Centre for Health Development, World Health Organization, I.H.D. Centre Building 9F, 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe, 651-0073, Japan,
J Urban Health. 2013 Dec;90(6):1041-52. doi: 10.1007/s11524-013-9808-9.
The burden of noncommunicable diseases and social inequalities in health among urban populations is becoming a common problem around the world. This phenomenon is further compounded by population aging. Japan faces the task of maintaining its high level of population health while dealing with these challenges. This study focused on the ten largest cities in Japan and, using publicly available administrative data, analyzed standardized mortality ratios to examine inequalities in relative mortality levels due to major noncommunicable disease at both city and subcity levels. On average, the ten major cities had excess mortality due to cancer and lower mortality due to heart disease and cerebrovascular disease compared to the country as a whole. Substantial inequalities in relative mortality were observed both between and within cities, especially for heart disease and cerebrovascular disease among men. Inequalities in relative mortality levels within cities appear to be increasing over time even while relative mortality levels are decreasing overall. The widely observed health inequalities signal the need for actions to ensure health equity while addressing the burden of noncommunicable diseases. Increasingly, more countries will have to deal with these challenges of inequity, urbanization, aging, and noncommunicable diseases. Local health governance informed by locally specific data on health determinants and outcomes is essential for developing contextualized interventions to improve health and health equity in major urban areas.
非传染性疾病负担和城市人口健康方面的社会不平等正成为全球普遍存在的问题。人口老龄化使这一现象更加严重。日本在应对这些挑战的同时，还面临着维持其高水平人口健康的任务。本研究聚焦于日本最大的十个城市，利用公开的行政数据，通过分析标准化死亡率比，在城市和次城市层面上研究了主要非传染性疾病导致的相对死亡率不平等问题。与全国平均水平相比，十大城市的癌症死亡率偏高，心脏病和脑血管病死亡率偏低。城市间和城市内的相对死亡率都存在很大差异，尤其是男性的心脏病和脑血管病死亡率。即使相对死亡率总体呈下降趋势，城市内的相对死亡率不平等也似乎在不断增加。这种广泛存在的健康不平等现象表明，需要采取行动确保健康公平，同时应对非传染性疾病的负担。越来越多的国家将不得不应对这些不平等、城市化、老龄化和非传染性疾病的挑战。基于健康决定因素和结果的本地特定数据进行的地方卫生治理对于制定改善主要城市地区健康和健康公平的有针对性的干预措施至关重要。
