food with the fog water.

German biologists Anne Lummerich and Kai Tiedemann created the system, and are behind Alimon, the German non-profit organization that has been working to bring drinking water to Peruvians since 2006. The “Green Desert” project is a two-stage affair, involving first human-made fog collectors, and then trees acting as natural fog collectors. According to the organization:

In the first stage fog collectors and water reservoirs are installed on the hilltop. Here we find the best conditions for a high water yield. Tree species which are adapted to aridity and are apt to comb fog are planted between the fog collectors and the water reservoirs. The fog water combed out by the fog collectors is conducted to the water tanks and is used fort the irrigation of the trees.

The second stage starts in the following winter season when the trees are no longer irrigated. Having reached a height of above 1 m they can irrigate themselves now. The taller ones have to do even more: They serve as natural fog-collectors. Channels or funnels are installed underneath them and a part of the water that falls down from their leaves and branches is conducted to the water tanks.

Source – Nov. 12, 2009, Treehugger

ATLANTA, Nov. 11 (UPI) — H1N1 flu in Mexico City and New York may have helped health experts understand the challenges posed by disease response in large cities, researchers say.

David M. Bell and colleagues at the Centers for Disease Control and Prevention in Atlanta said by 2025, almost three-quarters of the world’s population will live in cities.

“When millions of people are crowded together in huge cities, responses to disease outbreaks that have worked in rural areas or smaller towns may not work as well,” Bell said in a statement Wednesday.

“Several questions emerged. For example, how do you get many overlapping governmental agencies to cooperate? How do you get drugs and vaccines to people who travel, live in slums with no addresses, or are homeless? How do you separate ill family members from well ones in tiny one- or two-room apartments?”

U.S. health experts will need to answer these questions as the H1N1 pandemic continues, Bells said.

The findings are scheduled to be published to appear in the December edition of Emerging Infectious Diseases.

Source – UPI.com

PLoS Negl Trop Dis. 2009 Nov 10;3(11):e545.

Spatial evaluation and modeling of Dengue seroprevalence and vector density in Rio de Janeiro, Brazil.

Honório NA, Nogueira RM, Codeço CT, Carvalho MS, Cruz OG, Magalhães Mde A, de Araújo JM, de Araújo ES, Gomes MQ, Pinheiro LS, da Silva Pinel C, Lourenço-de-Oliveira R.

Laboratório de Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brasil. honorio@ioc.fiocruz.br

BACKGROUND: Rio de Janeiro, Brazil, experienced a severe dengue fever epidemic in 2008. This was the worst epidemic ever, characterized by a sharp increase in case-fatality rate, mainly among younger individuals. A combination of factors, such as climate, mosquito abundance, buildup of the susceptible population, or viral evolution, could explain the severity of this epidemic. The main objective of this study is to model the spatial patterns of dengue seroprevalence in three neighborhoods with different socioeconomic profiles in Rio de Janeiro. As blood sampling coincided with the peak of dengue transmission, we were also able to identify recent dengue infections and visually relate them to Aedes aegypti spatial distribution abundance. We analyzed individual and spatial factors associated with seroprevalence using Generalized Additive Model (GAM).

METHODOLOGY/PRINCIPAL FINDINGS: Three neighborhoods were investigated: a central urban neighborhood, and two isolated areas characterized as a slum and a suburban area. Weekly mosquito collections started in September 2006 and continued until March 2008. In each study area, 40 adult traps and 40 egg traps were installed in a random sample of premises, and two infestation indexes calculated: mean adult density and mean egg density. Sera from individuals living in the three neighborhoods were collected before the 2008 epidemic (July through November 2007) and during the epidemic (February through April 2008). Sera were tested for DENV-reactive IgM, IgG, Nested RT-PCR, and Real Time RT-PCR. From the before-after epidemics paired data, we described seroprevalence, recent dengue infections (asymptomatic or not), and seroconversion. Recent dengue infection varied from 1.3% to 14.1% among study areas. The highest IgM seropositivity occurred in the slum, where mosquito abundance was the lowest, but household conditions were the best for promoting contact between hosts and vectors. By fitting spatial GAM we found dengue seroprevalence hotspots located at the entrances of the two isolated communities, which are commercial activity areas with high human movement. No association between recent dengue infection and household’s high mosquito abundance was observed in this sample.

CONCLUSIONS/SIGNIFICANCE: This study contributes to better understanding the dynamics of dengue in Rio de Janeiro by assessing the relationship between dengue seroprevalence, recent dengue infection, and vector density. In conclusion, the variation in spatial seroprevalence patterns inside the neighborhoods, with significantly higher risk patches close to the areas with large human movement, suggests that humans may be responsible for virus inflow to small neighborhoods in Rio de Janeiro. Surveillance guidelines should be further discussed, considering these findings, particularly the spatial patterns for both human and mosquito populations.

indiaNorwegian photojournalist Jonas Bendiksen spent six weeks living in the slums of Nairobi, then Caracas, Mumbai, and Jakarta.

