FACULTY OF APPLIED SOCIAL SCIENCES

POSTGRADUATE PROGRAMME

MODULE TITLE: HEALTH IN THE CITY

MODULE CODE: HSP003N

MODULE STAFF: Dr Livingstone Musoro (module convenor)

Office Hours: Tuesdays 5-7pm
Room LH 226, l.musoro@londonmet.ac.uk
Phone: 020 7133 5079

SEMESTER AND YEAR: Spring (B), 2010/11

STUDY REQUIREMENTS: 9 hours weekly of which 3 hours will involve timetabled contact;
the remainder to be used for private study.

Module Booklet Contents

Module Booklet Contents..........................................................................................................................1
1. MODULE SPECIFICATIONS...............................................................................................................2
1.1. Introduction....................................................................................................................................2
1.2. Syllabus.........................................................................................................................................2
1.3. Module Aims..................................................................................................................................2
1.4. Learning Outcomes (LO)................................................................................................................3
1.5. Assessment strategy and instruments...........................................................................................3
1.6. Teaching and Learning Methods....................................................................................................4
1.7. Resources......................................................................................................................................4
1.8. Study Hours...................................................................................................................................5
1.9. Bibliography...................................................................................................................................5
2. Weekly Programme: Thursdays, 6-9pm...............................................................................................8
3. APPENDICIES...................................................................................................................................17
APPENDIX 1.......................................................................................................................................17
3.1.1. Assessment Guidelines – Essay......................................................................................................17
3.1.2. Remember the following...................................................................................................................17
3.1.3. Essay Assessment Marking Criteria.................................................................................................18
APPENDIX 2.......................................................................................................................................18
3.2.1. Referencing - The Harvard system...................................................................................................18
3.2.2. The List of References.....................................................................................................................19
 1. MODULE SPECIFICATIONS
1.1. Introduction
This multi-disciplinary module examines aspects of health and healthcare in urban settings
using public health materials from a wide range of social science disciplines. It focuses on
the notion of urban health crisis which is examined by reference to selected “global” and
"world” cities that include London, New York, etc as case studies. Their position as global
cities will be the starting point to explore their significance for health and healthcare.
Reference to London as an important source of background concepts will be outstanding
throughout the module. Hence, students will examine health challenges experienced in
London and other world cities by their residents, patients, communities, health workers,
service providers and local authorities against a background of globalization. The module
uses a public health approach grounded in the impact of social, economic, working and
living conditions on health exemplified in the work of various organisations in the UK and
abroad that include the London Health Commission, London Health Observatory, The Kings
Fund, “Globalization and World Cities Group" (GaWC) based at Loughborough University,
Comparative Urban Studies Project of Wirwood Wilson International Centre, World Health
Organisation Healthy Cities Project, United Nations Urban Observatory, WHO Commission
on the Social Determinants of Health and the World Commission on the Social Dimension of
Globalization.
The module highlights urban and public health issues and inequalities in health status
amongst population groups and communities within urban settings. In addition, it analyses
the outstanding factors that create differences in health and healthcare systems between
global / world cities in the developed and developing world. Therefore, it provides an
opportunity for students to develop skills that enable them to engage critically with the
process of formulating policy in relation to shifting public health agendas towards health
promotion and health care improvement in urban settings.

1.2. Syllabus
The module programme will concentrate on the following five main areas:
1. the controversy, principles and context of health in urban settings and global cities
2. wider determinants of health in urban settings and global cities
3. healthcare services and resources in cities
4. public health and health promotion approaches in urban settings
5. the influence of globalisation on health in the city

The module will address the theory, concepts and principles of health in urban settings. In
addition, it will look at practical aspects of managing health resources, developing primary
and public health, health planning and promotion, and ways of mitigating and
accommodating globalisation, migration and diversity in urban settings. It demonstrates
practical problems and strategies by extensively drawing real examples from both the
developed and developing world.

1.3. Module Aims

This module aims to:
• Examine the notion of urban health crisis by using reference material
from selected global / world cities that include London.
• Understand the significance for health and healthcare of London's and
other global cities' "world city" status.
• Grasp the impact of social and economic factors on the health of global
/ world city dwellers.

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 • Engage critically with public health materials regarding the health of
global / world city dwellers, including policy formulation process in
relation to shifting agendas towards health improvement in urban
settings.
• Create an understanding of the differences in health, health policy and
health-care systems between global / world cities in the developed and
developing world against a background of contemporary globalisation.
• Provide students with an opportunity to develop skills to get to grips
with specific public health issues in relation to specific population
groups in given cities.
• Critically analyse the influence of various international and national
policies on health promotion practice within urban settings.

1.4. Learning Outcomes (LO)

Upon completion of this module students will be able to:
1. Show evidence of an understanding of the notion of urban health crisis, and the
impact of socio-economic and other (especially living and working) conditions on
the health of Londoners and other global / world city dwellers.
2. Demonstrate a comparative understanding of the long-standing problems of
health and health service planning in London and other global / world cities.
3. Demonstrate grasp of links between cities’ (including London's) position as a
"world or global city" and the health and healthcare of residents and visitors.
4. Identify and analyse the outstanding factors and changes that are creating
differences in health, health policy and healthcare systems between global cities
in the developed and developing world against a background of globalisation.
5. Demonstrate grasp of associations between health status and access to socio-
economic resources outside of the formal medical system; and skills that enable
critical engagement with the process of formulating policy in relation to shifting
agendas towards health improvement in urban settings.
6. Show ability to describe, analyse and evaluate key texts, current social
science journal articles, "grey" materials and official documents on health and
healthcare in London and other global / world cities.
7. Incorporate the above learning outcomes in a well-presented written
account, maintaining academic conventions, of how to get to grips with one
health issue, in relation to a population group in a given city or on a given patch of
London

