MetaboliCity: How can metadesign support the cultivation of place in the city?

The sustainability agenda has inspired a growing interest and re-valuing of localized food production in cities such as London. This paper presents the findings from a one-year (October 2008 – October 2009) participatory design research project entitled ‘MetaboliCity’ (www.metabolicity.com). The project explored how designers can intervene sensitively within local urban food growing communities by providing a design thinking and crafting to help to sustain these initiatives and catalyse larger positive changes in the surrounding environment. The project was based at Central St. Martins in London, UK, facilitated by the design research group Loop.pH and funded by the Audi Design Foundation. The aim of the project was to create, test and adapt tools and services for collaborative food growing in challenging city spaces. These included community workshops, urban grow-kits and an online collaborative network. A team of designers guided local participants through a set of envisioning, crafting, planting and documenting processes. This paper will introduce the project’s socio-ecological approach to revaluing ‘awkward spaces’ (Jones, 2007) in the city to create places that are at the heart of local communities. Metabolicity is the first applied design research project to test and adapt collaborative tools and processes that were developed as a part of the ‘Benchmarking Synergy Levels within Metadesign’ project. This project was funded by the Arts and Humanities Research Council (AHRC) and the Engineering and Physical Sciences Research Council (EPSRC) and based at Goldsmiths, University of London (2005-2008). Metadesign is a systemic, inter-disciplinary and emergent design process aimed at transcending existing specialist boundaries to create more joined-up solutions for the benefit of society and nature

MetaboliCity: How can Design Nurture Amateur Cultures of Food Production in the City?

This paper introduces a current design research project that explores how designers can intervene sensitively within local urban food growing cultures by providing a design thinking and crafting that may help to sustain these initiatives and catalyse larger positive changes in the surrounding environment. MetaboliCity is the name for a vision of a city that metabolizes its resources and waste to supply its inhabitants with all the nourishment they need and more. This one-year (October 2008 – October 2009) participatory design research project on urban agriculture is based at Central Saint Martins, School of Art and Design and funded by the Audi Design Foundation. The aim of the project is to design an urban grow-kit accompanied by a set of guidelines to be tested and developed at a selection of sites in London, UK. This is a design-service system that integrates both traditional and hi-tech industrialized agricultural techniques into the fabric of the built environment whilst simultaneously being rooted in permaculture thinking. Permaculture is defined as an ‘ecological design system’ that empowers city-dwellers to create ‘sustainable human habitats by following nature’s pattern’. (Robert Hopkins, 2008, p203) The complex nature of the project calls for a Metadesign approach. Metadesign can be described as ‘a shared design endeavour aimed at sustaining emergence, evolution and adaptation’. It creates ‘open-ended and infinite interactivity capable of accommodating always-new variables’. (Giaccardi, 2005) Metabolicity will test and adapt collaborative tools and processes that have been developed as a part of the ‘Benchmarking Synergy Levels within Metadesign’, AHRC funded research project, at Goldsmiths, University of London (2005-2008). The project is facilitated by a design and research team, the participants are amateur food producers based at four different sites in London. There are special advisors on hand from the fields of plant science, permaculture, cooking, farming, wildlife and eco-architecture. The participatory nature of the project is informed by the notion of ‘Citizen Science’ (Irwin, 1995), where amateurs and specialists are engaged in a non-hierarchical process. The project explores how designers can work in multiple ways, taking on different roles within an interdisciplinary context, mediating between experts and amateurs in the field of urban agriculture. The role of the designers is to cultivate shared processes of envisioning, weaving and growing within each of these local contexts

The pasts and presence of art in South Africa: Technologies, ontologies and agents

