Santosh Sanjana, Kane Sumit
Nossal Institute For Global Health, Melbourne School Of Population And Global Health, Level 2, 32 Lincoln Square North, The University of Melbourne, Victoria 3010, Australia.
Gokhale Institute of Politics and Economics, BMCC Road, Pune 411004, India.
Health Policy Plan. 2025 Feb 6;40(2):259-271. doi: 10.1093/heapol/czae104.
Low- and middle-income countries (LMICs) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' have meant that health research in LMICs has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL, and Social Sciences Citation Index) and two Community Health Worker (CHW) resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban, such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.
低收入和中等收入国家（LMICs）正在迅速城市化，对此，有关城市医疗服务的学术研究不断扩展，政策关注度也显著提高。“城市优势”的理念与现实意味着，LMICs的健康研究过多地聚焦于农村地区的健康与医疗服务，而对城市健康的积极关注仍显不足。我们认为，这项研究与实践能够从更明确地借鉴其他学科围绕城市状况所形成的丰富概念性理解中受益。我们的批判性综述涵盖了来自四个数据库（MEDLINE、EMBASE、CINAHL和社会科学引文索引）以及两个社区卫生工作者（CHW）资源中心的出版物。我们借鉴社会学领域的学术成果来剖析城市状况的本质与特征；运用这些理论见解对城市社区卫生工作者项目的文献进行批判性审视，以此为例反思LMICs背景下的社区卫生实践与城市健康研究。通过这一分析，我们勾勒出城市的关键特征，如异质性、次级空间与联系、规模与密度、可见性与匿名性、不稳定的工作与生活条件、犯罪与不安全因素，特别是城市社区卫生工作者的社会定位，并阐述其对社区卫生实践的影响。我们提出了一个关于城市独特构想的概念框架，以指导LMICs背景下城市健康和社区健康项目中的健康研究与实践。该框架将使研究人员和从业者能够更好地理解城市环境中“社区”和“社区健康项目”的内涵。
