T03P07 - Urban Policies & Health Inequalities

Topic : Policy and Politics sponsored by Policy & Politics Journal

Panel Chair : Daniel Weinstock - directoradmin.ihsp@mcgill.ca

Panel Second Chair : Shona Hilton - shona.hilton@glasgow.ac.uk

Objectives and Scientific Relevance of the panel

Call for papers

Session 1 Identifying & Explaining Urban Health Inequalities

Wednesday, June 28th 16:15 to 18:15 (Block B 3 - 4 (35))

Discussants

Daniel Weinstock - directoradmin.ihsp@mcgill.ca - Institute for Health & Social Policy - Canada

Charting mental health inequalities: integrated mental health atlases as policy instruments

James Gillespie - james.gillespie@sydney.edu.au - Menzies Centre for Health Policy, University of Sydney. - Australia

Jennifer Smith-Merry - Jennifer.smith-merry@sydney.edu.au - University of Sydney - Australia

Most mental health care remains hospital centric and fragmented; it is riddled with gaps and poor alignment of spatial distributions of need and services. These limitations create major barriers to recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparisons over time and between regions and jurisdictions. Mapping must be based on a rigorous system of classification of services.

This paper presents the implications for policy of a major international program of mental health service mapping. Regional integrated mental health atlases are being used to enhance policy-making and priority setting through more fine grained evidence on local services and systematic international comparisons. The paper draws on recent mapping exercises in Australian cities, especially the Western Regions of Sydney, with comparisons from the application of the same methods in Finland, Spain, France and Chile.

Methods. A standard classification system, the Description and Evaluation of Services and Directories in Europe for Long-term Care model (DESDE LTC), developed under the leadership of Luis Salvador-Carulla, is used to describe and classify adult mental health services at regional level. The paper looks closely at the recent use of this coding scheme to produce accessibility maps and to analyse the provision of care for people with a lived experience of mental illness. The integrated map of Western Sydney mental health services is used to compare service provision with patterns of need. Comparisons are made with similar regional maps– internationally and at national level - to identify gaps or unusual patterns of service delivery.

The Atlas provided the foundation for other forms of health service analysis – including qualitative and historical methods to explain persistent service configurations.

Policy analysis. The paper looks at the identification of service gaps and inequalities identified in recent Australian mapping exercises.  It explores some of the challenges of extending the mapping model to lower income settings.

Right Here Right Now: piloting novel approaches for (near) real-time research to inform health policy within an urban context

Shona Hilton - shona.hilton@glasgow.ac.uk - University of Glasgow - United Kingdom

Health policymakers rely on appropriate evidence to inform decision-making, however, social, political and economic change often outpaces researchers’ capacity to produce meaningful evidence in a timely manner.  Widespread adoption of social and mobile technologies has increased opportunities for capturing context specific, real-time, concurrent data on people’s everyday experiences. Utilising these technologies could help to address some of the shortcomings of traditional research approaches, particularly in relation to timeliness and flexibility, and could increase public engagement in the processes of evidence generation, knowledge translation and policy decision-making.

In order to explore contemporary population health issues from the perspectives of citizens in near real-time researchers from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow collaborated with the Glasgow Centre for Population Health, the Institute for Design Innovation at the Glasgow School of Art and NHS Health Scotland to develop the Right Here Right Now pilot study. Based in Glasgow, Scotland, where there are stark health inequalities, researchers engaged with stakeholders and citizens to design an inclusive and user-friendly study, which made use of online technologies. Over a period of six months a sample of 180 ‘community researchers’ from across all areas of the city contributed their insights on a range of topical question sets developed with project stakeholders working in government, NHS and third sector organisations. Data were analysed thematically and key findings disseminated to all community researchers and stakeholders within two weeks of question issue.

The Right Here Right Now pilot provides key insights around the opportunities for developing new methods for gathering qualitative data in near to real-time that could inform our understanding of the impact of policies on health and social inequalities, and expand traditional views on engaging citizens in decision-making processes. This presentation will introduce Right Here Right Now and discuss the data collection methods employed, project outcomes, and next steps.