1.5. Assessment strategy and instruments

Module assessment is divided into two components:
(1) An oral (group) presentation of not more than 20 minutes, examining an urban health
issue for a particular population group on a specific London patch or another chosen city.
This presentation will be marked at 10% of the overall module mark and will be due in Week
9 on Thursday 7th April 2011.
(2) An extended coursework essay on a chosen urban health issue of 4,000 words. This
carries 90% of overall module mark. Students are STRONGLY advised to stay within the
word limit as failure to do so will be penalised. To PASS the module, students must past the
essay. Those who prefer to investigate health issues within London or New York must
choose a specific patch / borough. The coursework will have to use public health reporting
materials. It will indicate how the city context influences the urban health issue under
investigation. It will also have to consider how current policy and legislation present
opportunities and problems to address the issue. This will be considered in light of attempts
to develop a strategic approach to health and healthcare within that city or the London

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borough chosen. The coursework is to be handed-in in Week 14 on Thursday 26th May 2011
(for further details contact the Assessments Unit or see your e-vision account).

Marking Criteria - Presentation

Learning Outcome to be Addressed
LO1: Show evidence of an understanding of the notion of urban health crisis, and the
impact of socio-economic and other (especially living and working) conditions on the
health of Londoners and other global / world city dwellers.
Students should demonstrate ability to choose a RELEVANT urban health issue for a
target population group 20%
LO2: Demonstrate a comparative understanding of the long-standing problems of
health and health service planning in London and other global / world cities.
Students need to show ability to structure and synthesise a well-focused and coherent
presentation, using appropriate method of presentation. 20%
LO3: Demonstrate grasp of links between cities’ (including London's) position as a
"world or global city" and the health and healthcare of residents and visitors.
Students must be able to identify, demonstrate, analyse and evaluate factors, challenges,
opportunities and policy around the chosen topic / issue. 20%
LO5: Demonstrate grasp of associations between health status and access to socio-
economic resources outside of the formal medical system; and skills that enable them to
engage critically with the process of formulating policy in relation to shifting agendas
towards health improvement in urban settings.
Students must show good use of evidence to support their arguments. Higher marks are
awarded to demonstration of CRITICAL THINKING. 20%
LO6: Show ability to describe, analyse and evaluate key texts, current social science
journal articles, "grey" materials and official documents on health and healthcare in
London and other global / world cities.
Students should be able to demonstrate ORIGINALITY of THOUGHT and RESEARCH
and identify service gap/s and construct recommendations that address this / these
and prevent ill-health. They should also be able to identify and use relevant and
appropriate referencing, using the Harvard system. 20%

**NB: Detailed assessment guidelines for the essay are in Appendix 1

1.6. Teaching and Learning Methods

This module will use both lectures and interactive methods of learning and teaching.
Students will be required to read set texts and articles and to discuss these in class. As
indicated in the syllabus each student will be required to give a more formal presentation on
work-in-progress on their assessment task on one week in the programme. Hands-on
practical work will include sessions on web-based resources. Additional resources will be
available online via WebLearn. Participants have to make sure they are registered for this
module in order to access material on WebLearn. Module staff will be available to provide
face-to-face, telephone and email support to students during and outside timetabled
sessions.

1.7. Resources
Your key access points for information include the following websites: 1) London
Health Observatory. From this you can download Health of Londoners Project publications
and link to health related sites including the London Health Commission, the Kings Fund
and relevant data-bases: PCTs, Health Authorities and Local Authorities. 2) WHO European
Strategy - this gives a review of public health issues in the European region of WHO. 3)
Project Megapoles - will give you a Health Network for European Capital Cities/Regions and

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very useful health indicators). 4) WHO/Europe Healthy Cities Project. 5) Globalization and
World Cities Group (GaWC) is based at Loughborough University. 6) UN Urban
Observatory – provides many useful links to important issues covered in the module,
including MDGs. 7) WHO Commission on the Social Determinants of Health – this is linked
to the WHO and covers many aspects of the global issues on social determinants of health.
We are very fortunate in having a number of specialist libraries available. The King's
Fund Library is a crucial resource. The KF is now at 11-1 Cavendish Square, W1M 0AN. A
resource list is supplied which can be used by those who decide to do their thesis in this
area as well. Additional material and websites will be posted to the module WebLearn and
given during class.

1.8. Study Hours

Timetabled lectures 16.5 hours
Seminars, workshops and group work 16.5 hours
Preparation for assessment 40 hours
Self directed study 75 hours
Private review for assessment after feedback 5 hours

1.9. Bibliography
Essential
Bardsley M, Barker M, Bhan A, Farrow S, Gill M, Jacobson B and Morgan D (eds) (1998)
The Health of Londoners: a public health report for London. London: The Health of
Londoners Project.
Barer R, Davies H and Fitzpatrick J (2003) Health in London. London: LHC.
Baum F (1993) Healthy cities and change: social movement or bureaucratic tool? In Health
Promotion International 8: 31-40.
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Kawachi, I and Wamala, S (eds) (2007) Globalization and Health. New York: OUP.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Libman K, Freudenberg N, O’Keefe E. (2010) A Tale of Two ObesCities: Comparing
responses to childhood obesity in London and New York City. New York and London: City
University of New York and London Metropolitan University Childhood Obesity
Collaborative.
London Health Commission (2004) Health in London: focus on health of London’s black and
minority ethnic communities. London: Greater London Authority
Mayor of London (2004) Primary Care Access in London. [Online] Available at:
http://www.london.gov.uk/gla/publications/health.jsp
Mckintosh M (2005) London – the World in One City: An Analysis of 2001 Census Results.
London: Greater London Authority.
Olds K (2001) Globalization and Urban Change: Capital, Culture, and Pacific Rim Mega-
Projects. New York: Oxford University Press.
Piggott, G (ed), Greater London Authority and Data Management and Analysis Group
(2009) Focus on London 2009. London: GLA and TSO. [Online] Available at:
http://www.london.gov.uk/focusonlondon/docs/fol09-full.pdf
Popay J (2001) Regeneration and Health: A selected review of research. London: Kings
Fund.
Project Megapoles (2000) A Network for Public Health within the Capital Cities/ Regions of
the European Union: health indicators (www.megapoles.com):

