The Urban Health "Advantage (original) (raw)
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Toward an Urban Health Advantage
Journal of Public Health Management and Practice, 2005
Cities represent the dominant mode of living in the developed world and the pace of urbanization worldwide will continue to accelerate over the coming decades, particularly in the developing world. 1 According to United Nations 2000 forecasts, about half of the world's population is urban and by the year 2030 nearly two thirds of the world's population will live in urban areas. 2 About 75% of the US population lives in urban areas; according to the Office of Management and Budget, 90% live in more broadly defined metropolitan statistical areas (MSA). The National Center for Health Statistics, using a newer measure of urbanization, based on proximity to urban centers, finds that the proportion of persons living in MSA central city, MSA noncentral city, non-MSA adjacent, and non-MSA nonadjacent are approximately 29.5%, 48.3%, 12.1%, and 10.1% of the US population, respectively. 3 Health and disease in urban populations have been the subject of much popular and scientific literature. The historical perspective of cities is that their size and density, coupled with a pace of growth through immigration and commerce that outstrips resources, all result in exposures that produce excess morbidity and mortality. 4 More recently in the United States, many cities have had a migration of the middle class to suburbs amidst a decaying infrastructure and reduced services in inner cities that results in a worse response to health issues for the remaining population in these areas of concentrated disadvantage. Considering these demographic shifts, the inner cities and, more recently, the suburbs have become the focus of attention for the study of and interventions on health risks. The dominant conception of urban health in the existing literature is concerned primarily with the "urban health penalty." This approach posits that cities concentrate poor people and expose residents to unhealthy environments leading to a disproportionate burden of poor health, especially in what some have called "inner cities." 5 In the past 50 years, the departure of the middle class and jobs to the surrounding suburbs in the United States as well as other developed countries has led to intense urban poverty and increased racial segregation leaving cities with diminished capacity to meet the needs of increasingly impoverished populations. 6 By the late 20th century, United States and some European cities had higher rates, Vlahov and Galea are with the
Urban as a Determinant of Health
Journal of Urban Health-bulletin of The New York Academy of Medicine, 2007
Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.
Health differences in an unequal city
Cities have a significant influence on people's mental and physical health. City planning has the potential to change behaviors and incentivize a healthier lifestyle through the provision of public goods and urban infrastructure. The bulk of the evidence correlating city configuration and population health comes mostly from cities in the global north, with little evidence from cities in developing countries. This analysis seeks to contribute to bridging this evidence gap. This empirical analysis presents an insight into population health conditions (phy-sical health and overweight-obesity) and its correlation with gender and socioeconomic conditions. Data comes from an extensive annual population survey conducted in Cali, Colombia. Results show that women and the poor report a higher probability of poor physical health and a higher number of days reporting poor mental health. Overweight and obesity are slightly increasing in the city, particularly amongst women, but there is no clear pattern by socioeconomic conditions. Overweight and obese people are more common amongst married couples, with lower educational attainment and lack of physical activity. This analysis aims to provide insights that can better inform urban policies and city planners to contribute to the global agenda of the Sustainable Development Goals to make cities sustainable, equitable, and livable.
Urban health: evidence, challenges, and directions
Annu. Rev. Public Health, 2005
■ Abstract Urbanization is one of the most important demographic shifts worldwide during the past century and represents a substantial change from how most of the world's population has lived for the past several thousand years. The study of urban health considers how characteristics of the urban environment may affect population health. This paper reviews the empirical research assessing urban living's impact on population health and our rationale for considering the study of urban health as a distinct field of inquiry. The key factors affecting health in cities can be considered within three broad themes: the physical environment, the social environment, and access to health and social services. The methodologic and conceptual challenges facing the study of urban health, arising both from the limitations of the research to date and from the complexities inherent in assessing the relations among complex urban systems, disease causation, and health are discussed. Annu. Rev. Public. Health. 2005.26:341-365. Downloaded from arjournals.annualreviews.org by NEW YORK ACADEMY OF MED. on 03/17/05. For personal use only. URBAN HEALTH
Social Science & Medicine, 2005
A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention. r
The Underestimation of Urban Poverty and of Its Health Consequences
Third World Planning Review, 1995
TWPR, 17 (4) 1995 DAVID SATTERTHWAITE Viewpoint The underestimation ofurban poverty and ... care are correct, by the early 1990s most of the urban population are adequately DavidSatterthwaite is Director of the Human Settlements Programme, International Institute for ...