Urban health in developing countries: What do we know and where do we go?

doi:10.1016/j.healthplace.2008.03.004

Health & Place

Volume 15, Issue 1, March 2009, Pages 107-116

https://doi.org/10.1016/j.healthplace.2008.03.004 Get rights and content

Abstract

The world became mainly urban in 2007. It is thus timely to review the state of knowledge about urban health and the current priorities for research and action. This article considers both health determinants and outcomes in low-income urban areas of developing countries. The need to study urban health in a multi-level and multi-sectoral way is highlighted and priorities for research are identified. Interventions such as the Healthy Cities project are considered and obstacles to the effective implementation of urban health programmes are discussed. Concepts such as the double burden of ill health and the urban penalty are re-visited. Finally, a call for a shift from ‘vulnerability’ to ‘resilience’ is presented.

Introduction

The world became mainly urban in 2007. It is thus timely to review the state of knowledge about urban health and the current priorities for research and action. The sub-field of urban health is about 30 years old and there is now a journal dedicated to the subject, an international society and several conferences each year. The scope of this paper is developing countries, referred to here as the global south. What have we learnt about urban health in the last few decades? What are the gaps in our knowledge? The paper avoids repeating the arguments and data that can be found in urban health reviews written in the last two decades (e.g., Ruel et al., 1999; McMichael, 2000; Harpham and Molyneux, 2001; Lawrence, 2002; Galea and Vlahov, 2005; Montgomery and Ezeh, 2005a) and instead tries to link recent development approaches, like the livelihoods conceptual framework and the analysis of social capital to urban health. However, some of the more fundamental concepts like the urban advantage or the urban penalty and the ‘double burden’ of disease are necessarily reviewed in order to give a comprehensive conceptual grounding. This is not a systematic literature review but incorporates many of the references considered at the health part of the US Rockefeller Foundation's Urban Summit of 2007. The first part of the paper considers the determinants and outcomes of urban health and the final part concludes by addressing remaining challenges and research needs.

Section snippets

Determinants and outcomes

The scope of this paper covers the urban health system, which can be defined as the determinants and outcomes of health and the activities that link them. Because cities are particularly complex in terms of the range of environmental, social and service factors that can determine health, it helps to have a broad understanding of the health system. Essentially this breadth means thinking about determinants in both multi-sector and multi-level dimensions. These over-arching, cross-cutting

Aspects of urban health still requiring attention in different regions

A recent analysis of the burden of disease, which takes into account both morbidity and mortality, showed regional differences that help us understand the respective priorities by region (Lopez et al., 2006). The following diseases caused the top four burdens in each region in 2001:

•
Latin America: perinatal, depression, violence, and heart disease.
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Sub-Saharan Africa: HIV/AIDS, malaria, respiratory, and diarrhea.
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South Asia: perinatal, respiratory, heart disease, and diarrhea.

Although urban–rural

Acknowledgements

An earlier version of this paper was commissioned by The US Rockefeller Foundation for their 2007 Urban Summit. The paper was revised for Health and Place with support from the UK Department for International Development's DelPHE (Development Partnerships in Higher Education) project on Urban Environmental Health, which is a partnership between London South Bank University, the University of Johannesburg and the South African Medical Research Council. DelPHE is managed by the British Council

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Review EssayUrban health in developing countries: What do we know and where do we go?

Abstract

Introduction

Section snippets

Determinants and outcomes

Aspects of urban health still requiring attention in different regions

Acknowledgements

Social Science and Medicine

Social Science and Medicine

Journal of Development Economics

World Development

Health and Place

Health and Place

World Development

The Lancet

World Development

Health and Place

Keeping health in an urban environment: public health challenges for the urban poor

Moving beyond the survey in exploring social capital

Developing urban health systems in Bangladesh

IIED Participatory Learning and Action

HIV/AIDS and urbanization

Population and Development Review

The Influence of Community Factors on Health

Urban health: evidence, challenges and directions

Annual Review of Public Health

Community social capital

Urban health in developing countries: a review

Progress in Development Studies

Healthy city projects in developing countries: the first evaluation

Health Promotion International

Mental health and social capital in Cali, Colombia

Social Science and Medicine

Review Essay
Urban health in developing countries: What do we know and where do we go?