Urban Governance, Multisectoral Action, and Civic Engagement for Population Health, Wellbeing, and Equity in Urban Settings: A Systematic Review.

Objectives: To identify the validated and reliable indicators and tools to assess good governance for population health, wellbeing, and equity in urban settings, and assess processes of multisectoral action and civic engagement as reported by peer-reviewed articles. Methods: We conducted a systematic review searching six databases for observational studies reporting strategies of either urban health, multisectoral action or civic engagement for wellbeing, health, or equity. Results: Out of 8,154 studies initially identified we included 17. From the included studies, 14 presented information about high-income countries. The general population was the main target in most studies. Multisectoral action was the most frequently reported strategy (14 studies). Three studies used Urban Health Equity Assessment and Response Tool (Urban HEART). Health indicators were the most frequently represented (6 studies). Barriers and facilitators for the implementation of participatory health governance strategies were reported in 12 studies. Conclusion: Data on the implementation of participatory health governance strategies has been mainly reported in high-income countries. Updated and reliable data, measured repeatedly, is needed to closely monitor these processes and further develop indicators to assess their impact on population health, wellbeing, and equity

Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis

Abstract: Background: Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method: A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results: Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion: Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees’ views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations

Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models.

BACKGROUND Healthy ageing (HA) has been defined using multiple approaches. We aim to produce a comprehensive overview and analysis of the theoretical models underpinning this concept and its associated normative terms and definitions. METHODS We conducted a systematic review of peer-reviewed HA models in Embase.com, Medline (Ovid), Cochrane CENTRAL, CINAHL, PsycINFO, and Web of Science until August 2022. Original theoretical papers, concept analyses, and reviews that proposed new models were included. Operational models/definitions, development psychology theories and mechanisms of ageing were excluded. We followed an iterative approach to extract the models' characteristics and thematically analyze them based on the approach of Walker and Avant. The protocol was registered in PROSPERO (CRD42021238796). FINDINGS Out of 10,741 records, we included 59 papers comprising 65 models/definitions, published in English (1960-2022) from 16 countries in Europe, Asia, and America. Human ageing was described using 12 normative terms, mainly (models (%)): successful (34 (52%)), healthy (eight (12%)), well (five (8%)), and active (four (6%)). We identified intrinsic/extrinsic factors interacting throughout the life course, adaptive processes as attributes, and outcomes describing ageing patterns across objective and subjective dimensions (number of models/definitions): cognitive (62), psychological (53), physical (49), social (49), environmental (19), spiritual (16), economic (13), cultural (eight), political (six), and demographic (four) dimensions. Three types of models emerged: health-state outcomes (three), adaptations across the life course (31), or a combination of both (31). Two additional sub-classifications emphasized person-environment congruence and health promotion. INTERPRETATION HA conceptualizations highlight its multidimensionality and complexity that renders a monistic model/definition challenging. It has become evident that life long person-environment interactions, adaptations, environments, and health promotion/empowerment are essential for HA. Our model classification provides a basis for harmonizing terms and dimensions that can guide research and comparisons of empirical findings, and inform social and health policies enabling HA for various populations and contexts. FUNDING MM, ZMRD, and OI are supported by the European Union's Horizon 2020 Marie Skłodowska-Curie grant No 801076, and MM is also supported by the Swiss National Foundation grant No 189235

Good urban governance for health and well-being: a systematic review of barriers, facilitators and indicators

Rapid, unplanned urbanization is one of the major ecological and human challenges of the 21st century. UN Habitat predicts that, by 2050, nearly 70% of the world’s population will be living in cities, with disproportionate urban growth in low- and middle-income countries (10). While cities offer opportunities for employment and access to better public services, they also pose major health risks. Good local governance is critical for achieving the 2030 Agenda, and countries must strive to ensure that their cities are creating and improving their physical and social environments and their community resources to enable people to support each other and to develop to their maximum potential. Building on good practices in the WHO Healthy Cities programme, the World Health Organization (WHO) has identified health promotion in urban and local settings as critical to achieving the Sustainable Development Goals (SDGs) and health equity. The WHO and UN Habitat 2016 Global report on urban health concluded that good urban governance – notably the role of city governments and strong leardership – is key to ensuring health equity and the health and well-being of their citizens (10). WHO contracted the Institute of Social and Preventive Medicine, University of Bern, Switzerland, to review the evidence on two issues that are central to health promotion: achieving good governance for health and well-being, understood as participatory governance built on multisectoral action and civic engagement; and measuring the impact of governance on urban health outcomes. The aim of the systematic review was to identify barriers to and facilitators of multisectoral action and civic engagement and to suggest validated indicators and tools for assessing the processes and outcomes of participatory governance for health, equity and well-being in urban settings from published scientific evidence. Findings from the systemic review informed the development of the Urban governance for health and well-being: a step-by-step approach to conducting operational research in cities

Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis.

