Background: Many adults do not take recommended amounts of physical activity (PA). This is associated with adverse health outcomes such as obesity, overweight, diabetes and heart disease. Moreover, physical inactivity is socially patterned. People with lower socioeconomic status or who live in more deprived areas do less PA which may in turn contribute to inequalities in health outcomes. Identifying the causes and possible pathways for increasing PA and addressing health inequalities is a pressing national and international priority. There is increasing evidence that features of the built environment (BE) can support physical activities such as walking. The built environment may also ameliorate health inequalities by providing a supportive context for walking across diverse sections of the population. However, there is little evidence relating to the UK and Scottish context or about inequalities in these associations for different groups such as people with different demographic characteristics or people living in areas with different levels of deprivation. This study aimed to fill this knowledge gap, examining associations between built environments and walking in urban Scotland. It considered individual and spatial inequalities in these relationships. Methods: This study had a quantitative cross-sectional design. Geographical Information Systems (GIS) was used to create neighbourhood level BE measures of Area Walking Potential (AWP) across urban Scotland. These were destination accessibility, street connectivity, residential density and walkability (a composite measure of the former three measures). An examination of the distribution of AWP across Scotland and in relation to area deprivation was made. The measures were then appended to individual level walking data for adults aged 19+ years from the 2010 Scottish Health Survey. Regression analysis tested for associations between the AWP measures with four different walking outcomes: any walking, frequency of walking, achieving 30 minutes of walking per day and total minutes walked in the previous week. Individual and area level confounders were controlled for. Associations were examined using two sizes of neighbourhood area: 500m and 1000m zones around residential centres. Interactions with individual demographic, socioeconomic, household characteristics and area deprivation were evaluated. Results: There was modest evidence of positive associations between AWP and walking. After controlling for covariates, destination accessibility showed the strongest associations with frequency of walking. There were limited associations for street connectivity and walkability and no associations between residential density and walking. Positive associations remained for some groups less likely to walk, such as older adults. However, there were also interaction effects showing inequalities in associations between AWP and walking. In particular, people with lower educational attainment were less influenced by AWP. The spatial analysis showed areas with lowest deprivation had lowest AWP although people in more deprived areas walked less overall. Conclusions: There is some evidence that the BE supports some types of walking in Scotland. The BE may also enhance walking opportunities for certain groups who generally walk less, and therefore could potentially reduce inequalities in health outcomes. However, the socioeconomic inequalities in outcomes suggest multifaceted approaches to increasing walking are more likely to reach all sections of the population. The evidence that there are geographic inequalities in levels of AWP can be used to inform geographically targeted interventions aimed at improving walking environments. This research has generated original evidence in the Scottish context, highlighting the importance of context specific research.

Made available in DSpace on 2015-05-14T12:09:23Z (GMT). No. of bitstreams: 1 parte1.pdf: 1872538 bytes, checksum: 7e0cb6b9859e245152edac2657e4acb7 (MD5) Previous issue date: 2005-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Taking from the Brazilian Regulatory Standards NR 15 - Health and Safety at work, NBR 10151/1987 - Assessment of noise in residential areas to the comfort of the community - procedure, NBR 10152/2000 - Noise level for acoustic comfort, NBR 15220 - Thermal performance of buildings of Resolution RE No. 9 from January 16th 2003 - ANVISA on a reference to standard quality of the air inside indoor environments in artificially conditioned use of public and private as well as The technical regulation of the quality for efficiency energy services in commercial and public buildings, Annex to Decree No. 53/09 from INMETRO as a tool for evaluating energy efficiency, considered to be the Hospital Memorial São Francisco HSMF, facing the energy implications arising from its insertion into the urban network of the city of João Pessoa and it was concluded that in the hospital s planning, both in the choice of area of deployment and in the architectural design of the project, were not considered specific features of their surroundings, as well as basic principles of both thermal comfort, acoustic and olfactory breathing as the energy consumption. / Utilizando-se das Normas Brasileiras Regulamentadoras NR 15 - Segurança e Saúde do trabalho, NBR 10.151/1987 - Avaliação do ruído em áreas habitadas visando ao conforto da comunidade procedimento, NBR 10.152/2000 - Nível de Ruído para conforto acústico, NBR 15.220 - Desempenho térmico de edificações, da Resolução RE n° 9 de 16 de Janeiro de 2003 - ANVISA , sobre padrões de referência da qualidade do ar de interiores em ambientes climatizados artificialmente de uso público e privado, assim como do Regulamento técnico da qualidade para eficiência energética dos edifícios de serviços, comerciais e públicos, anexo da portaria INMETRO n° 53/09, como instrumento de avaliação de eficiência energética, analisou-se o Hospital Memorial São Francisco HSMF, frente às implicações energéticas decorrentes de sua inserção na malha urbana da cidade de João Pessoa, tendo-se concluído que no seu planejamento, tanto na escolha da área de implantação quanto na concepção do projeto arquitetônico, não foram consideradas características específicas do seu entorno, assim como princípios básicos tanto de conforto térmico, acústico e olfativo respiratório quanto de consumo energético.

