Ronak Patel

Urbanization--an emerging humanitarian disaster.

In 2008, the proportion of the worlds population living in urban areas crossed the 50% mark. Drs. Ronak Patel and Thomas Burke write that urbanization is a health hazard for certain vulnerable populations, and this demographic shift threatens to create a humanitarian disaster.

Improved health outcomes in urban slums through infrastructure upgrading.

The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortality. This growing problem creates a unique challenge for policymakers and public health practitioners. While the Millennium Development Goals (MDGs) aim to address these conditions and standards for water and sanitation as well as pertinent health outcomes, little evidence on interventions exists to guide policymakers. Upgrades in slum household water and sanitation systems have not yet been rigorously evaluated to demonstrate whether there is a direct link to improved health outcomes. This study aims to show that slum upgrading as carried out in Ahmedabad, India, led to a significant decline in waterborne illness incidence. We employ a quasi-experimental regression model using health insurance claims (for 2001-2008) as a proxy for passive surveillance of disease incidence. We found that slum upgrading reduced a claimants likelihood of claiming for waterborne illness from 32% to 14% and from 25% to 10% excluding mosquito-related illnesses. This study shows that upgrades in slum household infrastructure can lead to improved health outcomes and help achieve the MDGs. It also provides guidance on how upgrading in this context using microfinance and a public-private partnership can provide an avenue to affect positive change.

Vasopressin-induced neurotrophism in cultured neurons of the cerebral cortex: dependency on calcium signaling and protein kinase C activity

Neuronal process outgrowth has been postulated to be one of the fundamental steps involved in neuronal development. To test whether vasopressin can influence neuronal development by acting on the outgrowth of neuronal processes, we determined the neurotrophic action of the memory-enhancing peptide, vasopressin, in neurons derived from the cerebral cortex, a site of integrative cognitive function and long-term memory. Exposure to V(1) receptor agonist significantly increased multiple features of nerve cell morphology, including neurite length, number of branches, branch length, number of branch bifurcation points and number of microspikes. The dose-response profile of V(1) receptor agonist-induced neurotrophism exhibited a biphasic function, with lower concentrations inducing a significant increase while higher concentrations generally induced no significant effect. The neurotrophic effect of V(1) receptor activation did not require growth factors present in serum. Analysis of the regional selectivity of the vasopressin-induced neurotrophic effect revealed significant V(1) receptor agonist-induced neurotrophism in occipital and parietal neurons, whereas frontal and temporal neurons were unresponsive. Results of experiments to determine the mechanism of vasopressin-induced neurotrophism demonstrated that vasopressin-induced neurotrophism is dependent on V(1)a receptor activation, requires L-type calcium channel activation and activation of both pathways of the phosphatidylinositol signaling cascade, inositol trisphosphate and protein kinase C. These studies are the first to describe a functional cellular response for vasopressin in the cerebral cortex. The findings are discussed with respect to their implications for understanding the role of vasopressin-induced neurotrophism, the associated signaling pathways required for this response, and the ability of vasopressin to enhance memory function.

Rapid urbanization and the growing threat of violence and conflict: a 21st century crisis.

As the global population is concentrated into complex environments, rapid urbanization increases the threat of conflict and insecurity. Many fast-growing cities create conditions of significant disparities in standards of living, which set up a natural environment for conflict over resources. As urban slums become a haven for criminal elements, youth gangs, and the arms trade, they also create insecurity for much of the population. Specific populations, such as women, migrants, and refugees, bear the brunt of this lack of security, with significant impacts on their livelihoods, health, and access to basic services. This lack of security and violence also has great costs to the general population, both economic and social. Cities have increasingly become the battlefield of recent conflicts as they serve as the seats of power and gateways to resources. International agencies, non-governmental organizations, and policy-makers must act to stem this tide of growing urban insecurity. Protecting urban populations and preventing future conflict will require better urban planning, investment in livelihood programs for youth, cooperation with local communities, enhanced policing, and strengthening the capacity of judicial systems.

Urbanization and Humanitarian Access Working Group: toward guidelines for humanitarian standards and operations in urban settings.

1. Harvard Affiliated Emergency Medicine Residency, Brigham and Women’s Hospital and Massachusetts General Hospital. Boston, Massachusetts USA 2. Program on Urbanization and Humanitarian Emergencies. Associate Faculty, Harvard Humanitarian Initiative. Department of Emergency Medicine, Brigham and Women’s Hospital. Clinical Instructor, Harvard Medical School, Boston, Massachusetts USA 3. Senior Fellow & Scientist, Harvard Humanitarian Initiative, Harvard School of Public Health Cambridge, Massachusetts USA

Microfinance: Untapped Potential for Global Health

Microfinance has recently come under criticism for not meeting its potential for poverty reduction and its exploitation by for-profit entities. Access to finance still remains limited for many of the world’s poor. This re-examination of microfinance should not impede its proliferation and development into a tool to improve health for the underserved. There are significant returns on microfinance investments in health at the household level. Microfinance that allows the consumption of goods and services that can improve health can also lead to increased savings and productivity making it a financially viable and powerful tool for both health improvement and development.

