On November 3-4 AIDS Foundation East-West (AFEW) in partnership with Knowledge Action Change hosted a major international conference dedicated to engaging diverse communities in urban health and wellbeing. This is the 3rd City Health Conference, which has proved to be a good platform to move away from a focus on single urban issues and explore the cross-sector approaches and interventions to deal with city health concerns.
It is no coincidence that Amsterdam was chosen to host the 3rd City Health Conference. It is home to vibrant and diverse communities of families, young people, migrants, people who use drugs, sex workers and prisoners, and since the 1980’s Amsterdam has led the way in experimenting with creative interventions to respond to the spread of HIV.
The topics of discussion ranged from micro-level issues such as involving local communities into urban healthcare and safety to macro-level challenges including environment and city planning faced by policy makers and city officials to ensure sustainable urban development. Nearly 150 healthcare specialists, prison experts, policy makers, civil servants, community representatives, researchers and academics from a number of countries presented opportunities for innovative interventions. Among the most prominent guests were Michel Kazatchkine – UN special envoy on HIV/AIDS in Eastern Europe and Central Asia and Dr. Manuel Carballo from International Centre for Migration, Health and Development (Switzerland) who held a lecture on migration and urbanisation.
The Conference consisted of panel discussions and parallel sessions divided into several topics.
PRISON HEALTHCARE: THE DUTCH APPROACH
This parallel session included three presentations on effective through and aftercare for prisoners (as well as their family members and friends) and reduction of repeat offenses by providing social support (employment, housing, financial guidance) after release. Erik Masthoff representing a prison in the Dutch town of Vught, told that thorough research of a prisoner’s background, current needs and health problems has contributed to a decrease in the number of sentences.
“We consider health problems as a risk factor for future criminal behaviour, that’s why it is important to treat a prisoner inside, but most importantly – follow the principle of equivalence of healthcare inside the prison and outside,” Mr. Masthoff said.
Some quick facts about Dutch prisons that were surprising to conference participants from countries in Eastern Europe and Central Asia. Such facts include:
- 82 detainees / 100.000 general population / year (in the U.S. 716 detainees and in Russia over 600 detainees);
- 29 prisons (multiple locations);
- Duration of detention: 50% are released in less than 1 month; 43% are released within 12 months; 7% serve more than 1 year;
- Prisoners make use of innovative technology to improve their health: touch-screen computers with health tests and educational modules.
At the same time there is high prevalence of somatic and psychiatric disorders among prisoners with up to 70% suffering from psychiatric disorders including substance abuse or addiction.
In conclusion, Erik Masthoff highlighted a few points based on the experience of the Netherlands: without continuity of care, penitentiary treatment has little impact, and a crucial factor in providing effective healthcare in the prison system is the role of staff. Improving their knowledge, skills and attitude is a wise investment, he said.
“These presentations proved to me that our penitentiary system is standing on the right track, though we are far from such results,” said Sergo Chikhladze from NGO “Tanadgoma” (Tbilisi, Georgia). “It is very interesting to get European experience and see how members of communities participate in the protection of their own rights.”
Other sessions discussed health literacy through innovative technology and social media, mobile phones and digital story telling platforms to reach out to key populations and improve understanding.
AFEW’s Iryna Nerubaieva shared the experience of AFEW in Ukraine in building networks to help at-risk adolescents gain access to social and medical services. Through the system of client management, AFEWand its partners reach out to 2413 young people in four cities in Ukraine, providing them social and medical help. According to UNICEF data, there are nearly 85,000 at-risk adolescents in Ukraine. The plan is to promote the social bureau model and case management approach as effective tools in building networks to ensure access and provide quality services to clients. In addition, in 2015 AFEW plans to host a conference on best practices to work with vulnerable youth and advocate for prioritising the issues of most-at-risk adolescents in the healthcare policy of Ukraine.
The City Health Conference was widely represented by many city officials around the world. The Mayor of Almere in the Netherlands who is also the Board chairman of Association of Dutch Municipalities,Annemarie Jorritsma, spoke about the role of city leaders in ensuring health and well-being for all residents.
“One key conclusion I drew for myself is that city health is more than just good nutrition and availability of sports facilities. Good city health also depends on environment, city infrastructure and even architecture – when a visitor entering a building first sees the stairs, not the elevator, which he’d naturally choose,” said Lidiya Muhamedshina from Bishkek (Kyrgyzstan) City Hall.
Her colleague from Tbilisi (Georgia) City Hall Gela Chiviashvili, on the contrary, was interested in making the life of handicapped people, especially children, more comfortable.
“It is our priority at the moment since Georgia as an associate member of the EU pledged to ensure easy access to buildings for disabled people,” Mr. Chiviashvili said at the Conference.
“These have been inspirational two days,” said Fatemah Rabiee-Khan from Birmingham City University. According to Michel Kazatchkine, health has become global and it has to be seen different from traditional doctor-to-patient vertical approach.
“Health governance has to be based on science and evidence; it needs experts in the debate. It has a value: equity and human rights – the basis that drives the aspirations for health governance,” Mr. Kazatchkine said.
All of the conference materials, including the presentations of speakers, are available at site. The next City Health Conference will take place on 5-6 November in Barcelona, Spain.
