17 Feb 2005 11:16 AR AR238-PU26-15.tex AR238-PU26-15.sgm LaTeX2e(2002/01/18) P1: IBD 10.1146/annurev.publhealth.26.021304.144708 Annu. Rev. Public Health 2005. 26:341–65 doi: 10.1146/annurev.publhealth.26.021304.144708 Copyright c 2005 by Annual Reviews. All rights reserved First published online as a Review in Advance on August 18, 2004 URBAN HEALTH: Evidence, Challenges, and Directions Sandro Galea and David Vlahov Center for Urban Epidemiologic Studies, New York Academy of Medicine, and Department of Epidemiology, Joseph T. Mailman School of Public Health, Columbia University, New York, NY 10029; email:
[email protected];
[email protected] KeyWords multilevel, methods, social epidemiology, cities, mechanisms ■ Abstract Urbanization is one of the most important demographic shifts world- wide during the past century and represents a substantial change from how most of the world’s population has lived for the past several thousand years. The study of urban health considers how characteristics of the urban environment may affect population health. This paper reviews the empirical research assessing urban living’s impact on population health and our rationale for considering the study of urban health as a dis- tinct field of inquiry. The key factors affecting health in cities can be considered within three broad themes: the physical environment, the social environment, and access to health and social services. The methodologic and conceptual challenges facing the study of urban health, arising both from the limitations of the research to date and from the complexities inherent in assessing the relations among complex urban systems, disease causation, and health are discussed.