Urban Health Inequalities Research Articles

Water, Sanitation and Diarrhoeal Diseases in Nouakchott (Mauritania): Analysing the Determinant of Urban Health Inequalities

The lowest access to water and sanitation services in the city of Nouakchott leads to several practices and behaviours that create a social-ecological system which increasing risk of waterborne diseases transmission like diarrhoea. Using environmental, socio-economic and epidemiologic indicators from national statistic services, this study aims to assess the impact of Nouakchott’s social-ecological system on diarrhoeal diseases with particular emphasize on vulnerability to environmental health risks according to water and sanitation status. The results showed that respectively 25.6% and 69.8% of households had access to improved water sources and latrines with a large variability according to municipalities. The diarrhoeal morbidity (12.8%) was higher in dense urban areas where the lack of water supply and sanitation facilities affected mainly poor households (20.8% of the population). However, diarrhoeal risk is spatially variable in accordance to environmental sanitation disparities with a rate rising from 9.1% in municipalities with high level of improved water and latrines to 19.1% in communities with a lower level of ecosystem services. The correlation analysis between socio-economic, environmental and epidemiological variables reveals significant associations. Thus, the dynamic of social-ecological system demonstrated that environmental factors linked to unimproved drinking Water sources and sanitation services were the main driver of diarrhoeal diseases transmission in some municipalities. The reality of the linkage between health risks due to diarrhoea and urban environmental conditions addresses the issues of the Sustainable Development Goals (SDG) Health and Wellbeing and Water and Sanitation services in Mauritania context.

Mapping Urban Geographies of Food and Dietary Health: A Synthesized Framework

AbstractThis paper develops a theoretical and conceptual framework for research on urban geographies of food and dietary health. This framework conceptualizes urban dietary health inequities as produced relationally through multiscalar social, political, economic, and biological processes intersecting in place‐specific ways. It synthesizes perspectives from spatial analytical food access research, relational health geographies, political ecologies, and critical geographic information science (GIS). Recognizing the importance of relational, dynamic conceptions of both spatial context and human health, it suggests extending current approaches by integrating critical GIS methodologies for producing alternative spatial representations and political ecology's theorization of urban spaces as produced through the intersection of multiscalar social and ecological processes. Reflecting political ecological and critical GIS perspectives, it also emphasizes that (spatial) knowledge production processes materially impact urban environments and human health.

Addressing Inequities in Urban Health: Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015.

Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO’s Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities.

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde.

BackgroundThe lack of high-quality data to support evidence-based policies continues to be a concern in African cities, which present marked social, economic and cultural disparities that may differently impact the health of the groups living in different urban contexts. This study explores three urban units—formal, transition and informal—of the capital of Cape Verde, in terms of overweight/obesity, cardiometabolic risk, physical activity and other aspects related to the urban environment.MethodsQuantitative and qualitative research methods were used in this intra-urban study. A proportional stratified random sample (n = 1912 adults), based on geographical coordinates of private households, was selected to apply the UPHI-STAT questionnaire. In a second stage (n = 599), local nutritionists collected anthropometric measurements (e.g., height, waist circumference) and body composition by bioelectric impedance (e.g., body weight, body fat, muscle mass). In a third stage, pedometers were used to count study participants’ steps on working and non-working days for one week (n = 118). After a preliminary statistical analysis, a qualitative study was developed to complement the quantitative approach. Generalized linear models, among others, were used in the multivariate analysis.ResultsInsecurity was the main concern among survey respondents in the three units, notwithstanding with significant differences (p < 0.001) among units. About three-quarters (76.6%) of the participants of the informal unit emphasised the need for more security. The formal unit presents an older age structure (61.3% above 40 years old) and the transition unit a younger age structure (only 30.5% above 40 years old). Some health-related variables were analysed in each unit, revealing an excess of chronic conditions reported by inhabitants of informal unit, compared with the formal unit despite the informal unit’s younger age profile. The self-reported hypertension varied significantly among urban units (p < 0.001), with 19.3% in the formal unit, 11.4% in the transition unit and 22.5% in the informal unit. Women of the urban units present significant differences (5% level) for body mass index calculated from self-reported measures (p < 0.001), fat mass (p = 0.005), waist circumference (p = 0.046) and waist-to-height ratio (p = 0.017). For women, overall physical activity was 67.4% (95%CI [64.8,70.0]), with differences among urban units (p = 0.025). For men it was of 85.2% (95%CI [82.3,87.6]), without significant differences among urban units (p = 0.266). The percentage of women and men who reported physical activity in leisure time was discrepant, with 95%CI [22.6, 27.4] and [53.2, 60.2], respectively. The results of pedometers also indicated that men walk significantly more than women (p < 0.001), with a difference of approximately 2000 steps/day.ConclusionsThe data collection process itself also gave us some clues on the involvement of local communities, exploring the potential of social capital of these settings and the role of the woman in family and society in Cape Verde. The higher participation of women and residents of informal unit (the most disadvantaged groups) suggests these as the priority target groups for health promotion campaigns. The link between health planning, urban planning and security of the city needs to be reinforced to minimize health, social and gender inequalities.

