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Severe Acute Respiratory Syndrome (SARS)
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2003 - the first severe new disease of the 21st century - SARS highlighted the fact that no city is automatically protected by virtue of its wealth or its standards of living and health care from either the arrival of a new disease or the subsequent disruption it can cause.
SARS was, to a large extent, a disease of prosperous urban centers. Contrary to expectations, it spread most efficiently in sophisticated city hospitals.
Fortunately, the spread of SARS was halted less than four months after it was first recognized as an international threat.
Had SARS been allowed to establish a foothold in a resource poor setting, it is doubtful whether the demanding measures, facilities, and technologies needed to stop it could have been fully deployed
SARS was, to a large extent, a disease of prosperous urban centers. Contrary to expectations, it spread most efficiently in sophisticated city hospitals.
Fortunately, the spread of SARS was halted less than four months after it was first recognized as an international threat.
Had SARS been allowed to establish a foothold in a resource poor setting, it is doubtful whether the demanding measures, facilities, and technologies needed to stop it could have been fully deployed
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Health Inequalities
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Health inequalities are simply differences in health between groups of people. These differences might be due to non-modifiable factors such as age or sex, or modifiable factors such as socioeconomic status.
e.g. death rates among people in their eighties are higher than those among people in their twenties
e.g. death rates among people in their eighties are higher than those among people in their twenties
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Health Inequities
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Health inequities refer to the subset of health inequalities that are systematic, socially produced (and therefore modifiable) and unfair.
They are not distributed randomly, but rather show a consistent pattern across the population, often by socioeconomic status or geographical location.
e.g. In Glasgow, Scotland, male life expectancy varies from 54 to 82 years, depending on the part of the city in which the person lives
They are not distributed randomly, but rather show a consistent pattern across the population, often by socioeconomic status or geographical location.
e.g. In Glasgow, Scotland, male life expectancy varies from 54 to 82 years, depending on the part of the city in which the person lives
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Understanding urban health begins with knowing which city dwellers are affected by which health issues, and why.
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To achieve this understanding, available information must be disaggregated according to defining characteristics of city dwellers, such as their socioeconomic status or place of residence.
Disaggregated data invariably reveal urban health inequities, which are defined as health inequalities that are systematic, socially produced (and therefore modifiable) and unfair.
Health inequities are the result of the circumstances in which people grow, live, work and age, and the health systems they can access, which in turn are shaped by broader political, social and economic forces.
They are not distributed randomly, but rather show a consistent pattern across the population, often by socioeconomic status or geographical location.
No city - large or small, rich or poor, east or west, north or south - has been shown to be immune to the problem of health inequity.
Ultimately, urban health inequities are detrimental to all city dwellers. Disease outbreaks, social unrest, crime and violence are but a few of the ways that urban health inequities affect everyone.
Disaggregated data invariably reveal urban health inequities, which are defined as health inequalities that are systematic, socially produced (and therefore modifiable) and unfair.
Health inequities are the result of the circumstances in which people grow, live, work and age, and the health systems they can access, which in turn are shaped by broader political, social and economic forces.
They are not distributed randomly, but rather show a consistent pattern across the population, often by socioeconomic status or geographical location.
No city - large or small, rich or poor, east or west, north or south - has been shown to be immune to the problem of health inequity.
Ultimately, urban health inequities are detrimental to all city dwellers. Disease outbreaks, social unrest, crime and violence are but a few of the ways that urban health inequities affect everyone.
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Determinants of Health
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1. General socioeconomic, cultural, and environmental conditions.
2. Living and working conditions.
3. Social and community influences.
4. Individual lifestyle factors.
5. Age, sex, and hereditary factors.
2. Living and working conditions.
3. Social and community influences.
4. Individual lifestyle factors.
5. Age, sex, and hereditary factors.
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Cities present a number of health risks.
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Especially when they are poorly governed or fail to sufficiently prioritize health in all policies.
Many are confronted by multiple threats:
- Infectious diseases exacerbated by poor living conditions;
- Noncommunicable diseases and conditions (such as heart disease, cancer, and diabetes)
- Behavioral exposures from tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol;
- Occupational exposures
- Injuries (including road traffic accidents)
- violence
Many are confronted by multiple threats:
- Infectious diseases exacerbated by poor living conditions;
- Noncommunicable diseases and conditions (such as heart disease, cancer, and diabetes)
- Behavioral exposures from tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol;
- Occupational exposures
- Injuries (including road traffic accidents)
- violence
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Infectious Disease Disparities
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Infectious diseases are a major threat in many cities due to population density, overcrowding, lack of safe water and sanitation systems, international travel and commerce, and poor health-care access, particularly in urban slums.
Other infectious conditions, such as the human immunodeficiency virus (HIV), tuberculosis, pneumonia and diarrheal infections, have an ongoing presence in cities.
The urban poor suffer the greatest burden. Slums are productive breeding grounds for tuberculosis, hepatitis, dengue, pneumonia, cholera and diarrheal diseases, which spread easily in highly concentrated populations.
Other infectious conditions, such as the human immunodeficiency virus (HIV), tuberculosis, pneumonia and diarrheal infections, have an ongoing presence in cities.