O saneamento ambiental é um dos mais importantes meios de prevenção de doenças, mas infelizmente não é uma realidade em todos os setores da população, gerando uma situação preocupante para os profissionais de Saúde Pública.A problemática relativa à saúde e meio ambiente revela-se particularmente importante para as pessoas que vivem em favelas, ficando expostas a possíveis riscos de contaminação, devido à carência de infra- estrutura de saneamento. Neste estudo, de caráter descritivo-exploratório, utilizou-se métodos quali-quantitativos de investigação, visando o diagnóstico das condições da água para consumo humano em uma favela do município de Ribeirão Preto-SP, considerando-se a forma para obtenção e armazenamento da água, bem como a percepção dos moradores sobre a relação água e saúde. Foram realizadas entrevistas semi-estruturadas com 14 sujeitos, em seus domicílios, representando 24,5% das 57 moradias existentes, tendo sido ordenadas utilizando-se o Discurso do Sujeito Coletivo. Também foi realizada análise bacteriológica de 20 amostras de água provenientes do local de estudo. Paralelamente foi feito um levantamento dos prontuários médicos dos moradores dos 14 domicílios incluídos na investigação. Os discursos, montados a partir das falas das entrevistadas, revelaram que, apesar de parte dos moradores ter consciência sobre a importância da qualidade da água para a saúde humana, ainda utilizam a captação clandestina e o armazenamento inadequado, do ponto de vista sanitário, o que, provavelmente pode ser o fator impactante que interfere na qualidade da água disponível na área do estudo. O resultado da análise bacteriológica indicou a contaminação por coliformes em 25% das amostras analisadas e dentre os parasitas detectados nos exames parasitológicos de fezes, destacam-se Enterobius vermicularis e Ascaris lumbricoides, presentes em 54,5% dos 11 exames realizados. Consideramos importante o planejamento de ações, em conjunto com os profissionais de saúde e a população, que favoreçam a conscientização dos moradores em relação à melhoria das condições de saúde a partir de medidas simples para o manuseio e armazenamento da água, visando não só a prevenção de doenças infecto-parasitárias, mas também melhores condições de higiene e bem estar, mesmo que essas ações sejam limitadas pela precariedade da situação que enfrentam em seu cotidiano. / Environmental sanitation is one of the most important means of illness prevention but, unfortunately, it is not a reality in all sectors of the population, which creates a preoccupying situation for Public Health professionals. The health and environmental problem reveals to be particularly important for those people living in slums, who are exposed to possible contamination risks due to the lack of environmental sanitation infrastructure. In this descriptive and exploratory study, qualitative and quantitative research methods were used with a view to diagnosing the conditions of water for human consumption in a slum of Ribeirão Preto-SP, considering the form of obtaining and conserving water, as well as the inhabitants perception about the relation between water and health. Semi-structured interviews were made with 14 subjects, at their homes, representing 24.5% of the 57 existing residences; interviews were organized by means of the Collective Subject Discourse. Also a bacteriological analysis was realized in 20 samples of local water. In parallel, a surveyed the medical files of the inhabitants of the 14 residences included in the research. The interviewees’ discourse revealed that, although part of the inhabitants is aware of the importance of water quality for human health, they still use illegal captation and inadequate storage from the sanitary viewpoint, which may probably be the factor of impact that interferes in the quality of available water in the studied area. The result of a bacteriological analysis indicated the contaminacion by total coliforms in 25% of the analyzed samples and among the parasites detected in the parasitological faeces tests, Enterobius vermicularis and Ascaris lumbricoides stand out, which were present in 54.5% of the 11 tests that were realized. We consider it important to plan actions, together with the health professionals and the population, which favor the inhabitants’ becoming aware of the improvement in health conditions on the basis of simple measures for treating and storing water, not only with a view to the prevention of infectious-parasital diseases, but also to better hygiene conditions and well-being, even if these actions are limited due to the precarious situations they face in their daily life.

