 I'd like to refer to Victor's presentation where you talk about evaluation of health systems and you suggested kind of three domains, avoidable mortality, avoidable hospitalization and access to specialty care. Isn't the area of primary prevention actually left out in terms of the, as an indices for evaluation health systems? Most primary health care do not have primary prevention activities. So how do you incorporate that into evaluation? Yes, I agree primary prevention is left out and I agree it's very important and it's left out because I don't have any indicators because primary prevention includes all of health education, includes communication of health information. It includes so much that I don't, if you have some indicators to suggest that would be a start but it wouldn't be sufficient because we wouldn't have the data. So I was very limited by the data available to share with you the importance. Sometimes it's encompassed within primary care but I realize it doesn't catch everything you mentioned. More questions? Yes, please. Thank you. My name is Goromu from UN Habitat. I think we see three different presentations so very clear the difference between the North and the South. If you take the presentation of Catherine it shows very clear in Africa the post-neonatal mortality remained high. We know that in developed countries it's usually at the neonatal level and surprisingly the child mortality where we can say in most developed countries is almost existent. It's higher than the infant mortality in most African countries. This shows very clear the environmental problems of Africa and its remain to lack of water, lack of sanitation. And so based on that UN Habitat have initiated in 2004 the monitoring urban inactive program. That monitoring program was to show very clear the African cities are not uniform because when you look at national report always they show city is better than rural but those data show very clear in some area as you can see in Kibera have mortality higher than the rural area. And I hope that in this meeting we will have opportunity to address those inequalities and probably to have a program on that. Thank you. Thank you. Thank you. Thank you. Thank you. Thanks to the African cities. Thanks to the presenters. I've got one question for Katherine and Jason. It strikes me that a lot of what is said in terms of a preventative approach and in terms of the cumulative disadvantage that was referenced boils down to questions about family life. And from Katherine's work it seems clear that within slum conditions we're talking about a radically different conception of the family and dynamics of family life. And I'm curious how much of the research is focusing on that changing dynamic and how should our understanding of the changing family relate to strategies about how we intervene. Thanks. Any comment on that? One thing that I can say about some of the research we've done shows that actually even within the slums there are huge differences. And some of the slums we've studied are characterized by the split family phenomenon and actually outcomes, especially childhood outcomes, are better. In those slums which have split families as opposed to those slums which are more where the families, there are different generations of families living in the same slums. So I think it's an important question that is being addressed at different levels. And I think it goes back to the other issue that was raised about migration. The study also shows that recent migrants, especially women and children, have worse health outcomes and the main reason is because they don't have access. They don't know yet where the different services are. So it's an issue that we are looking at in much more detail and I think perhaps it needs to be further assessed, especially regarding the more long-term effects of different intergenerational transfers of different things, whether it's genetics, whether it's disease, whether it's knowledge, whether it's resources. Yeah, just quickly. I agree that the family dynamics have a role but our work in Nairobi in particular shows that more importantly is the presence or absence of community institutions to be able to respond to family dynamic change, to advocate for power and necessary services in different ways. So it's really that institution building and the sustaining of it that allows different family dynamics to succeed or not succeed in our research. Okay, is that it? Thank you. Thank you very much. That's who you are, Sharon. Sorry, Sharon Freel. It's a question for each of the speakers, so three separate questions. To Victor, being trying to be devil's advocate, you said at the beginning somewhere between 10% and 25% of the organization of health care and I would say medical care contributes to health, should we really be investing in it? A second question, well it's a question to Jason. Jason, you made the point I think very clearly of the racial segregation being such an important contributor in terms of health inequities. In your governance work, how are you addressing the structural determinant of racism? And then a question about the NCD's explosion that Catherine mentioned in Kenya. Is the NCD's explosion, you pointed towards the nutrition transition in street foods and fast food outlets. That is arguably something that's been exported from the west, from the rich world into some of the more developing countries. How is the discourse