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UN Habitat (2003) Water and Sanitation in the World’s Cities: Local Action for Global Goals.
Geneva: UN Human Settlements Programme/Earth Scan.
UN-HABITAT (2010) State of the World's Cities 2010/2011 - Cities for All: Bridging the
Urban Divide. [ Online] Available at:
http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2917
UN-HABITAT (2009) Global Report on Human Settlements 2009: Planning Sustainable
Cities. [Online] Available at:
http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2831
UN-HABITAT (2008) State of the World’s Cities 2008/2009 - Harmonious Cities. [Online]
Available at
http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=2562

Contextual issues: empirical information and social science narratives

Acheson, D (1998) Independent Inquiry into Inequalities in Health. London: The Stationary
Office.
Curtis, K and Roberts, H (2004) Children & health: making the link. London: London Health
Commission. [Online] Available at: http://www.londonshealth.gov.uk/pdf/Children_&_
Health__ A5_48pp.pdf
Gaffney, D (2004) Child poverty in the capital. In New Economy 2004; 11 (1): 3-14.
Greater London Authority (2004) Making London better for all children and young people:
the Mayor's children and young people's strategy. London: GLA. [Online] Available at:
http://www.london.gov.uk/mayor/strategies/children/docs/main.pdf; and summary at:
http://www.london.gov.uk/mayor/strategies/children/docs/summary.pdf
Greater London Authority. Mayor of London (2004) The state of London's children report.
London: GLA. [Online] Available at: http://www.london.gov.uk/mayor/children/docs/state_
london_children_full.pdf; summary: at: http://www.london.gov.uk/mayor/children/docs/
state_london_children_summ.pdf
Reynolds, B. (2009) ‘Feeding a World City: The London Food Strategy’. International
Planning Studies, 1469-9265, Volume 14, Issue 4, 2009: 417 – 424
Sassen S (1999) The global city. In S Fainstein & S Campbell (eds) Readings in Urban
Theory. Oxford: Blackwell.
Steel, Carolyn (2009) Hungry City: How Food Shapes Our Lives [Online] Available at:
http://www.hungrycitybook.co.uk/
Wallace R, Wallace D (1995) US Apartheid and the spread of AIDS to the suburbs: a multi-
city analysis of the political economy of spatial epidemic threshold. Social Science &
Medicine 41(3): 333-345.
Whiteis D (1998) Third world medicine in first world cities: capital accumulation, uneven
development and public health. Social Science & Medicine 47 (6):795-808.
Whitehead, M and Dahlgren, G (2006) Levelling up (part 1): a discussion paper on concepts
and principles for tackling social inequities in health. Studies on social and economic
determinants of population health, No. 2. WHO Regional Office for Europe.

Policy
Cummins, S., & Macintyre, S. (2002). "Food deserts"—evidence and assumption in health
policy making. British Medical Journal, 325(7361), 436.
Department of Health (COI for the Department of Health) (2010) Healthy Lives, Healthy
People: Our strategy for public health in England. London: The Stationery Office for HMG.
[Online] Available from: http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_121941
Department of Health (2006) Our Health, Our Care, Our Say. London: The Stationary
Office. Available on-line at: www.dh.gov.uk/ourhealthourcareoursay
Department of Health (2004) Choosing Health: Making healthy choices easier. London:
TSO.

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Department of Health (2000) The NHS Plan. London: DoH.
Department of Health (1999) Saving Lives: Our Healthier Nation. London: TSO.
Department of Health (1998) Our Healthier Nation, a contract for health. London: The SO.
London Health Commission (2010) Mayor's Health Inequalities Strategy. [Online] Available
at: http://www.london.gov.uk/sites/default/files/LondonHealthInequalitiesStrategy.pdf
NHS Executive London Regional Office (2000) The London Health Strategy. [Online]
Available from: http://www.doh.gov.uk/london/hstrat1.htm
NHS Executive (1999) The Modernisation Plan for the NHS in London 1999-2002.

Useful Websites
A Collection of Public Health: http://www.hyperion.ie/PublicHealth.htm
African Networks for Health Research & Development: http://www.afronets.org/ index.php
Association of Public Health Observatories: http://www.apho.org.uk/apho/
Department of Health Annual Health Surveys: http://www.dh.gov.uk/Publications
AndStatistics/PublishedSurvey/HealthSurveyForEngland/HealthSurveyResults/fs/en
Department of Health site map: http://www.dh.gov.uk/SiteMap/fs/en
European Commission - Public Health: http://ec.europa.eu/health/index_en.htm
European Network of Health Promoting Schools: http://www.who.dk/ENHPS
European Public Health Alliance: http://www.epha.org/
EU Public Health: http://www.europa.eu.int/comm/health/ph_information/dissemi-nation
/echi/echi_en.htm
Globalization and World Cities Group" (GaWC): http://www.lboro.ac.uk/gawc/
Greater London Authority’s publications of Focus on London at http://www.london.gov.uk/
mayor /publications/facts-figures/fol.jsp
John Hopkins Urban Health Institute: http://urbanhealthinstitute.jhu.edu/
London Health Observatory at http://www.lho.org.uk
London Health Commission at http://www.londonshealth.gov.uk/
Mayor of London – Londoner’s Health at http://www.london.gov.uk/londonissues/health.jsp,
New York Academy of Medicine – Urban Health: http://www.nyam.org/urban-health/
Office of National Statistics: http://www.statistics.gov.uk/
The London Health strategy website: http://www.doh.gov.uk/london/hstratl.htm
The King’s Fund Information and Library Service holds a database of over 75,000
bibliographic records. For more details visit http://www.kingsfund.org.uk/library or
http://www.kingsfund.org.uk/publications or call 020 7307 2568/9.
UK Department of Health: http://www.doh.gov.uk/index.htm
UN Urban Observatory: http://www.unhabitat.org/programmes/guo/
WHO/Europe Healthy Cities Project: http://www.euro.who.int/healthy-cities

