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Background The social-ecological systems theory, with its unique conception of resilience (social-ecological systems & resilience, SESR), provides an operational framework that currently best meets the need for integration and adaptive governance as encouraged by the Sustainable Development Goals. SESR accounts for the complex dynamics of social-ecological systems and operationalizes transdisciplinarity by focusing on community engagement, value co-creation, decentralized leadership and social innovation. Targeting Social Innovation (SI) in the context of implementation research for vector-borne diseases (VBD) control offers a low-cost strategy to contribute to lasting and contextualized community engagement in disease control and health development in low and middle income countries of the global south. In this article we describe the processes of community engagement and transdisciplinary collaboration underpinning community-based dengue management in rural primary schools and households in two districts in Cambodia. Methods Multiple student-led and community-based interventions have been implemented focusing on empowering education, communication for behavioral change and participatory epidemiology mapping in order to engage Cambodian communities in dengue control. We describe in particular the significance of the participatory processes that have contributed to the design of SI products that emerged following iterative consultations with community stakeholders to address the dengue problem. Results The SI products that emerged following our interaction with community members are 1) adult mosquito traps made locally from solid waste collections, 2) revised dengue curriculum with hands-on activities for transformative learning, 3) guppy distribution systems led by community members, 4) co-design of dengue prevention communication material by students and community members, 5) community mapping. Conclusions The initiative described in this article put in motion processes of community engagement towards creating ownership of dengue control interventions tools by community stakeholders, including school children. While the project is ongoing, the project’s interventions so far implemented have contributed to the emergence of culturally relevant SI products and provided initial clues regarding 1) the conditions allowing SI to emerge, 2) specific mechanisms by which it happens and 3) how external parties can facilitate SI emergence. Overall there seems to be a strong argument to be made in supporting SI as a desirable outcome of project implementation towards building adaptive capacity and resilience and to use the protocol supporting this project implementation as an operational guiding document for other VBD adaptive management in the region.

To reduce the burden of chronic disease, the Centers for Disease Control and Prevention (CDC) funded the Orange County Partnerships to Improve Health (OC-PICH) project in Orange County, California. One of the strategies included adding outdoor exercise equipment (OEE) in two parks in Garden Grove and Anaheim. Using a quasi-experimental pre-post design, we evaluated park users&rsquo, physical activity levels before and after OEE installation using the System for Observing Play and Recreation in Communities (SOPARC). The OEE was installed along a walking path in Edison Park (Anaheim) and grouped within a single area (a &ldquo, fitness zone&rdquo, ) in Garden Grove Park. In both parks, there were significantly greater odds of high-intensity physical activity overall after the installation&mdash, 19% higher odds in Anaheim, and 23% higher odds in Garden Grove. However, the fitness zone area in Garden Grove had substantially higher odds of increased physical activity post-intervention (OR = 5.29, CI: 3.76&ndash, 7.44, p &lt, 0.001). While the increases in physical activity levels are consistent with past studies that link OEE to higher levels of physical activity among park users, our findings also suggest that the location and placement of equipment within a park may be an important factor to consider when improving park amenities for physical activity.

This issue of the journal is devoted to the social determinants of health in urban settings and associated interventions that protect health and promote health equity. The great disparity in health opportunities and health status between and within different population groups in and between countries at different economic development levels is one of the great challenges for the global community at the beginning of the 21st century. The international community debated the issues of poverty, economic development, and health at a number of major summits toward the end of the 20th century, including the Rio Earth Summit in 1992 and the Copenhagen Social Summit in 1995. However, without specific targets or agreed dates for achieving those targets, progress on social and health equity was insufficient. One major reason was the lack of financial resources because of the noncompliance of affluent countries with the agreed aid target of 0.7% of their GDP. At the turn of the century, the international community took up the challenge of achieving better equity by formulating the Millennium Development Goals at the Millennium Summit in 2000, many of which include priority health issues. Progress is visible for some of the goals, but not enough for them to be met by the target year: 2015. The targets address the needs of the poorest people, but economic and social inequities and associated health inequities remain. It should also be remembered that the Universal Declaration on Human Rights, which almost all countries have signed, expressly states that all people have a right to live in conditions that promote health and protect life.

The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) has posed a provocative question for public health: “Why do we keep treating people for illnesses only to send them back to the conditions that created illness in the first place?”1 For the WHO Centre for Health Development (WHO Kobe Centre), hub of the Commission’s Knowledge Network on Urban Settings (KNUS), this represents a challenge to the public health sector not only to acknowledge the pervasiveness of urban poverty as a critical pathway to ill health and health inequities, but to address this as an urgent public health issue affecting a billion people living in informal settlements, or “slums.”1 People who live in informal settlements are often systematically excluded from opportunities, decent employment, security, capacity, and empowerment3 that would enable them to gain better control over their health and lives. As noted in the Interim Report by the Millennium Development Goals (MDG) Task Force, which focuses on improving the lives of urban slum dwellers: Much of urban poverty is not because of distance from infrastructure and services but from exclusion. They are excluded from the attributes of urban life that remain a monopoly of a privileged minority—political voice, secure good-quality housing, safety and the rule of law, good education, health services, decent transport, adequate incomes, access to goods and services, credit—in short, the attributes of full citizenship.4 The issue of urban poverty is not new, but it is often narrowly viewed as an economic issue that is best addressed by economic policies and interventions. Urban poverty today, as driven by globalization and rapid uncontrolled urbanization, also needs to be recognized as a social, political, and cultural process that has profound impacts on public health. Exclusion of the urban poor from the benefits of urban life fosters discontent and political unrest. Within the broader context of health and human development, rapid urbanization of poverty and ill health have been characterized as a new human security threat.5 Rapid uncontrolled urbanization results from the interaction between global and local forces. The interconnectedness of cities through trade, business, industry, tourism, international travel, information technology, and media is reshaping social determinants of health that are manifest at the city level. On the other hand, local and national governance capacity in relation to health systems, housing, transport, property rights, migration, land use policy, working conditions, and employment may be unable to cope with the speed of change brought about by global economic restructuring. Inequity in cities that leads to urban poverty, and poor health, therefore, are also products of global and local forces in the urban setting. Public health can play an important role in ameliorating urban poverty through social processes (participation, social capital, social accountability, and social inclusion) that influence urban governance at multiple nodes6 of power. Addressing urban poverty as an urgent public health issue opens a policy space for fairer health opportunities and healthier and more equitable cities.