Evaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012–2018)

Abstract

Rapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a longitudinal study design (“primary evaluations”). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.

The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing

“…Despite the abundant evidence on the relationship between housing, the built environment and health, studies on the health effects of urban regeneration in Latin America are scarce and mostly focused on slum upgrading [34]. RUCAS aims to narrow this gap by evaluating both proximal effects and more distal health effects of an urban regeneration program in two social housing neighborhoods in Chile.…”

“…Capitalizing on urban regeneration initiatives as natural experiments, these studies have shown increases in satisfaction with housing, improvements in perceived quality of life, reduction of violence, and mental health benefits, among others [29][30][31][32][33]. However, most of these studies have failed to support definitive conclusions regarding associations between urban regeneration and health [4,34,35]. Furthermore, most studies evaluating the health impacts of these interventions have been conducted in high-income countries.…”

Characterising variability and predictors of infant mortality in urban settings: findings from 286 Latin American cities

“…A growing body of work has documented how local interventions in cities can improve infant health. 33 For example, housing improvements and water and sanitation provision, 34 35 or more comprehensive urban redevelopment interventions 36 have been linked to reduction in respiratory and enteric infections 34 35 as well as in IM 36 in urban slums in LA.…”

A multi-scalar perspective on health and urban housing: an umbrella review

“…The 124 articles primarily included research from high-income countries (predominantly the UK, Europe and North America); few included studies from low-income countries (Alaazi & Aganah 2020; Henson et al 2020;Jung et al 2017;Katoto et al 2019;Quansah et al 2017;Shuvo et al 2020;Turley et al 2013), and these were mainly in relation to urban slum interventions or impacts. The types of studies included in each review were diverse, but mainly collated evidence from cross-sectional population surveys.…”

“…A total of 17 studies were identified in this category reporting on health outcomes and informality (three studies), urban infrastructure (three studies), type of development (three studies) and master planning (eight studies). The three studies reporting on informality assessed the health impacts of strategies to improve the infrastructure, conditions and land tenure of slums, including communicable and non-communicable disease prevention, the risk of injury from chemical and biological hazards, as well as social impacts such as quality of life, education and employment (Alaazi & Aganah 2020; Turley et al 2013;Henson et al 2020). Three studies looked at urban infrastructure: one study assessed urban drinking water and gastroenteritis risk (Beaudeau 2018); one study reported on the structural soundness of the city in the face of earthquakes and subsequent building collapses (Doocy et al 2013); and one study looked at urban exposure to overhead powerlines (Habash et al 2019).…”