Journals
Globalization and Health
Journal of Urban Health (Online ISSN 1468-2869 - Print ISSN 1099-3460). Published by
Springer from Volume 83, 2006

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 2. Weekly Programme: Thursdays, 6-9pm
Week 1 (10th Feb): Introduction to Health in the City Module
Lecture
• Overview of the module in the context of reasons for studying health in urban settings
• Introducing the urban health controversy – most visible in world / global cities
• Policy context of health in cities

Workshop
• Getting to know one another: who you are and what resources you bring to the group
• Negotiate group formation and topics for presentations in Week 9. This will be the topic
area for your component 1 of the assessment. Each week you will be encouraged to
consider the significance of the week’s issues for the topic you are working on for your
group presentation. Topics might include those listed below which, in each case, has a
pan-London overview, usually to be found in the reviews of the London Health Strategy
produced by the London Health Commission or Public Health reports produced by PCTs:
1. housing
2. environment & health: transport
3. sexual & reproductive health: sexually transmitted diseases, teenage pregnancy
4. drug use
5. communicable disease
6. child health
7. mental illness
8. ethnic minority health
9. refugees
• In addition, topics can include those with a pan-WHO perspective. “WHO's work on
Healthy Cities Project covers most aspects of public health relevant to urban settings.
Here is a wide range of related urban health topics, which are linked to responsible WHO
programmes and to some other relevant resources, agencies and institutions”
(http://www.euro.who.int/ healthy-cities/uht/20050806_1): ageing, air, alcohol drinking,
children and young people, city health development planning, community participation,
drugs, environmental health, equity and health, health care policy and planning, health
impact assessment, housing, mental health, non-communicable diseases, nutrition,
physical activity, poverty, sexual health, smoking, social care, socioeconomic
determinants of health , sustainable development, transport and health, urban
governance, urban planning, violence.

Week 2 (17th Feb): Urbanisation and Health

Lecture The session will examine some of the material developed in the Global Health
Watch 2 that looks at the process and outcomes of urbanisation and its bearing on health in
both the global south and global north. Urbanisation can have both negative and positive
influences on health. The world’s urban population continue to grow with largest numbers of
rapidly growing cities found in the global south. What is the implication of this to global south
mega cities and northern global cities like London?
Workshop:
Develop an interactive SWOT analysis for health in the London borough or city your group
is studying, carefully select the advantages and disadvantages posed by the borough / city’s
urban settings to the health of its inhabitants.
Readings

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Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
People’s Health Movement, Medact and Global Equity Gauge Alliance (2008) Global Health
Watch 2: An Alternative World Health Report. London and New York: Zed Books Ltd.
[Online] Available from: http://www.ghwatch.org/ghw2/ghw2pdf/ghw2.pdf

Week 3 (24th Feb): A Framework of Analysing Health in Urban Settings

Lecture In this session we will examine the notion and concept of health in urban settings
using the principles and concepts developed in the Healthy Cities Project and other
frameworks. Here, we introduce the understanding that the urban setting in its broadest
sense (physical, social, economic, and political) affects the health of all its residents.

Workshop: A Public Health Approach for the Analysis of Health in Cities

In this Workshop we will examine the how to use a public health approach in analysing
health in urban settings. Our discussions will have special reference to London’s strategic
approach to public health. Discuss the: 1) challenges for public health in London or a world
city your group is studying, 2) advantages for public health in London or a world city your
group is studying.

Readings
Ashton, J (ed) (1992) Healthy Cities. Buckingham: Open University Press
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Barten, Franc$oise; Mitlin, Diana; Mulholland, Catherine; Hardoy, Ana and Stern, Ruth
(2007) Integrated Approaches to Address the Social Determinants of Health for Reducing
Health Inequity. In Journal of Urban Health: Bulletin of the New York Academy of
Medicine, Vol. 84, No. 1 doi:10.1007/s11524-007-9173-7
Barer R, Davies H, Fitzpatrick J (2003) Health in London. London: London Health
Commission.
London Health Commission publications (2002, 2003, 2004, 2005, 2006/7)

Week 4 (03rd March): Determinants of Health in Urban Settings

Lecture The structure and mechanisms are derived from the WHO Commission on the
Social Determinants of Health and many materials from London, especially on health
inequalities in the capital. The following are areas of focus: wider determinants of health; in
particular social determinants – social and economic, living and working conditions;
inequalities in health.

Workshop: Discuss how inequalities and other determinants of health that affect the health
of the population group you are studying are being address. What are the gaps that exist
and how can they be met?