His remarkable panoramic images take us inside slum families’ lives, revealing the profound human impulse to fashion not only shelter but a home.

Link: http://www.foreignpolicy.com/articles/2009/11/03/planet_slum?page=0,0

Kisumu set to run prepaid water trial, Nov. 10, 2009.

Consumers in Kisumu town and its environs may soon be able to pay for the commodity in advance as the first prepaid billing system in the sector comes under pilot in a year’s time.

Under the system meant to curb payment default and ease administration costs, residents will purchase water to the value of cards that will be loaded onto their prepaid meters.

Water is sold in the town at Sh50 for 1000 litres of water and consumers will be able to buy prepaid cards based on their estimated consumption.

The managing director of the Lake Victoria Water Services Board Michael Ochieng’ said that the service would be rolled out in some estates in the town on a pilot basis.

Other areas that are targeted during this initial rollout include the middle class sections of the town and water kiosks in informal settlements.

“We will use this to gauge the response before scaling up the service to the rest of the town,” Mr Ochieng’ said.

Illegal connections

The prepaid service, which will be managed by the town’s water service provider, Kisumu Water and Sewerage Company (KIWASCO), is expected to be rolled out after the town’s water supply is stabilised.

He said he expected the company to “double profits within a year of introducing the system.”

It will be introduced under the second phase of the Sh3 billion Kisumu Water Supply and Sanitation Project funded by the French Development Agency that kicks off at the beginning of next year. The component that will introduce the prepaid water payment system will cost Sh50 million.

The project, as well a series of other interventions, is intended to increase water supply to 92 million litres by 2012.

KIWASCO managing director David Onyango said that at present, water supply in Kisumu is 23 million litres against a demand of 50 million litres.

In addition, an estimated 60 per cent of the water that is released from the water treatment plant cannot be accounted for due to leaks and illegal connections.

The company is in talks with mobile money transfer service providers to facilitate payments through mobile phones.

The company is also planning to introduce e-billing to inject efficiency into the system and boost revenue collection.

Source – Business Daily

The scourge of so-called “flying toilets” – where human waste is put into a plastic bag and tossed into the air, landing on roads or in gutters – has plagued the slums of Kenya’s capital Nairobi for decades. But an innovative project in the slum of Kibera has dramatically cut down on the problem by converting human waste into gas that can be used to fuel cookers and other devices.

Roseline Amondi cooks githeri at the community kitchen powered by gas from the community toilet in Kibera, Kenya
Roseline Amondi cooks githeri at the community kitchen powered by gas from the community toilet in Kibera, Kenya

Roseline Amondi is cooking up a storm. Today’s menu for the tiny restaurant she runs is githeri, a traditional dish consisting of beans and maize.

Amondi cooks every day in this community kitchen. She will then take the food back to her kiosk to sell to her customers. She says the community stove saves her a lot of money that she would otherwise spend on charcoal or wood.

“Before the gas started working, I was using almost 100 or 200 [shillings] per day for cooking any meal in the house, but right now, it is only 10 bob [shillings] per meal,” she said. “It is very cheap. If I cook two different types of food, I may use only 30 shillings for the whole day. That is wonderful.”

The gas that Amondi uses comes from an unlikely source, the community toilet. This is a rare sight in Kibera, where up to 200 people can share a single latrine in neighborhoods that have no electricity or running water.

The TOSHA community toilets in Kibera slum
The TOSHA community toilets in Kibera slum

The toilet and kitchen are run by a coalition of five community groups calling themselves TOSHA (Total Sanitation and Hygiene Access). “Tosha” also means “enough” in the national language Ki’Swahili.

Some 600 people a day use the toilets for a small fee.

The human waste is transported via pipes into an underground tank, where it is converted into bio-gas.

The gas is then piped up to the community kitchen, where members can use the stove for pennies per pot.

Groups often rent out the facility’s top floor for meetings and functions. TOSHA earns some $400 each month renting out the facility, the community kitchen and use of the toilets.

Aidah Binale is a coordinator with Umande Trust, a development group that partnered with TOSHA to formulate the project.

She says it was difficult at first for community members to accept the gas.

“People will have the idea of, ‘Ah, no, I can’t cook from there, it is from [human] waste.’ Right now we are still trying to capacity build, we are trying to tell them [there is] nothing wrong,” she explained. “We get to have more visitors from different countries coming to visit us. We make sure that when they come to the office, we tell them, ‘Let’s go down there and have tea.’ So when the community comes and sees us drinking tea, they are thinking, ‘Ah, this is a foreigner taking tea. These people are taking tea, we can also cook.’”

