Urban Health

by

Nicholas Freudenberg

• LAST REVIEWED: 23 February 2011
• LAST MODIFIED: 23 February 2011
• DOI: 10.1093/obo/9780199756797-0128

Introduction

In the early 21st century, city living is the norm for an ever-growing proportion of the world’s population. By 2007 half the world’s population lived in cities, and by 2030 more than three-quarters will live in urban areas. In the 19th and 20th centuries urbanization reshaped the world, and no human trend has had a more profound influence on health. Compared to nonurban areas, cities are characterized by population density and diversity, complexity, income inequality, and a rich array of formal and informal organizations. Each of these characteristics has positive and negative effects on well-being, making it difficult for researchers and policy makers to make clear recommendations for improving the health of urban populations. Increasingly the world’s urban population is concentrated in Africa, Latin America, and Asia, where high levels of poverty worsen the health impact of urbanization. As cities become the dominant form of living, their influence spreads to rural and suburban areas, emphasizing the importance of creating healthier urban physical and social environments. In the late 20th and early 21st centuries, research on urban health extended beyond comparing the health status of urban and rural populations to assessing the health consequences of varying urban environments, understanding the causes of and solutions to growing geographic and socioeconomic health inequities within cities in developing and developed nations, and evaluating the impact of multilevel and intersectoral initiatives to improve urban health.

General Overviews

Several works provide overviews of late-20th- and early-21st-century scholarship on urban health. Galea, et al. 2005 proposes a model for the study of urban health that considers the impact of health care and social services and additionally the impact of the urban social and physical environments. Galea and Vlahov 2005 describes the methodological and conceptual challenges that confront urban health researchers, which the authors attribute to the limitations of the research and the complexities of assessing the relations among urban systems, disease causation, and health. Dye 2008 argues that urban populations are healthier than rural ones but that well-off city dwellers benefit more than poor ones. The main obstacles to improved urban health, according to Dye 2008, are not technical or financial but rather governance and the organization of civil society. World Health Organization Centre for Health Development 2009 summarizes the challenges faced by megacities, the twenty cities around the world with populations of more than ten million. World Health Organization Centre for Health Development 2008 describes the health conditions in the slums and informal settlements where one billion people live in “deplorable conditions” and makes the case that improving these conditions is both a public health and a human rights imperative.

• Dye, Christopher. 2008. Health and urban living. Science 319:766–769.

  DOI: 10.1126/science.1150198

  Describes the demographic consequences of increasing urbanization and the growing importance of chronic, noncommunicable diseases. Argues that the main obstacles to improving urban health are not technical or financial but are related to governance and the organization of civil society.

• Galea, Sandro, Nicholas Freudenberg, and David Vlahov. 2005. Cities and population health. Social Science and Medicine 60.5 (March): 1017–1033.

  DOI: 10.1016/j.socscimed.2004.06.036

  Proposes a model for the study of urban health that considers both proximate and fundamental influences. Focuses on urban living conditions as a main determinant of population health.

• Galea, Sandro, and David Vlahov. 2005. Urban health: Evidence, challenges, and directions. Annual Review of Public Health 26:341–365.

  DOI: 10.1146/annurev.publhealth.26.021304.144708

  Reviews empirical research assessing urban living’s impact on population health and proposes that the study of urban health has become a distinct field of inquiry. Examines both salutogenic and pathogenic consequences of urbanization.

• World Health Organization Centre for Health Development. 2008. Our cities, our health, our future: Acting on social determinants for health equity in urban settings; Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings. Kobe, Japan: World Health Organization.

  Summarizes findings from the Commission on Social Determinants of Health on the structural and intermediate social determinants of health in urban settings. Reviews strategies to improve urban health with a focus on interventions that address structural causes of ill health in cities. Emphasizes the key roles of improving urban governance: developing integrated intersectoral strategies, focusing directly on inequities in health, investing in health, and fairer allocation of resources among varying urban populations.

• World Health Organization Centre for Health Development. 2009. Megacities and urban health. Kobe, Japan: World Health Organization.

  Describes the unique health characteristics of the twenty cities with populations of more than ten million. Describes the major challenges to improved health in megacities, including transportation, water and sanitation, governance, safety, food security, health care, emergency preparedness, and environmental issues.