Health Services Research and the City

Abstract

Health services research is, by nature, multidisciplinary, for it draws on the methods, concepts, and theories of social sciences, which are relevant to the study of how the organization and financing of health services can improve the delivery of health care services (Gray, et al., 2003). While medicine and public health, too, are multidisciplinary enterprises drawing on such disciplines as molecular biology, physiology, anatomy, genetics, epidemiology and more, health services research departs from these disciplines in focusing not on the nature of disease and health but rather on the financing and organization of health systems.So it is with urban health services research albeit that this field is more narrowly focused on health services in cities. The city focus has resulted in a large body of research on vulnerable groups, barriers to service access, public health clinics and community health centers. Likewise, it has led to important investigations of safetynet institutions, e.g. public hospitals and health centers, which serve a disproportionate share of uninsured and low-income patients. In addition, urban health services research has focused on a host of specific services associated with subpopulations suffering from TB, HIV/AIDS, drug addiction and other social pathologies that are typically associated with the "inner city."If one views the field of urban health services research through a kind of intellectual telescope, what is most striking are the many issues that have escaped careful scrutiny. The city, after all, is more than a center of disease, poor health and pervasive poverty (Rodwin, 2001;Glouberman, 2003). Since the oracle of Delphi and the miracles of Lourdes, the city has also functioned as an economic base for medical cures. Most large cities serve as headquarters for academic medical centers (Ginzberg and Yohalem, 1974), places where health professionals congregate, and more generally, strategic locations for health promotion (Freudenberg, 2000) as well as the diffusion of healthy lifestyles among the well-to-do. There is a significant Health Services Research and the City 297

The geography of suicide in older adults in Hong Kong: An ecological study

“…Social Vulnerability Index proposed by Gusmano et al and modified by Chau et al was adopted as one of the independent variables. Since it was tailor‐made for the older population and had been modified to suit the local context, this SVI was chosen.…”

Needed: Global Collaboration for Comparative Research on Cities and Health

“…Once again, Vlahov and Galea's focus on three dimensions of cities -social environment, physical environment and health and social services -is a useful starting point. 9 A focus on these dimensions would quickly lead to others. For example, one ought to include some indicators on the economic base of cities, their housing, transportation, socio-demographic and health and social services system characteristics.…”

“…We have previously suggested a preliminary framework, made the case to compare population health and health services among world cities in wealthy nations, 4 and highlighted the presence of cities, more generally, in health services research. 9 We understand that it remains easier to expand the field of urban health research by using the city as a sampling frame for the study of subpopulation groups who happen to be well-represented in cities, or for studies of disparities among neighborhoods and of specific health conditions that plague vulnerable populations, eg, those with drug resistant tuberculosis (TB), drug addiction and HIV/AIDS. For such research, the Journal of Urban Health provides a precious inventory of articles.…”