Vlahov David, Freudenberg Nicholas, Proietti Fernando, Ompad Danielle, Quinn Andrew, Nandi Vijay, Galea Sandro
Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA.
J Urban Health. 2007 May;84(3 Suppl):i16-26. doi: 10.1007/s11524-007-9169-3.
Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.
城市是主要的生活模式，城市的增长与集中了劣势因素的区域扩张有关。可预见的趋势是，在广泛的社会和健康层面，不平等现象将不断加剧。尽管在性质上有所不同，但这种趋势在发达国家和发展中国家都存在。改善贫民窟居民的健康状况需要新的分析框架。社会决定因素方法强调在塑造健康方面，包括全球、国家、城市和社区层面等多个层面起作用的因素的作用。这种方法表明，改善住房、就业、教育、平等、生活环境质量、社会支持和卫生服务等领域的生活条件，对于改善城市人口的健康至关重要。虽然社会决定因素和多层次视角并非城市所独有，但当通过城市的规模、密度、多样性和复杂性等特征来审视时，它们会发生转变。改善人们居住城市的直接生活条件，对于降低发病率、死亡率以及健康方面的差距，并改善生活质量和福祉，具有最大的潜力。