In 2015, #RhodesMustFall generated the largest student protests in South Africa since the end of apartheid, subsequently inspiring protests and acts of decolonial iconoclasm across the globe. The performances that emerged in, through and around #RhodesMustFall make it clear how analytically fruitful Alfred Gell’s notion that art is ‘a system of social action, intended to change the world rather than encode symbolic propositions about it’ can be, even when attempting to account for South Africa’s very recent history. What light can this approach shed on the region’s far longer history of artistic practices? Can we use any resulting insights to explore art’s role in the very long history of human life in the land now called South Africa? Can we find a common way of talking about ‘art’ that makes sense across South Africa’s long span of human history, whether considering engraved ochre, painted rock shelters or contemporary performance art? This collection of essays has its origins in a conference with the same title, arranged to mark the opening of the British Museum’s major temporary exhibition South Africa: the art of a nation in October 2016. The volume represents an important step in developing a framework for engaging with South Africa’s artistic traditions that begins to transcend nineteenth-century frameworks associated with colonial power

Commentary - Key stakeholders’ perspectives on prioritization of services for chronic respiratory diseases (CRDs) in Tanzania and Sudan: Implications in the COVID-19 era

Key Messages● Despite significant morbidity and mortality and socioeconomic consequences, chronic respiratory diseases (CRDs) are underprioritized in public health programs, especially in low-and middle income countries (LMICs)● COVID-19 is compounding this lack of prioritization and negatively impacting CRD-related (and other) health-care access, diagnosis, and management● Risk factors for exposure to untreated COVID-19, other respiratory infections, and CRDs overlap and could be addressed in concert● Prioritization of COVID-19 within the health system is likely to last for years, potentially allowing advocates to reframe the prioritization of CRDs as part of the pandemic preparedness and integration of health care. This includes advocating for approaches that integrate CRDs into existing programs and services systems strengthening

The JWST Resolved Stellar Populations Early Release Science Program I.: NIRCam Flux Calibration

We use globular cluster data from the Resolved Stellar Populations Early Release Science (ERS) program to validate the flux calibration for the Near Infrared Camera (NIRCam) on the James Webb Space Telescope (JWST). We find a significant flux offset between the eight short wavelength detectors, ranging from 1-23% (about 0.01-0.2 mag) that affects all NIRCam imaging observations. We deliver improved zeropoints for the ERS filters and show that alternate zeropoints derived by the community also improve the calibration significantly. We also find that the detector offsets appear to be time variable by up to at least 0.1 mag.Comment: Accepted for publication in RNAA

Key stakeholders’ perspectives on prioritization of services for chronic respiratory diseases (CRDs) in Tanzania and Sudan: Implications in the COVID-19 era

Key Messages ● Despite significant morbidity and mortality and socioeconomic consequences, chronic respiratory diseases (CRDs) are underprioritized in public health programs, especially in low-and middle income countries (LMICs) ● COVID-19 is compounding this lack of prioritization and negatively impacting CRD-related (and other) health-care access, diagnosis, and management ● Risk factors for exposure to untreated COVID-19, other respiratory infections, and CRDs overlap and could be addressed in concert ● Prioritization of COVID-19 within the health system is likely to last for years, potentially allowing advocates to reframe the prioritization of CRDs as part of the pandemic preparedness and integration of health care. This includes advocating for approaches that integrate CRDs into existing programs and services systems strengthenin

"Honestly, this problem has affected me a lot": a qualitative exploration of the lived experiences of people with chronic respiratory disease in Sudan and Tanzania.