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Readings
Bardsley M et al (eds) 1999 The Health of Londoners: a public health report for London.
London: The Health of Londoners Project. See chapters 1-2.
Barer R, Davies H and Fitzpatrick J (2003) Health in London: 2003 review of the London
Health Strategy high-level indicators: 2003 update: focus on the experience of disabled
Londoners. London: GLA. [Online] Available at: http://www.londonshealth.gov.uk/pdf/
hinl2003.pdf
Barer R, Davies H and Fitzpatrick J (2004) Health in London: review of the London Health
Strategy high-level indicators: 2004 update: focus on the health of London's black and
minority ethnic communities. London: LHC. [Online] Available at:
Fitzpatrick, J et al. (2004) The London health forecast: can London's health divide be
reduced? London: LHO. [Online] Available at:
http://www.lho.org.uk/Download/n1dkv3fhupx
14455gajzl4jz/live/8990/Health_Forecast_4.pdf
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
London Health Commission (2008) Mayor's Health Inequalities Strategy. [Online] Available
at: http://www.london.gov.uk/mayor/health/strategy
London Health Commission, et al. (2002) Health in London: 2002 review of the London
Health Strategy high-level indicators. London: LHC. [Online] Available at:
http://www.londonshealth .gov.uk/pdf/hinl2002.pdf
London Health Commission publications (2002, 2003, 2004, 2005, 2006/7)
Mindell, J., et al. (2004) Health inequalities in London: life expectancy and mortality 1998-
2002. London: London Health Observatory. [Online] Available at: http://www.lho.org.uk/
Download/yp4ji245ecvie245vyvwp0an/live/8811/Health_Inequalities_Report_4.pdf
***Regular updates on the Mayor's Health Inequalities Strategy can be found at:
http://www.london.gov.uk/mayor/health/strategy
Your reading on this topic will provide the basis to examine these issues in more depth,
identifying those which might be addressed at a regional level (pan-London) and those
which might be addressed locally by a PCT. This must include reference to reducing
inequalities, working with communities and agencies working for health and well-being

Week 5 (10th March): Promoting Health in Urban Environment / Settings

Lecture This session will look at approaches to promoting health in urban environment, with
particular focus on settings and targeting approaches. It will also look at how we gather
evidence to inform health promotion programmes in urban settings. We will then look at
different ways of promoting health in urban settings in view of the urban built-up
environment and circumstances. What are the main challenges of promoting health in
various settings of the urban environment? Are there any good examples of health
promoting settings in cities? How do we negotiate the intersection of culture, population
diversity and health promotion?
We will also look at different ways of promoting health in urban settings in view of the urban
built-up environment and resource circumstances. What are the main resource challenges
in promoting health in urban settings?

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Workshop:
Groups should identify whether any setting has been developed for their target population;
otherwise they can choose a specific settings example and identify and discuss the key
health issue/s being addressed or promoted. Groups should look critically at how the health
issue/s is/ are being addressed, stakeholders involved, the outcomes of interventions and
any challenges being faced. What suggestions can be made to improve the situation or
close gaps?
Readings
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Pike, S and Forster, D (edsEds) (1995) Health Promotion for All. New York: Pearson
Professional Ltd. See Section 3
Sidell, M; Jones, L; Katz, J; Peberdy, A and Douglas, J (edsEds) (2003, 2nd ed) Debates
and Dilemmas in Promoting Health: A Reader. New York: Open University Press and
Palgrave Macmillan. See Chapters 26, 34, 35, 36, and 37
Tones, K and Green, J (edsEds) (2004) Health Promotion: Planning and Strategies.
London: Sage Publications

Week 6 (17th Mar): Providing Healthcare in Urban Settings

Lecture The structure and mechanisms are derived from the WHO European Strategy (EU
health indicators), NHS White Paper on Primary Care and material on primary care
provision in London. The following are areas of focus:
• Mechanisms of providing healthcare: Primary Care Trusts (GP & community nurse-led
group, free-standing PCTs commissioning); Health Improvement Programmes (NHS-led
joint action programme between NHS trusts, other primary care professionals, local
authority to improve health & health care of specific section of population); local strategy
of NHS & non-NHS partners in most deprived areas. Other areas to focus on include:
• staffing problems and migration issues
• primary healthcare & community services
• financial constraint and funding for health care
• planning and healthcare infrastructure
• development of urban (and London-wide) health care information systems

Workshop: Your group should discuss the (re)organisation of providing healthcare services
to the general population and the particular population group that you are studying; paying
significant attention to primary care and any challenges related to commissioning of
services to this population group. Are the services provided to your target population group
appropriate? How are commissioning concerns addressed? What are the drivers of service
provision for your target population group?

Readings:
Boyle S, Smaje C (1993) Primary Health Care in London. London: Kings Fund.
Department of Health (1998) The Future of London’s Health Services
Galea S and Vlahov D (edsEds) (2005) Handbook of Urban Health: Populations, Methods
and Practice. New York: Springer.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.

11
 [Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Laing, W (2005) Trends in the London care market 1994-2024. London: King's Fund.
[Summary available online] at: http://www.kingsfund.org.uk/resources/publications/
trends_in_the.html
London Assembly Health Committee (2003) GP Recruitment and Retention: The Crisis in
London. London: Greater London Authority.
London Assembly and Mayor of London (2003) Access to primary care: a joint London
Assembly and Mayor of London scrutiny report. London: Greater London Authority.
[Online] Available at:
http://www.london.gov.uk/assembly/reports/health/primary_care_access.pdf
Mayor of London (2004) Primary Care Access in London. [Online] Available at:
http://www.london.gov.uk/gla/publications/health.jsp
Mountford, L and Rosen, R (2001) NHS walk-in centres in London: an initial assessment.
London: King's Fund. [Online] Available at: www.kingsfund.org.uk/go.rm?id=158
NHS Executive Pocket Guide to the NHS in London 1999/2000. London: NHS London. -
Read section 1 pp 1-4
O'Toole, K and Lister, J (2003) On the brink: a survey of the situation facing London's NHS
trusts and PCTs as they struggle to meet tough new government targets. London: London
Health Emergency. [Online] Available at: http://home.btconnect.com/london-
health/pdf/London roundupFeb03.pdf
Peters, Jean, et al. (2009) Health and use of health services: a comparison between
Gypsies and Travellers and other ethnic groups. In Ethnicity and Health 2009; 14 (4):
359-377 (August 2009).
Piggott, G (ed), Greater London Authority and Data Management and Analysis Group
(2009) Focus on London 2009. London: GLA and TSO. [Online] Available at:
http://www.london.gov.uk/focusonlondon/docs/fol09-full.pdf

