Urban Health Inequalities Research Articles

O1-1.3 The social and environmental determinants of urban health inequities in low and middle income countries: findings from the Rockefeller Foundation Global Research Network on Urban Health Equity

Throughout the 20th and 21st centuries, our increasingly urban world has seen significant improvements in indicators of health and life expectancy. However there are marked geo-spatial, socio-economic and socio-cultural differences...

Ill-health and poverty: a literature review on health in informal settlements

This paper reviews the literature on health in the informal settlements (and “slums”) that now house a substantial proportion of the urban population in Africa, Asia and Latin America. Although this highlights some important gaps in research, available studies do suggest that urban health inequalities usually begin at birth, are reproduced over a lifetime (often reinforced by undernutrition), and may be recreated through vulnerabilities to climate change and a “double burden” of communicable and non-communicable diseases. The review begins with a discussion of papers with a life-course perspective on health, poverty and housing, before considering recent literature on chronic poverty and ill-health over time. It then discusses the literature on the cost, quality and access to care among low-income groups, and the under-recognized threat of unintentional injuries. This includes recent literature that discusses where low-income residents may suffer an “urban penalty” rather than benefiting from urban bias — although there are also studies that show the effectiveness of accessible, pro-poor health care. The concluding section examines emerging risks such as non-communicable diseases and those associated with climate change. It notes how more gender- and age-sensitive strategies can help address the large inequalities in health between those in informal settlements and other urban residents. With greater attention to the multi-faceted needs of low-income communities, governments can create interventions to ensure that urban centres fulfil their enormous potential for health.

Revisiting urban health and social inequalities: the devil is in the detail and the solution is in all of us

This paper considers how the subject of urban inequalities has come to be given more consideration within the discussions of urban poverty and urban health. It suggests a need for more precision in understanding and acting on such inequalities — and discusses how measurement and policy response are influenced by whether the focus is on urban poverty, differentials, inequality or inequity. Many authors fail to clarify the difference between a differential, an unequal and an unjust distribution of services or resources, or health outcomes. This paper discusses what aspects of inequality can and cannot be addressed through conventional local government interventions (for instance, in upgrading informal settlements or public transport, or water pricing). It argues that to change urban inequalities at root, we have to recognize and address unjust distributions of power and control of resources.

Income-related inequalities of health and health care utilization

By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China’s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of health care utilization accounts for 0.13–0.2; insurance also enlarges the inequality of health care utilization; health inequality in rural area is larger than that of in urban area; and both rural and urban health inequality are increasing. From 1991 to 2006, income changes in urban districts and rural area account for 7.08% and 13.38% respectively of raising inequality of rural and urban health.

Closing the gap in urban health inequities

The recently released report, 'Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health' (hereafter, the Report),1 issued by the World Health Organization's Commission on Social Determinants of Health (hereafter, the Commission), provides actionable recommendations for achieving health equity on a global scale, and doing so with urgency: within one generation. In framing health inequality as an issue of social justice and by addressing the structural drivers of health inequity, the Commission acknowledges that we must expand on the traditional approach of highlighting biomedical pathways and their proximate causes. This acknowledgment, and the focus on timely action, must be applauded. Several key areas in the Report, however, could be improved.

Income and Health in Cities: the Messages from Stylized Facts

The benefits of good health to individuals and to society are strongly positive, and improving the health of the poor is a key millennium development goal (MDG). A typical health strategy advocated by some calls for increased public spending on health targeted to favor the poor backed by foreign assistance, combined with an international effort to perfect drugs and vaccines to ameliorate the major infectious diseases prevalent in developing nations. However, if the objective is better health outcomes at the least cost and a reduction in urban health inequity, our research suggests that the four most potent policy interventions are: improving access to clean water and sanitation; widely available primary care and health programs aimed at influencing diets and lifestyles; raising the level of education; and better urban land use and transport planning which contains urban sprawl and minimizes the trend towards sedentary living habits. The payoff from these four, in terms of health outcomes especially for those in low-income categories, dwarfs the returns from new drugs and curative hospital-based medicine, although these certainly have their place in a modern urban health system. We find, moreover, that the resource requirements for successful health care policies are likely to depend on an acceleration of economic growth rates, which increase household purchasing power and enlarge the pool of resources available to national and subnational governments to invest in and maintain health-related infrastructure and services. Thus, an acceleration of growth rates may be necessary to sustain a viable urban health strategy, which is equitable, and to ensure steady gains in health outcomes.

Urban development and health inequalities

Urban development and health inequalities

Urban development and health inequalities

Urban development has historically been seen as both a cause and solution for social inequalities in health. However, environmental and individual gradients within urban areas occur everywhere, and are resistant to change. Environments are influenced by the degree and type of industrialization, quality of housing, accessibility to green space and - of increasing concern - transport. Individual behaviour, however, also contributes to social differences, both through migration and by the effects on individuals of cultural experiences through the life-course. Reduction on inequalities may be possible through larger social action, for example urban regeneration. There remains an important role for public health in addressing determinants of health at the population level.

Urban development and health inequalities

Urban development and health inequalities

Urban Air Pollution and Health Inequities: A Workshop Report

Over the past three decades, an array of legislation with attendant regulations has been implemented to enhance the quality of the environment and thereby improve the public's health. Despite the many beneficial changes that have followed, there remains a disproportionately higher prevalence of harmful environmental exposures, particularly air pollution, for certain populations. These populations most often reside in urban settings, have low socioeconomic status, and include a large proportion of ethnic minorities. The disparities between racial/ethnic minority and/or low-income populations in cities and the general population in terms of environmental exposures and related health risks have prompted the "environmental justice" or "environmental equity" movement, which strives to create cleaner environments for the most polluted communities. Achieving cleaner environments will require interventions based on scientific data specific to the populations at risk; however, research in this area has been relatively limited. To assess the current scientific information on urban air pollution and its health impacts and to help set the agenda for immediate intervention and future research, the American Lung Association organized an invited workshop on Urban Air Pollution and Health Inequities held 22-24 October 1999 in Washington, DC. This report builds on literature reviews and summarizes the discussions of working groups charged with addressing key areas relevant to air pollution and health effects in urban environments. An overview was provided of the state of the science for health impacts of air pollution and technologies available for air quality monitoring and exposure assessment. The working groups then prioritized research needs to address the knowledge gaps and developed recommendations for community interventions and public policy to begin to remedy the exposure and health inequities.

Urban Air Pollution and Health Inequities: A Workshop Report

Urban Air Pollution and Health Inequities: A Workshop Report

Urban air pollution and health inequities: a workshop report.

Urban air pollution and health inequities: a workshop report.