and policy discussions happening within Kenya and within Nairobi that relates some of the processes of globalization to the health experience within cities? I don't know if we have time for three answers, but if you do it in two or three very short words, please. Victor. I can be very brief. The question was, I didn't, about the 10-25% that's attributable to medical care, what was the question? No, what? I didn't mean to say that it was not a good investment. What I was trying to say is that we need to work on many fronts at once and to the extent that health care has some impact, whether it's 10 or 25 depends on whether we include primary prevention probably. But the extent that it has some impact, I said that we should take an integrated approach and not just deal with the social determinants. On the issue of street foods, actually, it's not just globalization. In the slums, it's because for you to prepare a meal, you need fuel, you need salt, you need cooking oil, and if you have 20 shillings or 20 US cents, it's much better to buy a ready meal. So it's not so much about globalization and all that. It's just the convenience and the cost. At that point in time, it's cheaper to do that. As opposed to policy discourses, the Kenyan Noncommunicable Disease Policy I think is about one year old or less. So really not much has gone in terms of education. The issue of racism, structural racism is at the heart of our, the start of every conversation we have and needs to remain part of it. Obviously not an easy issue or easy conversation. Mayor, the Chilean mayor, yes, please. Ma'ven, un comentario, nosotros en la Comuna, a los niños que no tenían, que tenían más entrada al tema del alcohol, la droga y la violencia? He says he has a comment in reference to, in his case, in Loprado, Chile, in reference to the family dynamics of the children, the children from low income families who have problems, social problems like health, drugs, and other behavioral problems. Eran niños que no tenían una imagen adulta significativa. They were children who did not have a parental, maternal or parental image, meaningful parental, maternal image because the parents may be working, single family parents. Tampoco cuando entraban al colegio, los profesores eran una imagen que les daba sentido. And when they went to school they also saw the teachers also like an image, like an image. Y al salir del colegio después de las cuatro de la tarde y hasta las ocho de la noche estaban solos. And when they left school between four and eight p.m. they were at home alone. Tuvimos que hacer un programa de guardadoras infantiles con la propia comunidad para poder cuidarlos con afecto. So in order to solve this problem they created a problem with a nanny problem within the community to fill in this gap. Okay. Muchas gracias. Thank you very much. Well, we have seen this very different layout. It's $900 per capita a year, more than $50,000 per capita a year. I am wondering until, to which point we are comparing at the moment today now eukronial realities. That's to say, aren't we talking about Dickensioni and London today in Nairobi? And I think that that should generate some other approaches, more political. The level of unemployment in Nairobi, it's probably 60% of the population has not a real, appropriate job. Okay. Then why don't we cross all this information with employment and see what happens? Then the social condition and it's quite clear that the health, they influence a lot. Of course, we know that. But looking at the health of Kenya and Nairobi, I am recovering a little bit of faith in my profession because at the end I would be expecting more differences. There are only 10 or 12 years or 15 years of life expectancy difference between Kenya and New York. Look at these very global figures. Of course, the only difference, there's a lot of difference between London, Dickensioni and London and now. At that time there were no vaccination. And vaccination nowadays, although it has not solved things, it has represented vaccinations. All of them have represented a huge change in the life expectancy of people. It's not about medical care. It's about the medical or health knowledge applied more or less in life. But of course, I think that social conditions are very clearly here. As playing most of it, I'm able to say social and political because why don't we speak clearly? It's all that. It's about politics. It's about the organization of politics. There are a lot of differences between different mortality play descriptions in Paris and in Manhattan. How is that related to unemployment and how is that related to the coverage, social coverage in case of unemployment? I think that this is some of the ways that we can think on future because it's quite clear. We don't need to know everything. Things, in some way, there are evidence. We prefer to live in a better and rich society, in a poor and we prefer to have work to oppose not having work. And then the question becomes, at the end, if we want to be efficient, is how we can help the poor countries to have more employment and how we can help in the poor, in the rich country to recover employment? Thank you. It feels as if we've been here a long time. We actually started a quarter of an hour late, so we're running five minutes late in reality. Coffee, but could you please come back for 20, 25 minutes. Thank you to Ron Klos and thank you to all the speakers up in Manhattan.