Running water and sanitation facilities are virtually non-existent in slums like Kibera, where most people earn less than $1 a day. Human waste in plastic bags is often dumped on roads, alleys and gutters.

But locals say there has been a dramatic reduction in these so-called “flying toilets” since the bio-gas center was constructed two years ago.

Roseline Amondi is also secretary of TOSHA.

“At the time we were using flying toilets, there were so many diseases around us like cholera,” she noted. “Once an outbreak of cholera occurs, we are the sufferer. Many of us died, some got into the hospitals. But right now, for the last three months, there was an outbreak [of cholera] within Nairobi, but we were safe because of the bio-center.”

Project supporters say the TOSHA Bio-Gas Centre is a model for communities everywhere, especially those dealing with power shortages.

Paul Muchire, communication manager with Umande Trust.

“We have the problem of [supplying enough] energy. Poverty levels are going up. Sanitation is a problem in the developing world. We have the issue of pollution from the oil and diesel. There is need to go into other sources of energy, adapt other sources of energy that would be environmentally friendly,” he said.

Muchire says there are about 10 bio-gas centers in Kibera under construction and that an engineer is looking at how the gas can be piped into peoples’ homes.

Source – http://www.voanews.com/english/2009-11-07-voa17.cfm

International Society for Urban Health
8th International Conference for Urban Health
Urban Health Champions Forum
October 19, 2009

THE NAIROBI STATEMENT ON URBANIZATION AND HEALTH

WE, THE SIGNATORIES OF THE NAIROBI STATEMENT ON URBANIZATION AND HEALTH AND WELL BEING DECLARE THE FOLLOWING:

We Urge Recognition of the Facts of Urbanization:

  • Over half the world’s population live in cities
  • Urbanization is a reality facing all countries
  • Between now and 2050, 3 billion people will settle primarily in cities, a fact that demands planning and action now to assure urban health and well being
  • The majority of urban residents in developing countries live in informal settlements where they lack proper housing, water, sanitation, garbage disposal, security, schooling, and health services.

We Recognize the Benefits of Urbanization

  • People move to urban areas largely to improve their lives and economic opportunities and urban residents often provide important support to their rural home economies as a result.
  • Formal and informal economic contributions of the urban poor are often critical to overall economic development of cities and nations
  • Urban settings can improve access to health services, education, and social and cultural opportunities and, when growth is effectively managed , cities can be part of the solution and not just part of the problem in national growth.
  • If well managed, cities can be engines of development for national economies and centers of positive sociopolitical transformation
  • The high population density in cities can facilitate delivery of development interventions to large numbers of people

We Acknowledge the Risks of Urbanization

  • Countries that fail to plan for increasing urbanization place themselves and their citizens at serious health, economic, and security risk.
  • The health of slum dwellers is typically well below that in other urban and rural areas, even when stratified by poverty level. These inequities are also observed in other critical development indicators like schooling and affect the health of the entire city.
  • Settlements without legal status and services can become focal points for social tensions, conflict and illicit economic activity.

As Urban Health Champions, We commit to Promoting the Following Ideals to Improve Health Outcomes and Overall the Effectiveness of Cities and Major Urban Settlements in Our Countries:

  • Effective, transparent, accountable, and proactive governance that is broadly inclusive is a critical factor in the growth of healthy cities.
  • Solutions to urbanization should be developed within a framework that is inter-sectoral where governments work effectively in partnership with the public, organizations of civil society and the business community.
  • Donor agencies and governments must include urban concerns in their strategies as adapted to country circumstances
  • Interventions and programs to improve the functioning of urban areas and cities should be designed with equity consciousness to ensure that the most vulnerable urban dwellers have input to and benefit from the programs
  • An urgent priority is the development of effective strategies that create incentives to health to address the challenges of slum settlements to ensure they are places where the informal sector to thrive, human needs are met, and people can live decent lives.
  • Cities must integrate health and urban planning and begin planning for the growth of their cities now.
  • Links between urban health, sustainable development, and MDG’s must be demonstrated to policy makers
  • Cities should respond appropriately to climate change in the interest of protecting and promoting human health
    Improved surveillance, evidence, and research from robust evaluations of interventions must be shared and used to identify best approaches for investing in healthy cities.
  • Increased capacity is needed to assure the availability of the expertise to provide health impact evaluation and monitoring.

Overall Commitment to the Nairobi Statement

  • We commit to advancing the achievement of these Urban Health Champion Solutions through continued consultation, mutual learning and actions that promote development and evaluation of policies and programs that promote the health and well-being of all urban residents as a path to effective national economic and social development.

Source – http://www.icuh2009.org/nairobistatement.htm