The urban poor suffer the greatest burden. Slums are productive breeding grounds for tuberculosis, hepatitis, dengue, pneumonia, cholera and diarrheal diseases, which spread easily in highly concentrated populations.
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Non communicable disease disparities.
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Noncommunicable diseases and conditions, such as asthma, heart disease and diabetes, are a significant problem in urban centers.
Most of this heightened risk can be traced back to changes in diet and physical activity as a consequence of urbanization, as well as exposure to air pollutants, including tobacco smoke.
Urbanization is associated with a shift towards calorie-dense diets, characterized by high levels of fat, sugar and salt - As a result, obesity is on the rise in cities around the world.
People in cities tend to have physically inactive types of employment, and urban sprawl further discourages physical activity. Other factors that inhibit regular physical activity include overcrowding, high-volume traffic, overreliance on motorized transportation, crime and poor air quality.
Poor housing conditions, overcrowding, noise pollution, unemployment, poverty and cultural dislocation can cause or exacerbate a range of mental health problems, including anxiety, depression, insomnia and substance abuse.
Most of this heightened risk can be traced back to changes in diet and physical activity as a consequence of urbanization, as well as exposure to air pollutants, including tobacco smoke.
Urbanization is associated with a shift towards calorie-dense diets, characterized by high levels of fat, sugar and salt - As a result, obesity is on the rise in cities around the world.
People in cities tend to have physically inactive types of employment, and urban sprawl further discourages physical activity. Other factors that inhibit regular physical activity include overcrowding, high-volume traffic, overreliance on motorized transportation, crime and poor air quality.
Poor housing conditions, overcrowding, noise pollution, unemployment, poverty and cultural dislocation can cause or exacerbate a range of mental health problems, including anxiety, depression, insomnia and substance abuse.
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Disparities in injuries
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~ 16,000 people die every day as a result of injuries - about 10% of all deaths.
The principal causes of death from injury are road traffic accidents (22%), suicide (15%) and homicide (10%), with war accounting for another 3%.
Road traffic injuries alone are responsible for 1.3 million deaths per year globally. In many developing countries, urbanization and the increased number of motorized vehicles have not been accompanied by adequate transport infrastructure, enforcement of traffic regulations or implementation of measures to ensure improved road safety.
Low- and middle-income countries have higher road traffic fatality rates (20.1 and 22.1 per 100 000 population, respectively) than high-income countries (11.9 per 100 000).
More than 90% of the world's road fatalities occur in low- and middle-income countries, which have only 48% of the world's registered vehicles.
The principal causes of death from injury are road traffic accidents (22%), suicide (15%) and homicide (10%), with war accounting for another 3%.
Road traffic injuries alone are responsible for 1.3 million deaths per year globally. In many developing countries, urbanization and the increased number of motorized vehicles have not been accompanied by adequate transport infrastructure, enforcement of traffic regulations or implementation of measures to ensure improved road safety.
Low- and middle-income countries have higher road traffic fatality rates (20.1 and 22.1 per 100 000 population, respectively) than high-income countries (11.9 per 100 000).
More than 90% of the world's road fatalities occur in low- and middle-income countries, which have only 48% of the world's registered vehicles.
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Disparities in violence
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Worldwide, over 1.6 million people lose their lives to violence each year.
Suicide accounts for 844 000 deaths, homicide for 600 000 deaths, and collective violence for 184 000 deaths.
For every person who dies from violence, many more are injured and suffer a range of physical, mental, and other consequences.
Child maltreatment, youth violence, intimate partner violence, sexual violence, and elder abuse, although unlikely to result in death, are other highly prevalent forms of violence with significant behavioral and health consequences.
Major contributors to urban violence include social exclusion, poverty, unemployment, and poor housing conditions.
The fear of such violence further contributes to the fragmentation of cities, socially, economically, and politically.
Young people are particularly affected by urban violence. In urban areas, people aged 15 to 24 commit the largest number of violent acts and are also the principal victims of violence.
Suicide accounts for 844 000 deaths, homicide for 600 000 deaths, and collective violence for 184 000 deaths.
For every person who dies from violence, many more are injured and suffer a range of physical, mental, and other consequences.
Child maltreatment, youth violence, intimate partner violence, sexual violence, and elder abuse, although unlikely to result in death, are other highly prevalent forms of violence with significant behavioral and health consequences.
Major contributors to urban violence include social exclusion, poverty, unemployment, and poor housing conditions.
The fear of such violence further contributes to the fragmentation of cities, socially, economically, and politically.
Young people are particularly affected by urban violence. In urban areas, people aged 15 to 24 commit the largest number of violent acts and are also the principal victims of violence.
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Where do people live in slums?
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Urban population living in slums
1. Sub-saharan Africa 60-65%
2. Southern Asia
3. South-Eastern Asia
4. Eastern Asia
5. Western Asia
6. Oceania
7. Latin America & Caribbean 25%
1. Sub-saharan Africa 60-65%
2. Southern Asia
3. South-Eastern Asia
4. Eastern Asia
5. Western Asia
6. Oceania
7. Latin America & Caribbean 25%
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What do we know?