INTRODUÇÃO: A urbanização em bacias hidrográficas contribui para a eutrofização antrópica dos seus corpos d´água, propiciando proliferações de algas tóxicas como as cianobactérias. Existe um padrão característico de sazonalidade nas florações de algas e comunidades de cianobactérias, embora estas algas possam estar presentes ou mesmo dominantes, na maior parte do ano, trazendo problemas práticos associados à elevada biomassa de cianobactérias e potenciais ameaças à saúde pelo aumento de toxinas. A hipótese desta tese é de que as variações do tempo e do clima podem influenciar a qualidade da água de abastecimento ao propiciar florações das algas tóxicas, cianobactérias, que geram toxinas dificilmente filtradas pelos mecanismos comuns, gerando um problema de saúde pública que pode ser agravado com as mudanças climáticas conjuntamente o fenômeno de urbanização crescente nos países de economia emergente. OBJETIVO: O objetivo deste estudo foi investigar qual a influência do tempo e do clima na qualidade da água de abastecimento público de bacias urbanizadas através do indicador de algas tóxicas chamadas cianobactérias. MATERIAL E MÉTODOS: Para tanto investigou-se em primeiro lugar qual o contexto das proliferações de cianobactérias em reservatório de abastecimento público e suas consequências bem como qual o estado da arte sobre a qualidade da água de reservatórios eutrofizados em bacias urbanizadas, foi elaborado um mapeamento bibliográfico para saber qual a extensão do problema e do que se sabe a respeito. E, por fim, correlacionou-se a influência do tempo e do clima na qualidade da água para abastecimento no caso da bacia urbanizada da Represa Guarapiranga, localizada ao sul da Cidade de São Paulo, com vistas à previsibilidade e prevenção do fenômeno das florações das cianobactérias. RESULTADOS E DISCUSSÃO: Chegando-se a conclusão de que a pressão antrópica e o uso do solo são um fator determinante para a eutrofização de reservatórios de abastecimento e que, por tanto, bacias hidrológicas ocupadas pelo espraiamento urbano são particularmente propensas a apresentar reservatórios de água contaminados com algas toxicas, ao mesmo tempo que são as mais visadas para abastecer a população em seu entorno. O mapeamento bibliográfico mostrou que a proliferação de cianotoxinas em reservatórios eutrofizados é prevalente em diferentes latitudes e climas. A modelagem de correlação teve sucesso em explicar de 16% à 30% das florações na Guarapiranga de acordo com episódios de Irradiação e de precipitação pluviométrica, sendo resultados coerentes com a literatura, embora sejam baixo para gerar um modelo preditivo. CONSIDERAÇÕES FINAIS: A pressão antrópica da urbanização de bacias hidrográficas sem planejamento ou infra-estrura sanitária se mostrou uma questão de Saúde Pública e Saúde Urbana. As florações de cianobactérias se apresentaram como fenômenos presentes em diferentes latitudes, climas e graus de organização do espaço, mostrando assim serem uma questão global de saúde pública. A modelagem para o caso de São Paulo resultou em valores de explicação insuficientes para gerar um modelo preditivo do fenômeno das florações, evidenciando o sistema complexo de interação ambiente-ocupação humana-uso do solo- clima, exigindo assim que sejam acrescentadas demais variáveis ao modelo. / INTRODUCTION: Urbanization in hydrographic basins contributes to the anthropic eutrophication of their water bodies, propitiating toxic algae proliferation such as cyanobacterias. There is a characteristic pattern of seasonality in algae blooms and cyanobacteria communities, although theses algae may be present or even dominant during most part of the year. They cause practical problems associated with high biomass volumes, and potential health threats by the rise of toxins. This thesis\' hypothesis is that weather and climate variations can influence the quality of drinking water supply, because toxins are hardly filtered by ordinary mechanisms. The problem can be aggravated by climate change conjointly with the rapid widespread of urbanization in low and middle income countries. OBJECTIVE: This study\'s aim was to investigate the influence of weather and climate variables on the quality of water from the public drinking water supply system of an urbanized watershed through the indicator of toxic algae - denominated cyanobacterias. MATERIALS AND METHODS: First, the cyanobacterias\' blooms in eutrophic reservoir and its\' consequences, was studied by literature review and by an exploratory analysis of monthy weather varables and cyanobacterias data. Secondly, a bibliographical mapping review was drafted in order to know the extension of the problem and what is known regarding it. Finally, data of weather and climate were correlated with the quality of supple water of the, Guarapiranga reservoir, located on the south of São Paulo metropolitan area, acknowledging predictability and prevention of the phenomenon of cyanobacteria bloom. FINDINGS AND DISCUSSION: The conclusion was that the anthropic pressure and land use are determinant factors to the eutrophication of supply reservoir and, therefore, hydrological basins occupied by urban sprawling are particularly at risk of presenting water reservoirs contaminated