Handbook of Global Urban Health

Igor Vojnovic, Amber Pearson, Gershim Asiki, Geoff DeVerteuil, Adriana Allen, Igor Vojnovic, Amber L. Pearson, Gershim Asiki, Geoff DeVerteuil, Adriana Allen

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781315465432
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Sociologie

Through interdisciplinary and multidisciplinary perspectives, and with an emphasis on exploring patterns as well as distinct and unique conditions across the globe, this collection examines advanced and cutting-edge theoretical and methodological approaches to the study of the health of urban populations. Despite the growing interest in global urban health, there are limited resources available that provide an extensive and advanced exploration into the health of urban populations in a transnational context.

This volume offers a high-quality and comprehensive examination of global urban health issues by leading urban health scholars from around the world. The book brings together a multi-disciplinary perspective on urban health, with chapter contributions emphasizing disciplines in the social sciences, construction sciences and medical sciences. The co-editors of the collection come from a number of different disciplinary backgrounds that have been at the forefront of urban health research, including public health, epidemiology, geography, city planning and urban design.

The book is intended to be a reference in global urban health for research libraries and faculty collections. It will also be appropriate as a text for university class adoption in upper-division under-graduate courses and above. The proposed volume is extensive and offers enough breadth and depth to enable it to be used for courses emphasizing a U.S., or wider Western perspective, as well as courses on urban health emphasizing a global context.

PART 1

Urban Health

An Introduction and Overview

1

GLOBAL URBAN HEALTH

Inequalities, Vulnerabilities, and Challenges in the 21st Century

Igor Vojnovic, Amber L. Pearson, Gershim Asiki, Geoffrey DeVerteuil and Adriana Allen

Throughout history, health concerns have been particularly focused on areas of high population concentration, and hence the interest in public health in cities, in both high- and low-income settings. Each city maintains its own uniqueness and complexity, defined by its often diverse population, geographic setting, built form (including infrastructural support), governance capacity, and historical context. Intricate urban socio-demographic patterns, as sites of concomitant extreme wealth and poverty, marginalization of some sub-populations (such as indigenous groups and minorities), the aging imprint of residents, fertility, and migratory movements, along with the numbers and concentration of city dwellers, shape unique imprints on local public health (Baeza et al. 2018; LeDoux and Vojnovic 2013; Pearson et al. 2013; Satterthwaite et al. 2018; Vlahov et al. 2007; Vojnovic 2006, 2013, 2014; Vojnovic and Darden 2013). Ultimately, these variables have all influenced the condition and lifecycle dynamics of cities and the health of their residents from the past to the present.

Cities are also market hubs and centers of trade, and, coupled with their political, social, cultural, and institutional structure, these features have all influenced health outcomes and the distinct capacities of cities to provide healthcare services and to prevent or address emerging health challenges. From being key activity nodes in transportation and trade networks, to being sites of unparalleled population densities and the concentration of human activities—including production, consumption, and the resulting pollutant emissions and wastes—it is a complex set of factors that is responsible for influencing urban health outcomes (Baeza et al. 2018; Satterthwaite et al. 2018; Vlahov et al. 2007; Vojnovic 2006, 2013, 2014; Vojnovic and Darden 2013). Moreover, before the first decade of the 21st century came to a close, more than half of the world population was living in urban centers, bringing health challenges within cities—which are closely intertwined with political, economic, and environmental conditions—to the forefront of global health concerns, and resulting actions and policies.

With their concentrated populations and their distinct infrastructural support, cities have a unique capacity for potential infectious disease transmission, among other public health challenges. The urban form itself can also either promote or hinder healthy behaviors, including through the provision of basic infrastructure (such as water, sewage, and public transportation), healthy food options (Pearson and Wilson 2013), and neighborhood walkability and connectivity (Lovasi et al. 2008), and by accommodating for places to engage in relaxation, recreation, and physical activity (Nutsford et al. 2013). In addition to physical health, increasingly the mental health consequences and benefits of features of the urban social, natural, and built environments are under investigation in an effort to combat the increasing global health burden of depression and anxiety (Lim et al. 2012). For example, recent research has shown that, for residents living in a major urban center, increased views of blue space—bodies of water such as rivers, lakes, and oceans—is associated with lower psychological distress (Nutsford et al. 2016).

