بررسی و تحلیل متغیرهای حق به سلامت شهری (مطالعۀ موردی: شهر بجنورد)

نوع مقاله: پژوهشی - کاربردی

نویسندگان

1 دانشجوی دکتری جغرافیا و برنامه‌ریزی شهری دانشگاه تهران

2 دانشیار جغرافیا و برنامه‌ریزی شهری دانشگاه تهران

3 استاد جغرافیا و برنامه‌ریزی شهری دانشگاه تهران

4 استادیار جغرافیا و برنامه‌ریزی شهری دانشگاه تهران

چکیده

حق به سلامت یکی از اساسی‌ترین و مهم‌ترین حقوق شهروندان در شهر است که بسیاری از گزارش‌ها، منشورها، قوانین، رویکردها و نظریه‌های جهانی بر آن تأکید دارند. در حق به سلامت شهری تأکید می‌شود هرکس با هر ویژگی، نگرش و پایگاه اقتصادی-اجتماعی و در هر مکانی از شهر که زندگی می‌کند، حق به سلامت کامل جسمی، روانی و اجتماعی و همچنین حق به عوامل تعیین‌کننده‌ سلامت شهری اعم از امنیت و ایمنی، تغذیة مناسب، درآمد مناسب، شغل مناسب، مسکن مناسب، آب آشامیدنی سالم، پارک و فضای سبز، هوای پاک، پیاده‌روهای قابل پیاده‌روی، حمل‌ونقل عمومی، سازمان‌های پاسخگو، قوانین سلامت‌محور، فرهنگ سالم و... دارد. با توجه به اهمیت این موضوع، در پژوهش حاضر متغیرهای حق به سلامت شهری، شناسایی و تجزیه و تحلیل شدند. پژوهش حاضر نیمه بنیادی-کاربردی و توصیفی-تحلیلی است که گردآوری و تجزیه ‌و تحلیل داده‌ها و اطلاعات آن به‌صورت کیفی-کمی صورت گرفت. گردآوری داده‌ها و اطلاعات به‌کمک روش‌های کتابخانه‌ای و پیمایشی (مصاحبه) و تجزیه و تحلیل داده‌ها و اطلاعات با استفاده از نرم‌افزار میک‌مک فازی انجام شد. براساس نتایج، 57 متغیر حق به سلامت شهری شناسایی شدند. این متغیرها در مرحلة انتخاب نهایی که به روش مصاحبة دلفی انجام شد به 31 متغیر کاهش یافتند. براساس نتایج تجزیه ‌و تحلیل اثرات که با نرم‌افزار میک‌مک فازی انجام شد، متغیرهای درآمد مناسب، آموزش و اطلاعات، عدالت اجتماعی، سلامت اجتماعی، قوانین و سیاست‌ها، فرهنگ سالم، محیط فیزیکی سالم، سلامت روان، همکاری بین‌بخشی و شرایط کاری مناسب به‌ترتیب تأثیرگذارترین متغیرها به‌شمار می‌آیند. همچنین متغیرهای سلامت اجتماعی، مشارکت در سلامت، عدالت اجتماعی، سلامت روان، سرمایة اجتماعی، امنیت و ایمنی، سلامت جسم، فرهنگ سالم و محیط فیزیکی سالم، به‌ترتیب تأثیرپذیرترین متغیرهای حق به سلامت شهری محسوب می‌شوند. براساس نتایج پژوهش، توجه اساسی به متغیرهای تأثیرگذار نقش بسزایی در تحقق و پایداری حق به سلامت شهری دارد.

کلیدواژه‌ها


عنوان مقاله [English]

An Analysis of Variables of the Right to Urban Health (Case Study: Bojnourd, Iran)

نویسندگان [English]

  • Mohammad Ahmadi 1
  • Hossein Hataminejad 2
  • Ahmad Pourahmad 3
  • Keramatollah Ziari 3
  • Saeed Zanganeh Shahraki 4
1 PhD Candidate in Geography and Urban Planning, University of Tehran, Tehran, Iran
2 Associate Professor of Geography and Urban Planning, University of Tehran, Tehran, Iran
3 Professor of Geography and Urban Planning, University of Tehran, Tehran, Iran
4 Assistant Professor of Geography and Urban Planning, University of Tehran, Tehran, Iran
چکیده [English]