Week 7 (24th Mar): Health Impact and Health Equity Impact Assessments (HIA and
HEIA) in Urban Settings
Lecture In this session we will examine the importance and conduct of an HIA and HEIA as
tools to aide decision making when developing policy, projects and interventions that will
have a bearing on health in cities. Note that we will not treat the two as separate but that
HEIA is a special part of HIA that focuses on distribution, fairness, and equity of benefits or
harm.
Seminar: Groups should reflect back on health promotion interventions / settings they
looked at in Week 6 and consider the merits of HIA and HEIA for their target population.
Readings:
Bardsley M et al (2001) Monitoring Regeneration: a health indicators toolbox for
practitioners Health of Londoners Project.
Bowen C (2007) Health impact assessments in London: assessing the London
Mayoral strategies. In Vol. 18(9–10) NSW Public Health Bulletin: 185-187.
Capon A G (2007) Health impacts of urban development: key considerations. In
Vol. 18(9–10) NSW Public Health Bulletin: 155-156.
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Harris PJ; Harris-Roxas B F, Harris E and Kemp L A (2007) Health impact assessment and
urbanisation: Lessons from the NSW HIA Project. In Vol. 18(9–10) NSW Public Health
Bulletin: 198-201.

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Harris-Roxas B, Simpson S and Harris E. (2004) Equity Focused Health Impact
Assessment: a literature review. Sydney: Centre for Health Equity Training
Research and Evaluation (CHETRE) on behalf of the Australasian Collaboration
for Health Equity Impact Assessment (ACHEIA).
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Mahoney M, Simpson S, Harris E, Aldrich R, Stewart Williams J (2004) Equity
Focused Health Impact Assessment Framework. Sydney: The Australasian
Collaboration for Health Equity Impact Assessment (ACHEIA).
Mindell J, Sheridan L, Joffe M, Samson-Barry H, Atkinson S (2008) Health impact
assessment as an agent of policy change: improving the health impacts of the
mayor of London’s draft transport strategy. In J Epidemiol Community Health
2004;58:169–174. doi: 10.1136/jech.2003.012385
Thompson S (2007) A planner’s perspective on the health impacts of urban
settings. In Vol. 18(9–10) NSW Public Health Bulletin: 157-160.
Vohra S (2007) International perspective on health impact assessment in urban
settings. In Vol. 18(9–10) NSW Public Health Bulletin: 152-154.

Useful Websites:
European Centre for Health Policy, WHO Regional Office for Europe. Health Impact
Assessment Website:
http://www.euro.who.int/eprise/main/WHO/Progs/HPA/HealthImpact/20020319_1
International Health Impact Assessment Consortium. IIMPACT Website:
http://www.ihia.org.uk/
NHS Health Development Agency. Health Impact Assessment Gateway:
http://www.hiagateway.org.uk
Information on the Australasian Collaboration for Health Equity Impact Assessment
(ACHEIA). Visit http://chetre.med.unsw.edu.au/hia/acheia_efhia.htm

Week 8 (31st March): A Comparative Study of Health in Global Cities: Childhood

Obesity in London and New York
Lecture In this session, we shall look at a comparative study of New York and London. This
will be achieved by dividing the session into two parts: a) general contextual background
discussion on health with a comparative focus on the two cities, b) a comparative discussion
on childhood obesity in the two cities.
In this session, teaching staff will briefly highlight issues in relation to a population group.
This case study raises issues in a stark way about how social and economic factors as well
as cultural factors impact on health with exclusionary consequences. It further highlights the
fact that London and New York are capital cities attracting in-migration from elsewhere in
the UK and USA, respectively; as well as a World Cities, attracting net, and growing, in-
migration from abroad (London - a former centre of an empire). The purpose of the
teaching input in this session is to help you focus your own work, and be able to prepare for
your assessment by making links between the wider themes of the module; the policy
context; and the planning and delivery of specific services. The whole session relies on your
having read about health in London and New York City.
Workshop: Groups need to identify and discuss the extent to which child obesity affect their
target population. What are the determinants of childhood obesity in this population and
how are the challenges being addressed? What gaps exist in the interventions and what
else can be done to better address this problem?

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Readings:
Curtis, K and Roberts, H (2004) Children & health: making the link. London: London Health
Commission. [Online] Available at: http://www.londonshealth.gov.uk/pdf/Children_&_
Health__ A5_48pp.pdf
Gaffney, D (2004) Child poverty in the capital. In New Economy 2004; 11 (1): 3-14.
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Greater London Authority (2004) Making London better for all children and young people:
the Mayor's children and young people's strategy. London: GLA. [Online] Available at:
http://www.london.gov.uk/mayor/strategies/children/docs/main.pdf; and summary at:
http://www.london.gov.uk/mayor/strategies/children/docs/summary.pdf
Greater London Authority. Mayor of London (2004) The state of London's children report.
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
London: GLA. [Online] Available at: http://www.london.gov.uk/mayor/children/docs/state_
london_children_full.pdf; summary: at: http://www.london.gov.uk/mayor/children/docs/
state_london_children_summ.pdf
Libman K, Freudenberg, O’Keefe E (2010) A Tale of Two ObesCities: Comparing responses
to childhood obesity in London and New York. New York and London: City University of
New York and London Metropolitan University Childhood Obesity Collaborative.
White D (1998) Third world medicine in first world cities: capital accumulation, uneven
development and public health. Social Science & Medicine 47 (6): 795-808.
New York City Department of Health & Mental Hygiene (2004) Health Disparities in New
York.
*NB: Check on the Foresight, LHO, LCH and NY City Health Department websites for
background reading.