Equally important within the context of evolving global urban conditions, studies have shown that concentrated poverty and neighborhood disorder—including vacant housing, drug sales, and robbery—within cities hinder mental health, which in turn reinforces cycles of poverty (Anakwenze and Zuberi 2013; Lambert et al. 2015). Conversely, these same areas contain many of the key support services for those with mental illness (Wolch and Philo 2000) and substance abuse issues (DeVerteuil and Wilton 2009), a co-location that is problematic but also increasingly irreplaceable when faced with the threat of widespread gentrification (DeVerteuil 2015a). This tension between vulnerability and support in urban areas for those with mental health and substance abuse issues will be explored further later in this chapter.

Into the 21st century, with continued inequality, pressures on public budgets, and increasing urbanization—coupled in some regions, as in Africa and Asia, with expanding socio-political instability and civil unrest—political and humanitarian concerns, funding, programs, and coordinated action on global urban health have in many ways come into even more intense focus. This was evident, in part, with 189 countries signing the United Nations Millennium Declaration in September of 2000 (U.N. 2000), advancing eight Millennium Development Goals (MDGs). Some of these millennium targets were also directly health related, including eradicating extreme poverty and hunger, reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases.

The MDGs were time-bound targets, with an assessment expected in 15 years from when the Declaration was signed. By the time of assessment in 2015, there were promising outcomes, with many targeted strategies and interventions showing positive results. Over a period of two and a half decades, extreme poverty was more than halved, from 1.9 billion in 1990 to 836 million in 2015, and the proportion of undernourished people in lower-income regions of the world was reduced from 23.3% in 1990–1992 to 12.9% in 2014–2016 (U.N. 2015a). In addition, between 1990 and 2015, the global under-five mortality rate had declined by more than half, being reduced from 90 to 43 deaths per 1,000 live births, with the number of deaths of children under five declining globally from 12.7 million in 1990 to almost 6 million in 2015 (U.N. 2015a).

The study of the health of urban populations and sub-populations, however, is complex, taking on distinct dimensions at different geographic scales, during particular periods of history, and in specific global contexts. Global urban health challenges and outcomes are also shaped by culture, socio-political and economic conditions, networks, national to local institutional capacity, (neo)colonial practices, natural disasters, and technological access. This connects to a growing interest in how cities relate to each other, not just in terms of uneven networks of knowledge, people, and trade, but also in terms of networked diseases (Ali, S. and Keil 2008). The complexity of 21st century conditions is illustrated in the discussion below on the diversity and dynamics of global urban health stresses, and their implications and impacts at different spatial scales.

In the 21st century, growing global interconnections and the speed of travel have transformed the spread of (and speed of spread of) infectious disease and related epidemic control. The 2014 Ebola virus epidemic in West Africa—traced back to the death of a two-year-old child on December 6, 2013 in a small and remote Guinean village, Meliandou—would eventually result in over 28,000 cases and over 11,000 deaths worldwide (Baize et al. 2014). The outbreak, reported in March of 2014, would spread across Guinea, its villages, towns, and cities, and cross the borders into proximate Sierra Leone and Liberia. The Ebola epidemic would eventually reach the capital cities of Conakry (Guinea), Monrovia (Liberia), and Freetown (Sierra Leone). Whole towns were quarantined to end the spread of the virus. Cases and deaths from Ebola would also be reported as far as London (U.K.) and New York City and Dallas (U.S.), as health workers returning home from assisting with the outbreak in West Africa carried the virus back with them. Since this time, emerging, re-emerging, and endemic infections have greatly impacted numerous countries, sometimes on an annual basis, from Zika virus to influenza. Indeed, over the last 10,000 years, infectious diseases have influenced the evolution of humans, and the end of their influence on life and death in cities does not appear to be in sight.