Telecare Service Project Evaluation: A Case of Kaohsiung City

Wei-Ning Wu - weiningwu@mail.nsysu.edu.tw - National Sun Yat-sen University - Taiwan

Solutions to complex problems of service performance and low level of service users’ participation often must be developed by encouraging more and more service users to make their voices heard through the various approaches as well as enhance their willingness to experience in the service. Telecare Service Project (TSP) has the functions of health track and development of positive health behaviors. However, this service is users-initiated contact. Using TSP is an easy and free technically for citizens, but ensuring some degree of service users’ engagement has been challenging for the managers of health organizations. Despite calls for the importance of TSP in the service and information delivery process, fair treatment and access to use of health information, to the best of our understanding, very few empirical studies explore citizens’ TSP behaviors in the micro and individual level in Taiwan. This study provides a comprehensive understanding of the TSP evaluation, helps managers know citizens’ perceived perspectives toward the use of TSP , and assists these managers to develop an effective TSP in the future.

Mobile Public Service: A New Way of China 's Urban Management Service —Taking the Urban Mobile Public Service in the Minority Areas as an Example

ShengWang Miao - miaoshengwang0123@163.com - School of Public Management - China

Yinxi Liu - yinxiliu@126.com - Inner Mongolia University - China

Yang Yang - yangyangnd@163.com - Inner Mongolia University - China

[Abstract]Since the reform and opening up, China's urbanization is advancing rapidly, and the contradictions have been gradually highlighted. Many problems have prompted the government administrators to innovate the means and methods of management innovation, and put the city management in an important position. The sharing of basic public services within the city is of great significance to maintain regional social stability and promote the development of urbanization. In recent years, the practice of "mobile police room", "mobile library", "mobile hospital" and "mobile library" in the Mainland is the innovation of urban management service driven by the modernization of the country's grass-roots governance. Supply innovation has reduced the quality and quantity of the basic public services within the city, and satisfied the local people's demand for all kinds of basic public services, and promoted the rapid advance of urbanization.

"Mobile Public Service" has certain advantages in exploring the modernization of urban grassroots governance capacity, realizing the sharing of public services within the city, promoting the equalization of basic public services, guiding the healthy development of the city and establishing a service-oriented government. The author believes that the "mobile public service" in the field of urban development and public governance, especially in promoting the process of urbanization has a trial, the promotion of practical significance. Therefore, to improve the level and capability of urban management services and realize the rapid advance of urbanization, we can promote the communication and cooperation between the departments through the promotion of the concept of governance and the ability to govern, based on the concept of "mobile public service", to build a trust and cooperation platform, Reasonable and perfect mechanism of responsibility and strengthen the construction of service-oriented government, and so on to promote the process of modern urban development.

Keywords: mobile public services, service innovation, governance modernization, urbanization development

The impact of Uber’s Introduction on Drunk Driving in South Africa

Mark Daku - mark.daku@mcgill.ca - Montreal Health Equity Research Consortium - Canada

Jonathan Huang - jon.huang@mcgill.ca - McGill University - Canada

The advent of mobile phone-based ride sharing services such as Uber promise many individual benefits including reduce transportation cost and improved transparency and accessibility. One consequent population health benefit projected by proponents is a reduction in alcohol or other impaired operation of private vehicles and attendant reductions in motor vehicle collisions, related injuries, and ultimately deaths. Recent investigations in the United States, however, found little evidence to suggest introduction of Uber caused a reduction either in general road traffic-related or specific drunk-driving related mortality. However, other contexts may prove to be more amenable to the potential impact of ride sharing on in reduction of injuries and deaths.  We examine the case of Uber’s introduction in three urban centers in South Africa in order to assess whether or not the South African context creates the conditions for the purported health benefits that ride sharing may provide. We combine qualitative field research with difference-in-difference and regression discontinuity analysis to examine how the introduction of Uber may impact drinking and driving in three major South African cities. Important differences between contexts – and potentially between groups of consumers –mediate any impact that ride share services may have on drinking and driving outcomes. While a potentially useful intervention, policy makers who are considering limitations or incentives for ride sharing services should be mindful of the ways in which populations are differentially affected by these services. Any potential reduction in drunk driving, and resulting improvement in health outcomes, may only apply to certain populations.

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