Urban Renewal and Sustainable Development in Jamaica: Progress, Challenges and New Directions

The chapter discusses the history and context of urban renewal in Jamaica and shares the country’s integrated model for urban renewal, as well as the lessons learned from over two decades of implementation. As the urban planning landscape evolves there is a call to move in new directions, incorporating concepts which embody the development of human capital. One call is to re-position urban renewal as a public health tool to reduce crime and violence, communicable and non-communicable diseases, especially for the urban poor and urban youth who share a greater burden of Jamaica’s status as a Low/Middle Income Country (LMIC) and Small Island Developing State (SIDS). The call for the paradigm shift from gender-blind to gender-sensitive urban planning is expected to promote policy coherence between commitments to gender mainstreaming and gender equality and urban development modalities. There is also the need for a new governance framework to support the active participation of the average resident in the decision making process for land use management and other aspects of urban renewal to meet the goals of the New Urban Agenda and to realize Vision 2030 Jamaica, making “Jamaica, the place of choice to live, work, raise families and do business”

Factors affecting study efficiency and item non-response in health surveys in developing countries: the Jamaica national healthy lifestyle survey

BACKGROUND: Health surveys provide important information on the burden and secular trends of risk factors and disease. Several factors including survey and item non-response can affect data quality. There are few reports on efficiency, validity and the impact of item non-response, from developing countries. This report examines factors associated with item non-response and study efficiency in a national health survey in a developing Caribbean island. METHODS: A national sample of participants aged 15–74 years was selected in a multi-stage sampling design accounting for 4 health regions and 14 parishes using enumeration districts as primary sampling units. Means and proportions of the variables of interest were compared between various categories. Non-response was defined as failure to provide an analyzable response. Linear and logistic regression models accounting for sample design and post-stratification weighting were used to identify independent correlates of recruitment efficiency and item non-response. RESULTS: We recruited 2012 15–74 year-olds (66.2% females) at a response rate of 87.6% with significant variation between regions (80.9% to 97.6%; p < 0.0001). Females outnumbered males in all parishes. The majority of subjects were recruited in a single visit, 39.1% required multiple visits varying significantly by region (27.0% to 49.8% [p < 0.0001]). Average interview time was 44.3 minutes with no variation between health regions, urban-rural residence, educational level, gender and SES; but increased significantly with older age category from 42.9 minutes in the youngest to 46.0 minutes in the oldest age category. Between 15.8% and 26.8% of persons did not provide responses for the number of sexual partners in the last year. Women and urban residents provided less data than their counterparts. Highest item non-response related to income at 30% with no gender difference but independently related to educational level, employment status, age group and health region. Characteristics of non-responders vary with types of questions. CONCLUSION: Informative health surveys are possible in developing countries. While survey response rates may be satisfactory, item non-response was high in respect of income and sexual practice. In contrast to developed countries, non-response to questions on income is higher and has different correlates. These findings can inform future surveys

Health sector challenges and responses beyond the Alma-Ata Declaration: a Caribbean perspective Retos y respuestas del sector salud más allá de la declaración de Alma-Ata: una perspectiva Caribeña

<abstract language="spa">Al igual que el resto del mundo, el Caribe ha sido testigo del drástico paso de las enfermedades nutricionales y transmisibles a las enfermedades no transmisibles y crónicas. No obstante, en el Caribe este cambio ha coincidido con una nueva dinámica, creada por la emergencia de enfermedades transmisibles -como la infección por el VIH/sida- junto con los problemas relacionados con el envejecimiento, las enfermedades cardiovasculares, la violencia y las lesiones, entre otros. En este artículo se hace una revisión de la historia de la atención sanitaria en el Caribe, los retos y enfoques del sector salud y la nueva orientación en la atención primaria de salud (APS). Las observaciones se basan en trabajos publicados. En el Caribe, la Declaración de Alma-Ata sirvió como importante punto de giro y ofreció orientación, apoyo y dirección a medida que los países perfilaban sus servicios de salud para satisfacer sus necesidades. La creatividad y el ingenio surgieron como rasgos distintivos del enfoque caribeño en la reestructuración de la APS, ante los retos económicos, sociales, culturales, de recursos humanos y de políticas que enfrentaban. El fortalecimiento de de la capacidad institucional, la extensión de los programas sociales, los esquemas nacionales de seguros de salud, los programas específicos de promoción de salud y la ampliación de la investigación en apoyo al desarrollo de políticas continúan evidenciando el esfuerzo caribeño para responder a los cruciales retos epidemiológicos. A pesar de esos retos, se han establecido alianzas dentro y fuera del Caribe. Además, la Carta del Caribe para la Promoción de la Salud ha servido como elemento crítico para el desarrollo de la APS