with toxic algae. They are the most targeted to supply water to their neighbor population. The bibliographic mapping showed that the proliferation of cyanotoxins in eutrophized reservoirs is prevalent in different latitudes and climates. The correlation modeling was successful in explaining 16% to 30% of blooms in Guarapiranga according to episodes of irradiation and low precipitation, matching results found in literature, although they are low for the creation of a predicative model. FINAL CONSIDERATIONS: The anthropic pressure of urbanization on hydrographic basins without planning or sanitary infrastructure guidelines was shown to be a matter of public and urban health. Cyanobacterias\' blooms was shown to be a phenomena present in different latitudes, climates and degrees of space organization, proving to be a matter of global public health. The modeling for the case of São Paulo has resulted in insufficient explanation values to generate a predictive model of the phenomena of flowering, indicating the complex interaction system involving environment, human occupation, land use and climate, and demanding that more variables be acknowledged in the model.

Previous studies have suggested that health care workers may differ with respect to universal precautions knowledge, compliance, practice setting barriers, or exposure to patient body fluids in rural and urban areas. The purpose of this study was to determine whether or not there are rural/urban differences in the degree of precaution taken by health care workers to prevent the spread of blood borne pathogens, specifically human immunodefiency virus (HIV) and hepatitis B virus (HBV). A random sample of rural and urban registered and licensed practical nurses in Tennessee was surveyed. The respondents completed two instruments that assessed self‐reported universal precautions knowledge, precautions, and practice barriers. No measurable differences in universal precautions knowledge, compliance, or barrier scores between the two groups were found; yet rural nurses were 2.7 times as likely to be exposed to patient body fluids than urban nurses (P<0.005). The conclusion was that rural nurses were as experienced and as knowledgeable about universal precaution techniques as their urban peers, but their knowledge was not translated into practice to the same degree. Two possible explanations offered are (1) rural nurses are more likely to be acquainted with, and thus trusting of, their patients, and (2) the lower seroprevalence of human immunodefiency virus and hepatitis B virus in rural areas may lead to complacency.

Methamphetamine abuse is a growing global health concern. Cardiovascular disease is the leading cause of death in methamphetamine users because of its significant effects on vasoconstriction, pulmonary hypertension, atherosclerotic plaque formation, cardiac arrhythmias, and cardiomyopathy. Stimulants like methamphetamine and cocaine are known to induce severe coronary vasospasm resulting in angina and myocardial infarction (MI), but MI secondary to methamphetamine-induced coronary thrombosis is rarely reported. A 40-year-old female with medical history of immune thrombocytopenia s/p splenectomy, NSTEMI, tobacco and substance abuse presented to the hospital via EMS in an unresponsive state. Patient was admitted to the hospital 20 days before the current episode with complaints of chest pain and was diagnosed with NSTEMI due to troponin elevation without EKG changes; Echocardiogram at that time showed a left ventricular ejection fraction (LVEF) of 55-60% without any other abnormalities. Coronary angiography at that time was unremarkable except for mild luminal irregularities of the left anterior descending (LAD) artery. The patient’s symptoms resolved and was discharged home with a diagnosis of COVID-induced MI with nonobstructive coronaries. During the current episode, the patient started having crushing substernal chest pain radiating to left shoulder and associated with dizziness. She suffered cardiac arrest on the way to the hospital but was successfully resuscitated. EKG revealed anterior STEMI and the patient was loaded with aspirin. Emergent coronary angiography showed 100% occlusion of proximal LAD, while other coronaries were completely patent without any atherosclerotic plaque. A successful mechanical thrombectomy followed by a 4 x 28 mm drug-eluting stent was placed in the ostial-proximal LAD. TIMI-3 flow was restored and post-intervention troponin peaked at 70. Urine drug screen was positive for amphetamines and benzodiazepines. The echocardiogram showed a reduced LVEF of 30%. Patient was started on dual antiplatelet therapy with aspirin and ticagrelor, rosuvastatin, and low-dose metoprolol tartrate; further guideline-directed medical therapy could not be initiated due to patient’s low blood pressure. Hypercoagulability workup was negative for any abnormalities. As other usual causes were ruled out, the patient was deemed to have methamphetamine-induced coronary thrombosis resulting in myocardial infarction, and cardiomyopathy. Discussion Amphetamines are potent sympathomimetic agents that increase the risk of MI through various cardiovascular effects. Elevated serum catecholamines lead to increased