Disaggregating health inequalities within Rio de Janeiro, Brazil, 2002-2010, by applying an urban health inequality index.

An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain.

Spatial Indicators For Decision Making To Reduce Urban Health Inequalities

Spatial Indicators For Decision Making To Reduce Urban Health Inequalities

Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach

Introduction: Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. Methods: We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. Discussion: In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. Conclusion: This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation.

Informal settlements and a relational view of health in Nairobi, Kenya: sanitation, gender and dignity.

On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions.

What type of rural? Assessing the variations in life expectancy at birth at small area-level for a small population province using classes of locally defined settlement types.

BackgroundAlthough efforts have been made to articulate rural–urban health inequalities in recent years, results have been inconsistent due to different geographical scales used in these studies. Small-area level investigations of health inequalities will likely show more detailed pictures of health inequalities among diverse rural communities, but they are difficult to conduct, particularly in a small population region. The objectives of this study were: 1) to compare life expectancy at birth for females and males across small-areas classified by locally defined settlement types for a small province in Canada; 2) to assess whether any of the settlement types explains variations in life expectancy over and above the extent of socioeconomic disadvantage and social isolation; and 3) to examine variations in life expectancies within a (larger) area unit used as the basis of health inequality investigations in previous studies.MethodsSeven settlement types were determined for the ‘community’ units based on population per-kilometre-road density and settlement forms. Mean life expectancies at birth for both genders were compared by settlement type, both for the entire province and within the Halifax Regional Municipality—the province's only census designated metropolitan area, but also contains rural settlements. Linear regression analyses were conducted to assess the statistical associations between life expectancy and the settlement types, adjusting for indicators of community-level deprivation.ResultsWhile types of communities considered as ‘rural’ generally had lower life expectancy for both genders, the effects of living in any settlement type were attenuated once adjusted for socioeconomic deprivation and social isolation. An exception was the village and settlement cluster type, which had additionally negative effects on health for females. There were some variations observed within the Halifax Regional Municipality, suggesting the importance of further investigating a variety of health and disease outcomes at smaller area-levels than those employed in previous studies.ConclusionsThis paper highlighted the importance of further articulating the differences in the characteristics of rural at finer area-levels and the differential influence they may have on health. Further efforts are desirable to overcome various data challenges in order to extend the investigation of health inequalities to hard-to-study provinces.

Looking within and beyond the community: Lessons learned by researching, theorising and acting to address urban poverty and health

Urban poverty and health inequalities are inextricably intertwined. By working in partnership with service providers and communities to address urban poverty, we can enhance the wellness of people in need. This article reflects on lessons learned from the Family100 project that explores the everyday lives, frustrations and dilemmas faced by 100 families living in poverty in Auckland. Lessons learned support the need to bring the experiences and lived realities of families to the fore in public deliberations about community and societal responses to urban poverty and health inequality.

Right to a healthy city? Examining the relationship between urban space and health inequity by Aboriginal youth artist-activists in Winnipeg

This paper explores the relationship between place and health inequity as experienced by Aboriginal youth living in Winnipeg, Canada. Between 2010 and 2011, a team of youth (N = 8) associated with a community-based Aboriginal youth arts program undertook a participatory community mapping process in order to link their personal health geographies to their right to the city. The results demonstrated several ways in which place, mobility, and boundaries affected their health experiences and, in turn, reflected their perceptions of health inequity. The study confirms that urban spaces can produce, and are produced by, highly racialized geographies that work to socially isolate, segregate, and immobilize Aboriginal youth while concomitantly increasing their exposure to higher risks to their health and well being.

China’s Growing Urban Health Inequalities: The Challenges Ahead

China is undergoing a rapid transformation from a rural, peasant based society into an urban one. This radical change has had a profound effect on the Chinese population due to advancement through job opportunities and new modes of consumption, contributing to a huge spatial shift of population from countryside to city. This effect on China’s urban growth has resulted in a rise in the middle classes and in wealth. However this urban growth generates a number of key health issues and inequities, which present challenges for the future. The purpose of this paper is to explore these health issues and challenges that China’s urbanization growth poses. The policyimplications will be significant.

