Social Conditions and Urban Health Inequities: Realities, Challenges and Opportunities to Transform the Urban Landscape through Research and Action

Abstract

The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a "natural" or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low-and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.

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

“…8 In the developing world, mainly, the process of urbanization is often accompanied by high levels of slum dwelling. 2 As defined by the United Nations Human Settlements Programme (UN-HABITAT), a slum is a densely populated area with substandard housing and a low standard of living as depicted by the absence of one or more of the following: improved water supply, improved sanitation, sufficient living area, durability of construction, and security of tenure. Although the proportion of slum dwellers in developing urban regions in the world declined from around 50% in 1990 to 36% in 2005; in absolute terms, between 2000 and 2010, the numbers of slum dwellers in the developing world grew from 776.7 to 827.6 million.…”

“…GRNUHE's overarching research question asked: "What are the attributes of urban governance, urban daily living conditions (social and physical environments), and climate change that contribute to urban health inequities, particularly in cities of LMICs?" Papers by Smit et al, 1 Barten et al, 5 Friel et al 3,4 and Salgado et al 2 explore each of these issues in more detail. First, this model shows that the physical environment, social conditions, and changing environmental conditions (exemplified by, but not limited to, climate change), all interact to improve or worsen health inequities.…”

“…We conclude by proposing a way forward for urbanization that is based on principles of health, equity, and environmental sustainability and outline key components of a global research agenda to support such an approach to urban development. Papers by Smit et al, 1 Salgado et al, 2 Friel et al, 3,4 and Barten et al 5 describe in detail the relationship between urban health inequities in LMICs and each of the determinants, and review the evidence relating to action that has been used to address these causes of health inequities.…”

Velocidade de ganho de peso e práticas alimentares no primeiro ano de vida em lactentes de baixo nível socioeconômico

“…Grande parte das famílias avaliadas vive em moradias caracterizadas por condições ambientais e sanitárias precárias, e estudos indicam que moradores de favelas urbanas tendem a ter indicadores de saúde muito aquém do recomendado 21,22 . Estudos internacionais apontam a existência de maior risco de ganho de peso excessivo entre as pessoas de baixo nível socioeconômico em comparação àquelas com melhores condições econômicas 23,24 .…”

Urban Health Inequities and the Added Pressure of Climate Change: An Action-Oriented Research Agenda

“…This highlights the importance of taking direct action on urban health inequities by addressing the social determinants of urban health inequities, key aspects of which are addressed in the other papers in this series. 42,[50][51] …”