heart rate, and blood pressure resulting in increased myocardial oxygen demand, while also inducing coronary vasospasm which can limit myocardial oxygen supply. Furthermore, in-vitro studies have shown amphetamines are prothrombotic as they can induce tissue factor (TF) expression, activate endothelial cells, and inhibit the activity of tissue factor pathway inhibitor (TFPI). They also increase the expression of plasminogen activator inhibitor-1 (PAI-1), a key fibrinolysis suppressant. In contrast to cocaine, amphetamines can induce thrombosis even in a non-inflamed endothelium, affecting even young individuals without atherosclerotic risk factors. These cumulative procoagulant effects may result in coronary artery thrombi as seen in our patient, which combined with other adrenergic effects, poses a significant risk for acute coronary events.

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published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2006. / Typescript. Includes bibliographical references (leaves 188-199). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

PhD, Unversity of the Witwatersrand, Faculty of Health, School of Public Health / Rationale Understanding how to ensure and sustain the health and health equity of urban populations is of increasing importance as over half of the world population is now urban (UNFPA, 2007). Urbanisation is taking place rapidly across Africa, with fifty percent of the continent expected to be residing in urban areas by 2030 (UNFPA, 2007). South Africa has experienced a faster rate of urbanisation compared to neighbouring countries, with almost sixty percent of the population estimated to be urban (Kok & Collinson, 2006). This process of urban growth is accompanied by in-migration from within the country and across borders. Urban growth places pressure on limited, well-located and appropriate housing, resulting in the development of informal settlements within and on the periphery of urban areas. In addition to the multiple exposures to a variety of health hazards in informal settlements, HIV presents a contextual challenge, particularly in South Africa where the highest HIV prevalence is found within urban informal settlements (Shisana, Rehle, Simbayi, Parker, Zuma, Bhana et al., 2005). South African local government has a ‘developmental mandate’ which calls for government to work with citizens to develop sustainable interventions to address their social, economic and material needs (The Republic of South Africa, 1998a). This requires local government to address the challenges of urban growth, migration, informal settlements and HIV, as outlined above (Bocquier, 2008; Landau & Singh, 2008; Landau, 2007). The current (2007 – 2011) South African National Strategic Plan (NSP) for HIV signalled a welcome shift in HIV policy, with recognition of the role of government in ensuring that (1) internal and cross-border migrant groups and (2) residents of informal settlements are able to access the continuum of HIV-related services, which includes prevention, testing, support, treatment, and access to basic services. However, guidelines are lacking to assist local government in addressing HIV-related concerns with migrant groups and in informal settlements at the local level. As a result, migrant groups and residents of informal settlements struggle to access HIV-related services, including healthcare, adequate housing, and basic services such as water, sanitation and refuse removal. Given the developmental mandate of local government in South Africa (The Republic of South Africa, 1998a), this raises the question: how should local government respond to the urban challenges of migration and informal settlements in the context of high HIV prevalence? This thesis explores how the challenges of migration and informal settlements – within a context of high HIV prevalence – interact to generate a specific urban reality that requires an appropriate urban health response at the local government level. The question of how to address the gap between discourse, theory and action is tackled. Various frameworks for urban health have been developed that aim to assist in understanding the impact of city living on urban health, several of which draw on the concept of the social determinants of urban health (SDUH) (for example Galea, Freudenberg, & Vlahov, 2005; WHO, 2008b, 2008a). However, as I will go on to argue, none of the existing urban health frameworks deal adequately with the specific complexities of developing country urban environments. In particular, the frameworks have failed to adequately account for guiding local government in responding to the challenges identified above, namely: urban growth and informal settlements; internal and cross-border migration; high HIV prevalence; and, the responsibilities of a developmental local government. Aim Based on the findings from four studies, this PhD research aims to generate a revised urban health framework that will address the following specific challenges that I argue are associated with developing country contexts: (1) urban growth and informal settlements; (2) internal and cross-border migration; (3) high HIV prevalence; and, (4) the responsibilities of developmental local