Research and application : applying an ecosystem approach to the determinants of health in Centro Habana
Date
1999
Journal Title
Journal ISSN
Volume Title
Publisher
Blackwell Science
Abstract
The difficult economic times that Cuba has had to face have taken a considerable toll on its urban ecosystems, with data suggesting that indicators of health, the environment, and social services have been deteriorating. This has been particularly evident in Centro Habana, a municipality with the highest population density in the country. More than half the population was without daily access to potable water, waste disposal was insufficient, overcrowding was serious, disease vectors were prevalent, and rates of various infectious as well as non-communicable diseases and injuries were highest in the country. To improve the situation, the municipality requested help from the National Institute for Hygiene Epidemiology and Microbiology (lNHEM) to determine the best use of scarce resources to improve health. INHEM performed an ecological descriptive study and conducted focus groups in five communities to assess perceptions of health, social, and environmental factors, followed by a household survey. INHEM then engaged collaborators at the University of Manitoba to assist in developing a framework, analyzing the data, and planning and undertaking the evaluation requested. Maximum likelihood factor analysis was used to reduce the dimensionality of the data. The perception data were then merged with the ecological level health and environmental data to ascertain the relationship between these two data sources and determine which indicators might be useful for an intervention analysis. The perception results indicated that the greatest community concern was quality of housing, but that the risk perception results were independent of ecological data on morbidity, mortality, and basic sanitation indicators. Based on this conclusion, it was decided to use a combined qualitative and quantitative approach to evaluate actual and potential interventions, using the driving force-pressurestate-exposure-effects-action (DPSEEA) framework. It was also decided to adopt an ecosystem approach that fully involves the community in developing a set of ecosystem human health indicators. Data from repeat focus groups and household surveys are planned, with these data to again be integrated with ecological data including environmental, socioeconomic, and health outcome information, using a pre- versus postintervention with concurrent control design. Our findings in this first phase indicated that an ecosystem framework is invaluable in ascertaining determinants of health and prioritizing and evaluating interventions to improve the health of communities.
Description
item.page.type
Journal Article (peer-reviewed)
item.page.format
Text
Keywords
ECOSYSTEM APPROACHES, CUBA, ENVIRONMENTAL HEALTH, PUBLIC HEALTH, HEALTH INTERVENTION, DETERMINANTS OF HEALTH, RISK ASSESSMENT