Gender differences in the effects of urban neighborhood on depressive symptoms in Jamaica

OBJECTIVE: To explore the mental health effects of the urban neighborhood on men and women in Jamaica and the implications for urban planning and social development. METHODS: A cross-sectional household sample of 2 848 individuals 15-74 years of age obtained from the Jamaica Health and Lifestyle Survey 2007-2008 was analyzed. Secondary analysis was undertaken by developing composite scores to describe observer recorded neighborhood features, including infrastructure, amenities/services, physical conditions, community socioeconomic status, and green spaces around the home. Depressive symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Bivariate and multivariate methods were used to explore the associations among gender, neighborhood factors, and risk of depressive symptoms. RESULTS: While no associations were found among rural residents, urban neighborhoods were associated with increased risk of depressive symptoms. Among males, residing in a neighborhood with poor infrastructure increased risk; among females, residing in an informal community/unplanned neighborhood increased risk. CONCLUSIONS: The urban neighborhood contributes to the risk of depression symptomatology in Jamaica, with different environmental stressors affecting men and women. Urban and social planners need to consider the physical environment when developing health interventions in urban settings, particularly in marginalized communities

Neighbourhood socioeconomic characteristics and blood pressure among Jamaican youth: A pooled analysis of data from observational studies

Introduction. Neighbourhood characteristics are associated with several diseases, but few studies have investigated the association between neighbourhood and health in Jamaica. We evaluated the relationship between neighbourhood socioeconomic status (SES) and blood pressure (BP) among youth, 15–24 years old, in Jamaica. Methods. A pooled analysis was conducted using data from three studies (two national surveys and a birth cohort), conducted between 2005–2008, with individual level BP, anthropometric and demographic data, and household SES. Data on neighbourhood SES were obtained from the Mona Geo-Informatics Institute. Neighbourhood was defined using community boundaries from the Social Development Commission in Jamaica. Community characteristics (poverty, unemployment, dependency ratio, population density, house size, and proportion with tertiary education) were combined into SES scores using principal component analysis (PCA). Multivariable analyses were computed using mixed effects multilevel models. Results. Analyses included 2,556 participants (1,446 females; 1,110 males; mean age 17.9 years) from 306 communities. PCA yielded two neighbourhood SES variables; the first, PCA-SES1, loaded highly positive for tertiary education and larger house size (higher value = higher SES); while the second, PCA-SES2, loaded highly positive for unemployment and population density (higher value = lower SES). Among males, PCA-SES1 was inversely associated with systolic BP (β-1.48 [95%CI −2.11, −0.84] mmHg, p \u3c 0.001, for each standard deviation unit increase in PCA-SES1 score) in multivariable model accounting for age, household SES, study, BMI, fasting glucose, physical activity and diet. PCA-SES1 was not significantly associated with systolic BP among females (β −0.48 [−1.62, 0.66], p = 0.410) in a similar model. Associations for PCA-SES2 was assessed using linear splines to account for non-linear effects. The were no significant associations between systolic BP and PCA-SES2 among males. Among females, higher PCA-SES2 (i.e. lower SES) was associated with higher systolic BP at spline 2 [z-score -1 to 0] (β4.09 [1.49, 6.69], p = 0.002), but with lower systolic BP at spline 3 [z-core 0 to 1] (β-2.81 [−5.04, −0.59], p = 0.013). There were no significant associations between diastolic BP and PCA-SES1, but PCA-SES2 showed non-linear associations with diastolic BP particularly among males. Conclusion. Higher neighbourhood SES was inversely associated with systolic BP among male Jamaican youth; there were non-linear associations between neighbourhood SES and systolic BP among females and for diastolic BP for both males and females