BACKGROUND: Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. METHOD: A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. RESULTS: Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. CONCLUSION: Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees' views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations

Characteristics of injuries during the 2006 Lebanon conflict: a three-center retrospective study of survivors, 16 years after the conflict

BackgroundArmed conflict injury is a growing public health concern, particularly in regions like the Middle East and North Africa (MENA). The protracted conflicts and political unrest in this region have led to a substantial number of injuries. Despite this, there is still limited understanding of the specific injury patterns stemming from conflicts, such as the 2006 Lebanon conflict. This study aimed to assess the characteristics and burdens of injuries resulting from this conflict, which occurred 16 years prior to this research.MethodsThis retrospective study analyzed data of individuals affected by the 2006 Lebanon conflict, across three tertiary care centers. Demographics, injuries, complications, injury management, and hospitalization expenses were extracted from medical records and analyzed using SPSS version 29.0. Categorical variables were presented as counts and proportions, and continuous variables as mean ± standard deviation (SD). Hospital comparisons utilized chi-square or Fisher’s exact tests for categorical variables, and one-way ANOVAs for continuous variables. Analysis was conducted from September to November 2023.ResultsAcross three hospitals, 341 patients were studied, comprising 73.6% males and 26.4% females. Among them, a notable proportion (57.3% males and 34.1% females) fell within the 18–39 age range. Children and adolescents under 18 years accounted for 15.9% of males and 25.9% of females. Blast-related injuries predominated, with 24.5% resulting from direct damage caused by explosive parts and 33.3% from blast wave forces. Extremity trauma occurred in 49.0% of patients, and head/neck trauma in 24.9%. Common injuries, including penetrating, musculoskeletal, and traumatic brain injuries affected 34.9%, 31.1, and 10.0% of patients, respectively. Wound repair, fracture treatment, and debridement were the most performed procedures on 15.5, 13.5 and 9.7% of the patients, respectively. The total cost of care was USD 692,711, largely covered by the Ministry of Public Health (95.9%).ConclusionConflict-related injuries significantly contribute to the global burden of disease. Therefore, there is a pressing need to improve national guidelines to prioritize life-threatening cases and potential long-term disabilities. Furthermore, enhancing electronic registry systems to collect clinical data on injured patients is essential for conducting research and better understanding the needs of conflict casualties

Defining Healthy Ageing: The Role of Ethnicity and Lifestyle Factors

Abstract Background Healthy ageing is a heterogeneous concept that requires clarification on, first, its defining characteristics and, second, how factors such as ethnicity, sociodemographics, and lifestyle affect it. Over the past two decades, healthy ageing has become the focus of research and policy as the world demographically shifts into an older population. This dissertation has three aims: 1) to provide a conceptual overview and analysis of healthy ageing and explore if a monistic definition is possible; 2) to describe healthy ageing multidimensionally in a multiethnic population and explore the factors associated with it; and 3) to explore how long-term mental health as one domain of healthy ageing is associated with lifestyle patterns. Methods For aim 1, a systematic review and concept analysis based on the PRISMA and Walker and Avant methods were conducted. The concept attributes, antecedents, consequences, and dimensions were described, and the included conceptualizations were classified into types based on their characteristics. For aim 2, healthy ageing was operationalized using the Healthy Ageing Score (HAS) constituting of seven biopsychosocial domains in the Healthy Life in an Urban Setting Cohort Study (HELIUS) including Surinamese, Ghanaians, Turkish, Moroccans, and Dutch residents of Amsterdam. Logistic regression was used to explore the associations between ethnicity, age group, and sex, as well as ethnic differences in the HAS domains. For aim 3, pre-defined long-term mental health patterns were described in adults of Dutch origin in the Doetinchem Cohort Study (DCS). Logistic regression was used to explore the associations between mental health and lifestyle patterns for sleep, smoking, BMI, alcohol intake, and physical activity and to investigate the role of sociodemographic factors in these associations. Results The first study showed that conceptualizations of healthy ageing were mostly from high-income countries with “successful” and “healthy” as the main terms used. Healthy ageing was characterised by life-long adaptations through person-environment interactions across objective and subjective dimensions, mainly cognitive, psychological, physical, and social. Three types of definitions were found based on health-state outcomes, adaptations, or a combination of both, with some definitions also emphasizing person-environment congruence and health promotion. The second study showed that ethnic minorities aged less healthily than adults from Dutch origin according to the HAS. Ageing poorly was associated with sex (worse in females), marital status, educational, and occupational levels and was also observed in the younger age category (≤ 45 years). The third study found that over a 20-year period persistent good and changing mental health patterns were more common than poor patterns in Dutch adults, while persistent poor and changing patterns were associated with unhealthy sleep and smoking over the same period. Conclusions Healthy ageing is a multidimensional concept, determined by person-environment interactions over the life course, and cannot be monistically defined. It is disproportionately manifested between ethnic groups, is less healthy among minorities compared to the host population, is less healthy in females, and is observed at a young age in adulthood. Long-term unhealthy lifestyle could lead to suboptimal mental health in adults. Implications Bridging the gap between conceptual and operational definitions of healthy ageing and promoting interdisciplinarity in healthy ageing research that accounts for multidimensionality, context, and ethnicity would improve the evidence and its application in practice and policy. Promoting a healthy lifestyle early in adulthood might help improve mental health, and potentially other dimensions and domains of healthy ageing where further investigations in different ethnicities are warranted