BackgroundOver 500 million people live with chronic respiratory diseases globally and approximately 4 million of these, mostly from the low- and middle-income countries including sub-Saharan Africa, die prematurely every year. Despite high CRD morbidity and mortality, only very few studies describe CRDs and little is known about the economic, social and psychological dimensions of living with CRDs in sub-Saharan Africa. We aimed to gain an in-depth understanding of the social, livelihood and psychological dimensions of living with CRD to inform management of CRDs in Sudan and Tanzania.MethodWe conducted 12 in-depth interviews in 2019 with people with known or suspected CRD and 14 focus group discussions with community members in Gezira state, Sudan and Dodoma region, Tanzania, to share their understanding and experience with CRD. The data was analysed using thematic framework analysis.ResultsPeople with CRD in both contexts reported experiences under two broad themes: impact on economic wellbeing and impact on social and psychological wellbeing. Capacity to do hard physical work was significantly diminished, resulting in direct and indirect economic impacts for them and their families. Direct costs were incurred while seeking healthcare, including expenditures on transportation to health facility and procurement of diagnostic tests and treatments, whilst loss of working hours and jobs resulted in substantial indirect costs. Enacted and internalised stigma leading to withdrawal and social exclusion was described by participants and resulted partly from association of chronic cough with tuberculosis and HIV/AIDS. In Sudan, asthma was described as having negative impact on marital prospects for young women and non-disclosure related to stigma was a particular issue for young people. Impaired community participation and restrictions on social activity led to psychological stress for both people with CRD and their families.ConclusionChronic respiratory diseases have substantial social and economic impacts among people with CRD and their families in Sudan and Tanzania. Stigma is particularly strong and appears to be driven partly by association of chronic cough with infectiousness. Context-appropriate measures to address economic impacts and chronic cough stigma are urgently needed as part of interventions for chronic respiratory diseases in these sub-Saharan African contexts

Towards universal health coverage in Vietnam: a mixed-method case study of enrolling people with tuberculosis into social health insurance

Background: Vietnam’s primary mechanism of achieving sustainable funding for universal health coverage (UHC) and financial protection has been through its social health insurance (SHI) scheme. Steady progress towards access has been made and by 2020, over 90% of the population were enrolled in SHI. In 2022, as part of a larger transition towards the increased domestic financing of healthcare, tuberculosis (TB) services were integrated into SHI. This change required people with TB to use SHI for treatment at district-level facilities or to pay out of pocket for services. This study was conducted in preparation for this transition. It aimed to understand more about uninsured people with TB, assess the feasibility of enrolling them into SHI, and identify the barriers they faced in this process. Methods: A mixed-method case study was conducted using a convergent parallel design between November 2018 and January 2022 in ten districts of Hanoi and Ho Chi Minh City, Vietnam. Quantitative data were collected through a pilot intervention that aimed to facilitate SHI enrollment for uninsured individuals with TB. Descriptive statistics were calculated. Qualitative interviews were conducted with 34 participants, who were purposively sampled for maximum variation. Qualitative data were analyzed through an inductive approach and themes were identified through framework analysis. Quantitative and qualitative data sources were triangulated. Results: We attempted to enroll 115 uninsured people with TB into SHI; 76.5% were able to enroll. On average, it took 34.5 days to obtain a SHI card and it cost USD 66 per household. The themes indicated that a lack of knowledge, high costs for annual premiums, and the household-based registration requirement were barriers to SHI enrollment. Participants indicated that alternative enrolment mechanisms and greater procedural flexibility, particularly for undocumented people, is required to achieve full population coverage with SHI in urban centers. Conclusions: Significant addressable barriers to SHI enrolment for people affected by TB were identified. A quarter of individuals remained unable to enroll after receiving enhanced support due to lack of required documentation. The experience gained during this health financing transition is relevant for other middle-income countries as they address the provision of financial protection for the treatment of infectious diseases

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

Objectives Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. Methods A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. Results The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Conclusions Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs—particularly women and the poor—forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower quality care, while their expenditures represent a higher share of their annual household consumption. This calls for targeted interventions that enhance health care accessibility and provide financial protection from the consequences of NCCDs, especially for vulnerable populations

Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study

Background: Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam. Methods: Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches. Results: Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0–516] USD vs. 656 [IQR: 462–989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548–5418] USD vs. 301 [IQR: 0–824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household’s primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6–80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5–344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7–470.3]) were associated with experiencing catastrophic costs. Conclusion: Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household’s primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required