Homicides, Public Goods, and Population Health in the Context of High Urban Violence Rates in Cali, Colombia.

Abstract

Obesity and frequent mental and physical distress are often associated with major health problems. The characteristics of the urban environment, such as homicide rates and public goods provision, play an important role in influencing participation in physical activity and in overall mental health. This study aimed to determine whether there was a relationship between homicide rates and public goods provision on the health outcomes of the citizens of Cali, Colombia, a city known for its high urban violence rate and low municipal investment in public goods. We used a linear probability model to relate homicide rates and public goods provision (lighted parks, effective public space per inhabitant, and bus stations) at the district level to health outcomes (obesity and frequent mental and physical distress). Individual data were obtained from the 2014 CaliBRANDO survey, and urban context characteristics were obtained from official government statistics. After controlling for individual covariates, results showed that homicide rates were a risk factor in all examined outcomes. An increase in 1.0m2 of public space per inhabitant reduced the probability of an individual being obese or overweight by 0.2% (95% confidence interval (CI)=-0.004 to -0.001) and the probability of frequent physical distress by 0.1% (95% CI=-0.002 to -0.001). On average, the presence of one additional bus station increased the probability of being obese or overweight by 1.1%, the probability of frequent mental distress by 0.3% (95% CI=0.001-0.004), and the probability of frequent physical distress by 0.02% (95% CI=0.000-0.003). Living in districts with adequate public space and lighted parks lowers the probability of being obese and high homicide rates, which are correlated with poor health outcomes in Cali, Colombia. Investments in public goods provision and urban safety to reduce obesity rates may contribute to a better quality of life for the population.