Health, poverty, and place in Accra, Ghana: mapping neighborhoods

The overall objective of our research project is to understand the spatial inequality in health in Accra, the capital city of Ghana. We also utilize GIS technology to measure the association of adverse health and mortality outcomes with neighborhood ecology. We approached this in variety of ways, including multivariate analysis of imagery classification and census data. A key element in the research has been to obtain in-person interviews from 3200 female respondents in the city, and then relate health data obtained from the women to the ecology of the neighborhoods in which they live. Detailed maps are a requirement for these field-based activities. However, commercially available street maps of Accra tend to be highly generalized and not very useful for the kind of health and social science research being undertaken by this project. The purpose of this paper is to describe street maps that were created for the project's office in downtown Accra and used to locate households of respondents. They incorporate satellite imagery with other geographic layers to provide the most important visual interpretation of the linkage between imagery and neighborhoods. Ultimately, through a detailed analysis of spatial disparities in health in Accra, Ghana, we aim to provide a model for the interpretation of urban health inequalities in cities of urbanizing and often poor countries.

Out of our inner city backyards: Re-scaling urban environmental health inequity assessment

In this paper, we report the results of a three-year research project (2008–2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city.

HEALTH INEQUALITIES AMONG URBAN CHILDREN IN INDIA: A COMPARATIVE ASSESSMENT OF EMPOWERED ACTION GROUP (EAG) AND SOUTH INDIAN STATES

As India rapidly urbanizes, within urban areas socioeconomic disparities are rising and health inequality among urban children is an emerging challenge. This paper assesses the relative contribution of socioeconomic factors to child health inequalities between the less developed Empowered Action Group (EAG) states and more developed South Indian states in urban India using data from the 2005-06 National Family Health Survey. Focusing on urban health from varying regional and developmental contexts, socioeconomic inequalities in child health are examined first using Concentration Indices (CIs) and then the contributions of socioeconomic factors to the CIs of health variables are derived. The results reveal, in order of importance, pronounced contributions of household economic status, parent's illiteracy and caste to urban child health inequalities in the South Indian states. In contrast, parent's illiteracy, poor economic status, being Muslim and child birth order 3 or more are major contributors to health inequalities among urban children in the EAG states. The results suggest the need to adopt different health policy interventions in accordance with the pattern of varying contributions of socioeconomic factors to child health inequalities between the more developed South Indian states and less developed EAG states.

Barriers to knowledge production, knowledge translation, and urban health policy change: ideological, economic, and political considerations.

In this paper, we consider social forces that affect the processes of both knowledge production and knowledge translation in relation to urban health research. First, we briefly review our conceptual model, derived from a social-conflict framework, to outline how unequal power relations and health inequalities are causally linked. Second, we critically discuss ideological, political, and economic barriers that exist within academia that affect knowledge production related to urban health and health inequalities. Third, we broaden the scope of our analysis to examine how the ideological, political, and economic environment beyond the academy creates barriers to health equity policy making. We conclude with some key questions about the role that knowledge translation can possibly play in light of these constraints on research and policy for urban health.

Urban Inequities; Urban Rights: A Conceptual Analysis and Review of Impacts on Children, and Policies to Address Them

This paper explores current conceptual understanding of urban social, environmental, and health inequality and inequity, and looks at the impact of these processes on urban children and young people in the 21st century. This conceptual analysis was commissioned for a discussion paper for UNICEF's flagship publication: State of the World's Children 2012: Children in an Urban World. The aim of the paper is to examine evidence on the meaning of urban inequality and inequity for urban children and young people. It further looks at the controversial policies of targeting "vulnerable" young people, and policies to achieve the urban MDGs. Finally, the paper looks briefly at the potential of concepts such as environment justice and rights to change our understanding of urban inequality and inequity.

No Data, No Problem, No Action: Addressing Urban Health Inequity in the 21st Century

No Data, No Problem, No Action: Addressing Urban Health Inequity in the 21st Century

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

Climate change will likely exacerbate already existing urban social inequities and health risks, thereby exacerbating existing urban health inequities. Cities in low- and middle-income countries are particularly vulnerable. Urbanization is both a cause of and potential solution to global climate change. Most population growth in the foreseeable future will occur in urban areas primarily in developing countries. How this growth is managed has enormous implications for climate change given the increasing concentration and magnitude of economic production in urban localities, as well as the higher consumption practices of urbanites, especially the middle classes, compared to rural populations. There is still much to learn about the extent to which climate change affects urban health equity and what can be done effectively in different socio-political and socio-economic contexts to improve the health of urban dwelling humans and the environment. But it is clear that equity-oriented climate change adaptation means attention to the social conditions in which urban populations live-this is not just a climate change policy issue, it requires inter-sectoral action. Policies and programs in urban planning and design, workplace health and safety, and urban agriculture can help mitigate further climate change and adapt to existing climate change. If done well, these will also be good for urban health equity.

Social conditions and urban health inequities: realities, challenges and opportunities to transform the urban landscape through research and action.

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.