Weeks 9 (07th April): Student-led Presentations of an Urban Health Issue as Work-in-

Progress
The session will have student-led (group) presentations of an urban health / service
issue. If you were familiar with the topic before embarking on this module, you may use
your account of it as a point of departure for further investigation. For instance, you could
consider links between a pan-London topic with transport or housing, or an organizational
issue such as the operation of a local Primary Care Trust, in relation to a chosen population
group. However, if this material is new to you, then you are strongly advised to work in
depth on the published topic. For this presentation and if you are looking at London you
might have wanted to visit the Kings Fund Library to access in-depth resources. You are
further advised to use the guide to assessment available on the module’s Weblearn site.

Week 10 (14th Apr): The London Plan: influencing health, health policy and healthcare
services in London – an urban planning case study
Lecture This session will give the module an opportunity to have a guest speaker to help us
to examine issues around the London Plan, published by the Mayor of London as a
strategic plan for the capital. The session will also help us to understand how the Plan
influences the determinants of health and well-being, health policy and health services in
the capital against the background of national legislation and policy.
Workshop: Groups should investigate to see whether their target population is included
into any city plans and how these influence the population’s health. What are the
implications of the issues identified in any city plan/s for:

14
• addressing inequalities in health and well-being in relation to the target population?
• health services provision to the target population at the local level?

Readings:
Galea S and Vlahov D (eds) (2005) Handbook of Urban Health: Populations, Methods and
Practice. New York: Springer.
Greater London Authority (2008) The London Plan: Spatial Development Strategy for
Greater London Consolidated with Alterations since 2004. London: GLA. [Online]
Available at: http://www.london.gov.uk/thelondonplan/thelondonplan.jsp
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
Lowdell C (2001) A Guide to Health & Health Services for Town Planners in London.
[Online] Available at: www.holp.org. (This was written for people who are NOT health
experts, so it is a very useful introduction to healthcare planning basics.
Mayor of London (2004) The London Plan (Spatial Development Strategy for London). The
Greater London Authority: on-line. Available at http://www.london. gov.uk/mayor/
strategies/sds/index.jsp
Mayor of London (2007) The Draft Mayor’s Housing Strategy. The Greater London
Authority: on-line. Available at http://www.london.gov.uk/mayor/housing/ strategy/index.jsp
Mayor of London (n.d) The London Plan Annual Monitoring Report 3. The Greater London
Authority: on-line. Available at http://www.london.gov.uk/mayor/ planning/docs/
monitoring_report3.pdf
NHS London Healthy Urban Development Unit (2005) Watch out for health. London: HUDU.
[Online] Available at: http://www.healthyurbandevelopment.nhs.uk/documents/planning_
checklist/Watch_Out_ For_Health_Planning_Checklist.pdf

E A S T E R B R E A K H E R E ! ! !

Week 11 (05th May): The Influence of Globalisation on Health in Urban Settings

Lecture Everywhere around the world globalisation is heavily influencing national

economies and policies of governments. There are growing differences in the ways nations
are benefiting from the accelerating pace of globalization. These rapid changes are
nowhere as clear as they are in world cities, with profound effects on migration, wealth
accumulation, employment, housing, transport, health and health care and other public
services.
In this session we examine the process of globalization and its influence on public health in
world cities. Some of the issues to be discussed are migration, skills drain of health
professionals from developing to developed countries (what is the impact of this on health
and health care delivery in both source and recipient countries?), global economic policies
of multilateral and donor institutions, the rising influence of global non-governmental
organisations, and globalisation of the world economy with rising differences in urban
poverty in some parts of the world and urban wealth in others. How do these differences
affect health and healthcare delivery in world cities in different parts of the world?

Seminar / Workshop: What are the health benefits and negative impacts has globalisation
brought about to your target population? What are the local and global strategies being put

15
in place to address the consequences of globalisation on health and healthcare delivery in
the world city your group is examining in relation to your target population?

Readings
Bettcher, D and Lee, K (2002) Globalisation and public health. (Available from)
http://jech.bmjjournals.com/cgi/reprint/56/1/8 [Accessed on 26/09/06]
De Vogli, R., et al. (2009) The policies-inequality feedback and health: the case of
globalisation. In Journal of Epidemiology and Community Health 2009; 63 (9): 688-691
(September 2009).
Fidler, D. P (2001) The globalization of public health: the first 100 years of international
health diplomacy (Available from) http://www.who.int/bulletin/archives/79(9)842.pdf
[Accessed on 26/09/06]
Kjellstrom, T (2007) Our cities, our health, our future: Acting on social determinants for
health equity in urban settings. Kobe, Japan: WHO Centre for Health Development.
[Online] Available as PDF file [70p.] at: http://www.who.int/social_determinants/resources/
knus_report_16jul07.pdf
"Globalization and World Cities Group" based in Loughborough University, England
(GaWC), can be accessed at http://www.lboro.ac.uk/gawc/
Labonte R, Schrecker T, Sanders D & Meeus W (2004) Fatal Indifference: The G8, Africa
and Global Health. Cape Town: UCT Press; Ottawa: IDRC Press.
Martineau T, Decker K, & Bundred P (2002) Briefing note on international migration of
health professionals: leveling the playing field for developing country health systems.
Liverpool: Liverpool School of Tropical Medicine.
Ray S (2005) “The NHS as Part of Global Health” in UK Health Watch 2005: The
Experience of Health in an Unequal Society. POHG (2005);
http://www.pohg.org.uk/support/downloads/ukhealthwatch-2005.pdf
Wade, R. H (2002) “Globalisation, poverty and income distribution: does the liberal
argument hold?” in Gruen D, O'Brien T, Lawson J, editors. Globalisation, Living Standards
and Inequality: Recent Progress and Continuing Challenges. Canberra: Reserve Bank of
Australia, 2002: 37-65.
World Commission on the Social Dimension of Globalization (2004), A Fair Globalization:
Creating Opportunities for All. Geneva: ILO.
Yach, D and Bettcher, D (1998) The globalization of public health, I: Threats and
opportunities American Journal of Public Health, Vol 88, Issue 5 735-738.
Yach, D and Bettcher, D (1998) The globalization of public health, lI: Threats and
opportunities American Journal of Public Health, Vol 88, Issue 5 738-741.

