Abstract
Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.
Highlights
Few urban initiatives have greater potential to promote health equity and to advance the well-being of poor households in the Global South than participatory, multi-objective slum upgrading.Urban informal settlements are communities that are highly diverse and have a range of locally-specific names
We suggest that the lack of evaluations for urban slum upgrading is a lost opportunity for improving understanding of what can work for global health
Urban slum upgrading is a process and set of outcomes that can positively influence multiple determinants of health and potentially reduce health inequities experienced by the urban poor
Summary
Few urban initiatives have greater potential to promote health equity and to advance the well-being of poor households in the Global South than participatory, multi-objective slum upgrading.Urban informal settlements are communities that are highly diverse and have a range of locally-specific names (such as barrios, bustees, mjondolo, or favelas). Few urban initiatives have greater potential to promote health equity and to advance the well-being of poor households in the Global South than participatory, multi-objective slum upgrading. We use the terms “slums” and “informal settlements” to denote largely self-built urban communities, which are rarely recognized officially and typically are denied life-supporting services and infrastructure. Can upgrading these settlements improve health outcomes via enhanced access to shelter, water, or clean energy, but it can advance the 2030 Agenda for Sustainable Development. The 2030 Agenda has established 17 interrelated Sustainable Development Goals (SDGs), which will require implementing multi-sectoral strategies to support health and well-being and include explicit reference to slum upgrading. As we will highlight, upgrading projects are rarely designed to explicitly improve nor are they evaluated for how well they have positively shaped the social determinants of slum health
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