The high cost of diarrhoeal illness for urban slum households–a cost-recovery approach: a cohort study

Objectives Rapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea with greater household costs due to illness. This study sought to determine the monetary cost of diarrhoea to urban slum households in Kaula Bandar slum in Mumbai, India. The study also tested the hypotheses that the cost of water and sanitation infrastructure may be surpassed by the cumulative costs of diarrhoea for households in an urban slum community. Design A cohort study using a baseline survey of a random sample followed by a systematic longitudinal household survey. The baseline survey was administered to a random sample of households. The systematic longitudinal survey was administered to every available household in the community with a case of diarrhoea for a period of 5u2005weeks. Participants Every household in Kaula Bandar was approached for the longitudinal survey and all available and consenting adults were included. Results The direct cost of medical care for having at least one person in the household with diarrhoea was 205 rupees. Other direct costs brought total expenses to 291 rupees. Adding an average loss of 55 rupees per household from lost wages and monetising lost productivity from homemakers gave a total loss of 409 rupees per household. During the 5-week study period, this community lost an estimated 163u2005600 rupees or 3635 US dollars due to diarrhoeal illness. Conclusions The lack of basic water and sanitation infrastructure is expensive for urban slum households in this community. Financing approaches that transfer that cost to infrastructure development to prevent illness may be feasible. These findings along with the myriad of unmeasured benefits of preventing diarrhoeal illness add to pressing arguments for investment in basic water and sanitation infrastructure.

To do no harm: humanitarian aid in conflict demands political engagement

Humanitarian aid in settings of conflict has always been fraught with challenges. In the absence of political engagement, however, manipulation by state authorities, however, have the potential to pervert aid intervention to inflict harm. South Sudan exemplifies how states may abuse the humanitarian response to retreat from public responsibility, divert funds to further violence and conflict and dictate the distribution of aid. Recent trends toward nationalist policies in the West that favor disengagement and limited military strikes have the very effect of allowing this abuse to transform humanitarian aid into a tool for harm. (Disaster Med Public Health Preparedness. 2018;12:567-568).

The Demand for Disaster Microinsurance for Small Businesses in Urban Slums: The Results of Surveys in Three Indian Cities

Background: Small informal businesses make up the core markets for many poor urban communities, providing essential goods, services, and livelihoods. Many of these communities and businesses exist in hazardous locations. In most cases, these business owners do not have access to proper coping mechanisms including risk transfer and lack resilience to shocks. Access to risk-transfer in the form of insurance for these small businesses is extremely limited. This demand survey is the first phase of an intervention to test disaster microinsurance for these businesses. Previous research has examined the demand for and value of microinsurance to protect poor households but not micro- and medium-sized informal urban businesses. Objective: This study investigates knowledge about and demand for microinsurance among small informal business owners in three different cities of India. Methods: Survey of all informal business owners (n=4919) identified through purposive sampling of the most vulnerable in three proposed study sites: Guwahati in Assam (n=1622), Puri in Odisha (n=1551) and Cuddalore in Tamil Nadu (n=1746). Results: Our findings reflect that while small business owners largely did not know about disaster microinsurance, after describing it, a vast majority wanted to subscribe to such a program. Without it, they often rely on personal savings, forgo basic necessities, or take out costly loans that trap them in debt to cope with disasters. Discussion: This research supports the need for more experiments on actual adoption patterns, feasibility studies, and innovative trial programs by governments, non-governmental organizations, and insurance providers.

Discussion Informed by Recurrent Lessons from a Systematic Review on Targeting Practices in Urban Humanitarian Crises

Introduction: Urbanization has challenged many humanitarian practices given the complexity of cities. Urban humanitarian crises have similarly made identifying vulnerable populations difficult. As humanitarians respond to cities with chronic deficiencies in basic needs stressed by a crisis, identifying and prioritizing the most in need populations with finite resources is critical. Methods: The full systematic review applied standard systematic review methodology that was described in detail, peer-reviewed, and published before the research was conducted. Results: While the science of humanitarian practice is still developing, a systematic review of targeting vulnerable populations in urban humanitarian crises shed some light on the evidence base to guide policy and practice. This systematic review, referenced and available online, led to further findings that did not meet the pre-defined inclusion and exclusion criteria for evidence set out in the full review but that the authors, in their expert opinion, believe provide valuable insight nonetheless given their recurrence. Discussion: These additional findings that did not meet criteria for evidence and formal inclusion in the full manuscript, but deemed valuable by the subject expert authors, are discussed in this commentary