Improving human and environmental health in urban informal settlements: the Revitalising Informal Settlements and their Environments (RISE) programme

Abstract

Urbanisation is a major demographic trend globally. Urban informal settlements account for much urban growth, with nearly 1 billion people currently living in informal settlements and 2 billion having inadequate water and sanitation services.1UN-HabitatState of the world's cities. UN-Habitat, Nairobi2016Google Scholar, 2WHODrinking-water fact sheet.http://www.who.int/mediacentre/factsheets/fs391/enDate: 2017Date accessed: September 10, 2017Google Scholar Polluted water and inadequate water supply, sanitation, and hygiene cause around 80% of diseases and one in four deaths in low-income countries.3Luthi C McConville J Norström A et al.Rethinking sustainable sanitation for the urban environment.https://www.sswm.info/sites/default/files/reference_attachments/LUETHI%20et%20al%202009%20Rethinking%20Sustainable%20Sanitation%20for%20the%20Urban%20Environment.pdfDate: 2009Date accessed: September 10, 2017Google Scholar Projections indicate that, unless radical changes are made, more than 3 billion people will live in urban informal settlements by 2050.1UN-HabitatState of the world's cities. UN-Habitat, Nairobi2016Google Scholar Informal settlements exacerbate the inextricably linked challenges of sanitation, water provision, environmental degradation, and public health. Conventional, centralised trunk water and sanitation approaches to these challenges have changed little in 150 years; come at major financial, environmental, and social costs; and frequently overlook informal settlements. Part of the Wellcome Trust's Our Planet, Our Health funding programme, the Revitalising Informal Settlements and their Environments (RISE) programme is empirically testing an alternative, water-sensitive-cities approach to upgrading informal settlements that integrates environmentally sustainable and socially inclusive design with management of the water cycle, benefiting human health and urban ecosystems. The RISE hypothesis is that changing the physical environment and improving water servicing will enhance psychological, social, and economic outcomes in informal settlements, resulting in further benefits to human health and wellbeing. The programme is empirically testing whether water-sensitive revitalisation leads to improved physical characteristics, including altered microbial and biological diversity, bioacoustics, greenness, and flood hazards, and decreased potential for vector breeding and pathogen contamination. Additionally, the programme is investigating whether the interruption of faecal–oral transmission reduces infection, leading to reduced enteric inflammation and carriage of drug-resistant gene markers, increased diversity of the gastrointestinal microbiome, and increased responsiveness to oral vaccines. RISE is upgrading 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji; each site comprises an average of 50 dwellings, assuming five to six people per dwelling, with a total of 6000–7200 people. This intervention scale and sample size will ensure statistical power to assess primary health and environmental outcomes. The research programme uses a parallel-cluster, randomised controlled trial design, with plans for stratified randomisation by tidal versus non-tidal sites. Six settlements in each of Suva and Makassar will be randomly assigned to the intervention group and six to the control group. Environment and human health monitoring will be undertaken for all settlements for 24 months after implementation of the intervention to monitor and assess the effects on primary outcomes. In close consultation with government stakeholders and communities, RISE has developed a community co-design process that facilitates residents' involvement in planning and design, and addresses each individual sites' unique bio-physical opportunities and constraints. The programme has established one pilot site in each country for trialling and fine-tuning the implementation of the water-sensitive interventions (eg, constructability). These also serve as demonstration and stakeholder-engagement platforms during the co-design phase of the programme. The RISE programme is pioneering a new approach to informal settlement upgrading that is underpinned by the emerging discipline of planetary health. It will provide new evidence linking environment and human health in some of the world's poorest and most vulnerable urban environments. Implementation in Fiji and Indonesia is ongoing, and baseline data will be available in mid-2018. Valuable lessons have been learned during the first year of implementation. These include how to operationalise meaningful interdisciplinary research across diverse disciplines, comprising science, engineering, medicine, architecture, urban design, economics, sociology, anthropology, and international development. Funding Wellcome Trust. Contributors All authors contributed to the study design and data collection, analysis, and interpretation. Declaration of interests We declare no competing interests. Acknowledgments RISE is principally funded by the Wellcome Trust's Our Planet, Our Health programme, with additional support from the participating universities, Fijian and Indonesian governments, and industry partners (Melbourne Water and South East Water).