government. It is proposed that this revised framework will assist local government in responding to the interlinked challenges of informal settlements and migration in a context of high HIV prevalence. Methods A series of four studies were undertaken in Johannesburg. A review of international and local literature – including existing policy – was undertaken. In order to engage with the complexity of the urban environment, the four studies draw on both quantitative and qualitative methods. These include: a cross-sectional household survey across Johannesburg inner-city and one urban informal settlement (n = 487); a cross-sectional survey with ART clients at four ART sites in the inner-city (n = 449); and semi-structured interviews with community health worker volunteers, healthcare providers, local level policy makers and programmers involved with urban health and HIV in Johannesburg. By reflecting on involvement in participatory photography and film projects, the experiences of rural migrants who enter the city through ‘hidden spaces’ are examined; the concept of ‘being hidden’ is explored as a tactic employed by marginalised groups so that they are able to find a way to enter and participate in the city. Through the four studies, a series of four central themes were identified: (1) rights to the urban social determinants of health; (2) urban livelihoods; (3) policy and governance; and (4) urban methodologies. These four themes assist in synthesising the study findings and generating a revised approach to guide local government in responding to urban health challenges in a developmental way. Key findings The developmental mandate of local government is evolving very slowly (Paper I, V). Local level responses to the interlinked urban health challenges of migration, informal settlements and HIV are lacking (Paper I, V). Where they do exist, HIV is not viewed as an intersectoral developmental challenge and vertical HIV programmes prevail (Paper V). It will be argued that informal settlements require integrated local developmental responses (Paper V). In general, policies and guidelines that outline the right to basic healthcare and ART for crossborder migrants are not implemented at the local level (Papers I and III). In addition, residents of informal settlements struggle to access adequate housing and basic services (Papers IV and V). Some internal migrant groups, who reside in ‘hidden spaces’ of the innercity, are found to employ deliberate tactics in order to evade the state, whilst others are marginalised through a lack of state intervention (Paper II). The research shows that innovative methods are required to engage with urban populations, both for research and intervention purposes. Participatory approaches are found to be useful methods for engaging with urban migrant groups and this research draws on participatory photography and film projects as examples (Paper II, V). It is essential that urban public health practitioners and other development professionals learn how to engage with the complexities of the urban environment. A review of existing urban health frameworks finds that whilst these frameworks are themselves complex, and include the multiple levels and determinants that ultimately impact health outcomes, they result in generalised and static models of urban health. I argue that these existing frameworks are unable to inform responses to the specific complexities present within a particular urban context. Through the synthesis of the four study findings, an alternative approach to assist local government and other stakeholders in responding to urban health challenges is proposed. The idea of ‘concept mapping’ is suggested as a way to vii enable local government, and other actors, to engage with the complexities of the urban context in a participatory way. A core set of components have been identified that can be used to guide the creation of city-specific ‘concept maps’, that are able to work towards identifying and addressing the specific urban health needs associated with different areas within a city. A recommitment to intersectoral action, ‘healthy urban governance’ and public health advocacy is considered critical to the effectiveness of such an approach. It is suggested that the resultant ‘concept map’ will assist local government in responding in a developmental way to the interlinked challenges of migration and informal settlements in a context of high HIV prevalence. Implications Based on the findings of the PhD research, a new approach to urban health is suggested. ‘Concept mapping’ is presented as a new tool to assist local government in achieving its developmental mandate and address urban health. Whilst developed to address the challenges faced by urban migrants and residents of informal settlements in a context of high HIV prevalence, the concept map approach is likely to be a useful tool for considering the health and development needs of other urban groups. Future research is needed to evaluate the effectiveness of the application of participatory ‘concept mapping’ to assisting local level urban health policy makers, planners, and other stakeholders respond to the interlinked challenges of migration and informal settlements in a context of HIV.