Week 12 (12h May): Class Revision & Write-Up

Week 13 (19th May): Write-Up

Week 14 (26th May): Assessment Essay Submission Deadline!

Work is submitted to Assessments, Room LHG20. Further
details are on your e-vision account.

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 3. APPENDICIES

APPENDIX 1
3.1.1. Assessment Guidelines – Essay
Think of this as contribution to the development of a multi-agency, department / ministry of
health or a national health service-led initiative to improve health and health care for a
particular group of people in London or any other world city. Imagine that you are the
spokesperson for a group which hopes to get an issue taken up by those who commission
services. You are trying to ensure that a specific problem on a specific patch is included or
given a higher or different emphasis from that in recent planning in that city. It should help
people from very different political starting points understand the issue. It must show that
you have a grasp of the socio-economic and planning context within which service
commissioners operate and that needs have to be prioritised. Points below are for general
guidance only and should be used with imagination.

1. Introduction:
Outline of what the reader will find in each of the sections. Try to find an arresting
quotation, example, paragraph-length case study to get right to the point.
2. An aspect of health on a patch in relation to a specific population group
Give an overview of the information produced at local level on your topic. Include
information produced by health and local authority professionals and by community groups.
To ensure that you have digested this material, you must ask yourself how useful the
documentation is in presenting the basis for EVIDENCE-BASED planning. What sort of hard
and soft information does it provide in relation to disability, class, race, gender, sexuality,
age? What does it say about integrated care (between acute, community & primary
services)? What does it say about joint-working between local authority (especially social
services and housing depts) & health care sectors)? What does it say about finance?

3. The city’s / London’s background

Show how features of the city background impact on the issue you have chosen: patterns of
health & illness; structure and organisation of relevant health services; aspects of the social
and economic environment.

4. Application of city’s health strategy

Formulate and justify any two recommendations to address your issue: one immediate
short-term recommendation; one longer-term strategic recommendation. Show how your
recommendations relate to the city’s health strategy as embodied in its health
commission/s.

5. The social science context.

Show how social science materials help you to make sense of the issues you have
investigated, for example materials on inequalities in health and the constraints within which
you have identified the feasibility of your recommendations.

Conclusion
Underline the main points and key evidence discussed about the health issue you chose
and relate them to the broader content of the module.

3.1.2. Remember the following

At post graduate level the pass mark is 50%

17
 Your essay should demonstrate your ability to meet the:-
I. module aims, and
II. learning outcomes
3.1.3. Essay Assessment Marking Criteria

Your assessment essay should address all the six LOs given in Section 1.4 on p3. They
all carry the same weight of 20%, with LO3 and LO4 combined into single weighting. .
Examiners will use the following marking criteria to assess the work.
Appropriate content: 20%
Analysis of relevant aspects: 20%
Consistent structure and discussion: 20%
Presentation - structure, grammar, written expression, spelling: 20%
Appropriate referencing and use of evidence: 20%

APPENDIX 2
3.2.1. Referencing - The Harvard system
In the Harvard system sources are identified within the text by name of author and date
of publication. If the author's name occurs naturally in the sentence the year of publication
should appear in parenthesis. For example:
Bowling (1997) claims that......
Naidoo and Wills (1998) discuss this briefly.....
If you are attributing ideas, arguments or research findings the author/s and publication date
appear in parenthesis. For example:
Accident prevention initiatives are based on various approaches to health promotion (Ewles
and Simnett, 1999).
A recent study has demonstrated..... (Acheson, 1998).
For a direct quote the page number should also be cited in the text. The quotation should
appear in inverted commas and, if more than a phrase or short sentence, it should be
indented in the text. For example:
"In recent years, there has been more skepticism about screening in official circles, and
new procedures have been established to evaluate the cost effectiveness of screening”
(Baggott, 2000:133).
If a source is written by two people cite both names. If there are more than two authors cite
the first name followed by et al., but you must include all authors in the list of references at
the end of the work. If you are citing two or more sources by the same author, published in
the same year, place an ‘a’ after the date of one and a ‘b’ after the date of the second and
so on. This should be repeated in the References listing at the end.
Where one author (A) has referenced another (B) and you wish to use the ideas of B it
should appear as follows:
B (1996 cited by A, 2000) describes that.......
A (2000) cites B's (1996) argument that.......
In the List of References you list full details of A. Similarly, where the work you are citing is a
chapter in an edited book, you should bear in mind that the work to be acknowledged is that
of the chapter author, not the editor/s. But, the source of the chapter, i.e. the editor, should
be included to guide the reader and full details of the book should be listed in the List of
References section.

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3.2.2. The List of References
This is a list of all reference sources cited in the essay used in preparation of your work.
Please try to use primary sources. Do not use too many secondary sources, (i.e. information
cited by other authors)
The list should be presented in alphabetical order with full publication details. All sources
should be listed in alphabetical order at the end of the essay section - before the
appendices.
The following examples show the key requirements for referencing books, articles,
videos/TV programs, Internet sources but all sources must be listed in alphabetical order as
stipulated above.
Books:
Author/s, Initials, Date, Name of book, Publisher, Place of publication.
Articles:
Author/s, Initials, Date, Name of article, Name of journal, Volume number, Issue number,
Pages.
Videos/TV programmes:
Producer/TV company, Date of transmission or production, Name of programme, Channel
(if appropriate).
Internet sources / web pages:
Author/Editor’ name(s); date of publication on the web; title of the web page not the domain
or company name; Publisher (eg The Health Development Agency); Universal Reference
Location (full details of the web address on the relevant page not the generic web area); the
date you accessed the web page (URL).

19