Michael VanRooyen 2014-04-08 4:11 PM

 通过基础设施升级而得到改善的城市贫民窟的卫生成果 Improved health outcomes in urban slums through infrastructure upgrading

论文摘要
世界正在迅速城市化,一半以上的世界人口目前都居住在城市地区。随着城市人口增长的同时,条件贫瘠的贫民窟人数比例也随之攀升。这些条件会集中对健康造成危害,这导致了高发病率和死亡率。这个日益严重的问题给政策制定者和公共卫生从业人员创造了独特挑战。虽然千年发展目标(MDGs)目标于解决这些 水和卫生设施以及相关的健康结果的条件和标准,但对干预措施仍很少有证据存在来指导决策者。贫民窟居民生活用水和卫生系统的升级还没有得到严格评估以证明是否有直接方法来改善健康结果。本研究旨在表明在艾哈迈达巴德,印度实行的贫民窟改造使得当地水传染疾病发病率显著下降。我们通过将健康保险理赔(2001-2008年期间)作为发病率被动监测的代表来实施准实验回归模型。我们发现贫民窟改造将索赔人水传染疾病申诉的可能性从32%降低至14%,假如不包括蚊子有关疾病的话则这种可能性从25%降低到了10%。这项研究表明贫民窟家庭基础设施升级可导致改善的健康结果并能帮助实现千年发展目标(MDGs)。它还提供了在这一背景下利用小额信贷和公私合作伙伴关系升级能如何提供影响积极变化新途径的相关指导。

Abstract 
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 claimant's 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.

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Michael VanRooyen

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