Addressing the Social and Environmental Determinants of Urban Health Equity: Evidence for Action and a Research Agenda

Abstract

Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges--economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central policy goals for urban management.

City planning as preventive medicine

“…High levels of social stressors such as social isolation and violence are also known to adversely impact the health of urban residents. In cities, the greater spatial proximity of one's social networks may accentuate their role in shaping individual and population health (Friel et al, 2011).…”

Urbanisation, climate change and health equity: how can health promotion contribute?

“…Aspects of urbanisation which are health promoting for humans include access to education, employment, health care, social support, places of cultural/spiritual significance, fresh food and water and material support (Butterworth 2000;Baum 2008;Friel et al 2011a). Additionally, access to nature via urban parks and gardens can promote urban residents' physical, social and mental health and improve their well-being (see Kaplan and Kaplan 1989;Maas et al 2006;Henderson-Wilson and Townsend 2007).…”

“…Globally, the greatest burden of climate change will fall on urban communities in low-income countries, low-lying coastal communities, socially disadvantaged people living and working in urban areas, elderly people and children (GRNUHE 2010;Friel et al 2011aFriel et al , 2011b. This paper developed from collaborative research for an IUHPE position statement on Climate Change and Health (IUHPE, n.d.) into an exploratory narrative review focusing on the nexus of three phenomena -urbanisation, climate change and health equity.…”

Benefits of environmental inequality assessments for action

“…A two-pronged approach is suggested (see also Friel et al 29): At the level of policies and project planning, equity-focused impact assessments should be implemented as they examine both overall environmental and/or health impacts and the distribution of these impacts within a given population. The focus of such impact assessments should thus be the prospective prevention of new or enforced inequalities 30…”