Ebola is one among many emerging and previously unknown diseases. Others include Sars and Zika, which have spread without warning, with devastating consequences for vulnerable urban dwellers, particularly for pregnant women and infants. Between 2007 and 2016 Zika expanded from remote areas to high-density urban informal settlements. Zika became an explosive threat in 65 countries—amidst possible outbreaks in Africa, the Pacific Islands, the Americas, and Southeast Asia—with the largest number of cases reported in Brazil, the Caribbean, and several Central and South American countries (Ali, A. et al. 2017).

In Brazil, Zika was first identified in 2014 and spread rapidly through the country, reaching over 190,000 by 2016 and an additional almost 10,000 cases reported in 2017 alone. According to the Brazilian Ministry of Health, Zika was responsible for thousands of children born with microcephaly, almost half of them from single mothers. Poor information on contraception, lack of awareness of the fact that Zika can be sexually transmitted, and criminalized abortion are all compounding factors affecting disproportionally women in low-income settlements.

Lack of running water coupled with poor sanitation creates perfect breeding conditions for the Aedes aegypti mosquito that spreads Zika. In Brazil’s poor, dry northeast and other parts of South America, thousands of children living in urban areas have been affected by epilepsy, myopia, and visual impairment among many other disabilities after their mothers were infected by the Zika virus. In cities like Recife, those affected are known as the “Zika children” and treated mostly by charitable organizations.

Also in 2014, very different urban health crises were evolving in countries across Africa and into Asia, with protests, revolutions, and political and ethnic conflicts erupting into civil wars, mass casualties, and displacement, at scales never previously witnessed. U.N.H.C.R. (2018), the U.N. Refugee Agency, estimated that by the end of 2017 the numbers of forcibly displaced people worldwide was 68.5 million. One thread to this latest round of socio-political unrest could be traced back to the beginning of the 21st century, to the events and actions stemming from the September 11, 2001 coordinated al-Qaeda terrorist attacks on the U.S. The downing of the flights in New York City and Washington, DC killed close to 3,000 people. The U.S. and coalition forces responded with the invasions of Afghanistan in 2001 and Iraq in 2003, triggering an added round of instability across Asia and Africa. This regional volatility has been unfolding for more than a decade and a half now, being driven by the invasions themselves, erupting sectarian violence, continuing attacks by evolving terrorist organizations, and also, in part, the promise of more democratic rule, or at least the possibility of over-throwing political despots. These evolving and coupled socio-political and public health crises also illustrate the growing relevance of a globalizing world, where at the same time the manifestation and most severe impacts produce stresses with critical urban dimensions.

The invasion of Iraq by the U.S.-led coalition in March of 2003 in itself effectively illustrates the complexity of humanitarian and urban public health challenges during wartime. The public health crisis, and particularly urban health crisis, following the invasion was immediate. A study published in the Lancet conservatively estimated that in Iraq, between March 2003 and September 2004, some 100,000 deaths were attributed to the invasion (Roberts et al. 2004). The study also recognized that two-thirds of the violent deaths were reported in one city, Falluja, which was excluded from the initial estimates because of the high mortality in this urban cluster. Falluja was likely the city with the most violence in Iraq, making it an outlier whose inclusion in the study would have skewed the mortality estimates.

An updated study was published in Lancet by the same research group, and it showed that by July of 2006 there were over 650,000 Iraqi deaths attributed to the war (Burnham et al. 2006). Les Roberts (2013, p. 85), a leading member of the research team, revealed that there might have been as many as 200,000 deaths in just the Falluja cluster. These and other longer-term studies, including covering the post-2006 period, would also show that Baghdad was another war-related, high-mortality cluster (Hagopian et al. 2013; Lafta et al. 2015), illustrating the acute urban health pressures experienced in cities during war, owing in part to the high population concentrations.

In addition to the deaths and injuries from violence, there were public health challenges resulting from the invasion and ongoing civil unrest, including the large-scale displacement of the Iraqi population. Over a period of about four years—from the point of th...