Introduction
Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity. Health is the result of a complex interaction between socio-economic conditions, the natural environment and the built environment as emerging on individual and social levels.
Despite the considerable advancements in today’s healthcare, studies show the existence of a huge gap in the access to health and health outcomes. Health disparities, inequities and inequalities, especially in cities, are much sharper and deeper. In recent decades, especially in Third World countries, sectoral planning, ignoring of spatial planning and land use planning programs and paying less attention to rural areas have led to the centralization of services and facilities in cities, mass migration to urban areas and the urban rapid population growth. Rural immigrants often migrate to cities for economic reasons, such as unemployment. Due to lack of skills, literacy or capital, they are not incorporated into the formal section of the urban population and they often have to work in non-formal sectors and live in the suburbs or in non-formal regions. Lack of literacy, skills, capital, and occupation and a proper social status as well as living in the suburbs or non-formal regions are known as the most important factors leading to low levels of health and quality of life among citizens. Therefore, it can be said that urban health and urban health system can serve as key determinants of health equality and equity among citizens. Urban health includes social factors related to individual health, environmental health, healthy settlements, road traffic safety, healthy lifestyles, security, violence, food safety, appropriate recreational facilities and a sense of belonging to the community. A brief description of the current situation in Iran indicates major inefficiencies, inequalities and weaknesses in Iran’s urban health system. Therefore, it is essential to recognize the status of this system and its evaluation as well as to analyze components and variables from a pathological perspective. The study and pathology of the structure of this system can be conducted through different aspects and dimensions. However, in recent years, urban scholars have occasionally used the idea of ​​"the right to the city" in their studies. In 1967, the French philosopher and sociologist Henry Lefebvre introduced the idea of “the right to the city” in his book Le droit à la ville. In general, the right to the city means that everyone has uninhibited access to the city and its spaces and services free of discrimination based on gender, race, ethnicity, age, political or religious orientation, cultural personality or identity and social or economic status. Because of the importance of the right to urban health and the necessity of collecting and introducing its variables for measurement and presentation, the present study aims to identify and evaluate the right to urban health and its variables.
Methodology
The present study is based on a descriptive-analytical research method. The required data were collected via literature review and survey procedures (interviews). To examine the foundations, relevant articles, dissertations, books, plans and reports were collected and reviewed for the concepts and variables related to the subject. After studying the sources, 57 variables were identified for the right to urban health. For the final selection and rating of the variables, specialists and experts in the field were interviewed using the Delphi method. The interviews were conducted in two stages: In the first stage, it was conducted after the review of relevant sources and semi-structured interviews were held with experts, officials and specialists in urban and health affairs in Bojnourd city, Iran, to select the final variables. In the second stage, via three interview sessions, the experts and specialists were asked to rate the effects of each variable on each other. The results were formulated into N*N matrices.
The study population was selected via the snowball sampling method. Fifteen participants were selected and divided into two interview groups, G1 (n=7) and G2 (n=8), as calculated on the basis of expert opinions on the Delphi method and the principle of theoretical saturation. Finally, the resulting data were analyzed with the FLMICMAC software.
Results and discussion
According to the results of the study, a total of 57 variables were identified for urban health. These variables were reduced to 31 at the final stage of selection conducted with interviews using the Delphi method. The results of the analysis of the effects with the FLMICMAC software showed that the variables of proper income, education and information, social justice, social health, rules and policies, cultural health, healthy physical environments were the most influential variables, in order. The variables of social health, health engagement, social justice, mental health, social capital, security and safety, bodily health, cultural health and healthy physical environments were the most influenced variables of the right to urban health.
Conclusion
It can be stated that the right to health is one of the most basic and most important rights of citizens in the city, as it has been emphasized by numerous reports, charters, laws, approaches and world theories. The right to urban health stipulates that everyone with any attribute,  socio-economic status or location of residence is entitled to full physical, mental and social health. The determinants of health are including proper income, education and information, security and safety, proper nutrition, proper employment, proper housing, safe drinking water, parks and green spaces, clean air, walkable sidewalks, responsible organization, health-oriented laws, cultural health, and etc. According to the results of this study, the realization of the right to urban health is highly affected by the variables of proper income, education and information, social justice, social health, rules and policies, cultural health, healthy physical environments and mental health. These variables are the most critical and most effective variables that determine any changes in the right to urban health.

کلیدواژه‌ها [English]

  • The right to the city
  • urban health
  • Bojnourd
  • FLMICMAC
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