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Very little is known about health differences that exist within cities.
Poor city dwellers are often totally neglected because public health authorities do not collect information in informal or illegal settlements, and miss homeless people altogether.
The majority of municipalities have no clear information about the type and extent of health inequities that lie within their cities.
Poor city dwellers are often totally neglected because public health authorities do not collect information in informal or illegal settlements, and miss homeless people altogether.
The majority of municipalities have no clear information about the type and extent of health inequities that lie within their cities.
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Under 5 mortality rate by region in 42 Low and Middle income countries
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Mortality rates in urban areas of Africa are roughly double those of the Americas and Asia.
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UNDER-FIVE MORTALITY RATE IN URBAN AREAS OF SEVEN SELECTED COUNTRIES
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Children from the poorest urban families are roughly twice as likely to die as children from the richest urban families, but all income levels affected, not just poor.
-Impact of social safety nets. Colombia vs Bolivia
-Morocco has lower mortality rate as compared to lower income countries in Africa: Morocco is higher income
-Impact of social safety nets. Colombia vs Bolivia
-Morocco has lower mortality rate as compared to lower income countries in Africa: Morocco is higher income
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INEQUITY IN CHRONIC MALNUTRITION AMONG CHILDREN LESS THAN FIVE YEARS OF AGE FOR 47 DEVELOPING COUNTRIES, COMPARING URBAN TO RURAL INEQUALITIES, 1994 - 2004
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The degree of socioeconomic inequity in stunting was higher in urban areas in comparison to rural areas, for 32 of the 47 countries.
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CHRONIC MALNUTRITION AMONG CHILDREN LESS THAN FIVE YEARS OF AGE,BY REGION, IN 41 LOW- AND MIDDLE-INCOME COUNTRIES
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Similar story for malnutrition.
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CHRONIC MALNUTRITION AMONG CHILDREN LESS THAN FIVE YEARS OF AGE IN URBAN AREAS OF SEVEN SELECTED COUNTRIES
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...
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FACTORS THAT CONTRIBUTE TO INEQUITIES IN CHRONIC MALNUTRITION AMONG CHILDREN LESS THAN FIVE YEARS OF AGE IN URBAN AREAS OF SEVEN SELECTED COUNTRIES
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...
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SKILLED BIRTH ATTENDANCE COVERAGE, BY REGION, IN URBAN AREAS OF 44 LOW- AND MIDDLE-INCOME COUNTRIES
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...
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SKILLED BIRTH ATTENDANCE COVERAGE IN URBAN AREAS OF SEVEN SELECTED COUNTRIES
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...
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FACTORS THAT CONTRIBUTE TO INEQUITIES IN SKILLED BIRTH ATTENDANCE, IN URBAN AREAS OF SEVEN COUNTRIES
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Mother's education, region of residence, household wealth, child's biological characteristics, partner's education, other factors.
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PREVALENCE OF SELF-REPORTED DIABETES DIAGNOSED BY A PHYSICIAN, ADULTS AGE 45 AND OLDER, URBAN
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-Bangladesh: richest 20% are more likely to have diabetes: disposable income results in more choices that exacerbate the risk for diabetes.
-Underreporting in poor communities
-Underreporting in poor communities
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PERCENTAGE OF HOUSEHOLDS WITH ACCESS TO PIPED WATER, IN URBAN AREAS OF 44 LOW- AND MIDDLE-INCOME COUNTRIES
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-Mitigation of diarrhea has been successful by providing access to piped water
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INEQUITIES IN ACCESS TO PIPED WATER IN URBAN AREAS FROM SEVEN SELECTED COUNTRIES
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...
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Death rates in children under 5 and infants in Nairobi by neighborhood
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HOMICIDE RATES VARY BY A FACTOR OF FOUR BETWEEN SUBDISTRICTS OF CAPE TOWN, SOUTH AFRICA, 2001-2004
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GEOGRAPHICAL RELATIONSHIP BETWEEN PERCENTAGE OF RESIDENTS LIVING IN POVERTY AND LIKELIHOOD OF DYING FROM AIDS, NEW YORK CITY, UNITED STATES
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...
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POOR URBAN WOMEN ARE MOST LIKELY TO HAVE HIV INFECTION
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...
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PROPORTION OF URBAN POPULATION LIVING IN SLUM AREAS, 1990 AND 2010
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Mostly decreasing in all continents.
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Cities, especially those in wealthier areas, have been significant contributors to climate change.
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Collectively, cities account for 75% of global energy consumption and a similar proportion of all waste.
According to latest estimates, urban areas contribute directly to more than 60% of greenhouse gas emissions.
It is no coincidence, therefore, that climate change has emerged at the forefront of international debate at precisely the same time that the planet has become predominantly urban.
-Cities need to be addressed in order to have significant impacts on climate change.
-Urban areas now dominate over rural areas
According to latest estimates, urban areas contribute directly to more than 60% of greenhouse gas emissions.
It is no coincidence, therefore, that climate change has emerged at the forefront of international debate at precisely the same time that the planet has become predominantly urban.
-Cities need to be addressed in order to have significant impacts on climate change.
-Urban areas now dominate over rural areas
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