Riley Lee W, Ko Albert I, Unger Alon, Reis Mitermayer G
Division of Infectious Disease, School of Public Health, University of California, Berkeley, California, USA.
BMC Int Health Hum Rights. 2007 Mar 7;7:2. doi: 10.1186/1472-698X-7-2.
Urban slums, like refugee communities, comprise a social cluster that engenders a distinct set of health problems. With 1 billion people currently estimated to live in such communities, this neglected population has become a major reservoir for a wide spectrum of health conditions that the formal health sector must deal with.
Unlike what occurs with refugee populations, the formal health sector becomes aware of the health problems of slum populations relatively late in the course of their illnesses. As such, the formal health sector inevitably deals with the severe and end-stage complications of these diseases at a substantially greater cost than what it costs to manage non-slum community populations. Because of the informal nature of slum settlements, and cultural, social, and behavioral factors unique to the slum populations, little is known about the spectrum, burden, and determinants of illnesses in these communities that give rise to these complications, especially of those diseases that are chronic but preventable. In this article, we discuss observations made in one slum community of 58,000 people in Salvador, the third largest city in Brazil, to highlight the existence of a spectrum and burden of chronic illnesses not likely to be detected by the formal sector health services until they result in complications or death. Lack of health-related data from slums could lead to inappropriate and unrealistic allocation of health care resources by the public and private providers. Similar misassumptions and misallocations are likely to exist in other nations with large urban slum populations.
Continued neglect of ever-expanding urban slum populations in the world could inevitably lead to greater expenditure and diversion of health care resources to the management of end-stage complications of diseases that are preventable. A new approach to health assessment and characterization of social-cluster determinants of health in urban slums is urgently needed.
城市贫民窟与难民社区一样，是一个产生一系列独特健康问题的社会群体。目前估计有10亿人生活在这类社区，这一被忽视的人群已成为正规卫生部门必须应对的多种健康状况的主要源头。
与难民群体不同，正规卫生部门在贫民窟人群患病过程中相对较晚才意识到他们的健康问题。因此，正规卫生部门不可避免地要以比管理非贫民窟社区人群高得多的成本来应对这些疾病的严重和终末期并发症。由于贫民窟定居点的非正规性质，以及贫民窟人群特有的文化、社会和行为因素，对于这些社区中引发这些并发症的疾病谱、负担及其决定因素，尤其是那些慢性但可预防的疾病，人们知之甚少。在本文中，我们讨论了在巴西第三大城市萨尔瓦多一个有5.8万人的贫民窟社区所做的观察，以强调存在一系列慢性疾病及其负担，而这些疾病在正规部门卫生服务中直到导致并发症或死亡才可能被发现。贫民窟缺乏与健康相关的数据可能导致公共和私人医疗服务提供者对医疗资源进行不恰当和不切实际的分配。在其他有大量城市贫民窟人口的国家可能也存在类似的错误假设和资源分配不当的情况。
持续忽视世界上不断扩大的城市贫民窟人口可能不可避免地导致医疗资源更多地用于管理可预防疾病的终末期并发症，从而产生更大的支出并造成资源转移。迫切需要一种新的方法来评估城市贫民窟的健康状况并确定其社会群体健康决定因素。
