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Our Cities, Our Health, Our Future Acting on Social Determinants for Health Equity in Urban Settings

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Our Cities, Our Health, Our Future Acting on Social Determinants for Health Equity in Urban Settings Our cities, our health, our future Acting on social determinants for health equity in urban settings Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings Disclaimer/Statement for work published by Knowledge Networks (KNs) This work was made possible through funding provided by the World Health Organization (WHO) and the institutions where the writers were employed. It was undertaken for the Knowledge Network on Urban Settings (KNUS), established as part of the WHO Commission on Social Determinants of Health. The views expressed in this publication are those of the authors and do not necessarily represent the decisions, policy or views of WHO or Commissioners. © World Health Organization 2008 All rights reserved. Requests for permission to reproduce or translate WHO Centre for Health Development publications – whether for sale or for noncommercial distribution – should be addressed to the WHO Centre for Health Development, I.H.D. Centre Building, 9th Floor, 5-1, 1-chome, Wakinohama- Kaigandori, Chuo-ku, Kobe City, Hyogo Prefecture, 651-0073, Japan (fax: +81 78 230 3178; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Japan. TABLE OF CONTENTS ACKNOWLEDGEMENTS ······························································································ i ACRONYMS ·············································································································· ii FOREWORD ············································································································· iii EXECUTIVE SUMMARY ······························································································· vi 1. INTRODUCTION ···································································································· 1 2. URBANIZATION AND THE URBAN SETTING AS HEALTH DETERMINANTS ························· 5 2.1 Urbanization in a global context ········································································ 5 2.2 Slum formation with rapid urbanization ······························································ 6 2.3 A conceptual framework for urban health ··························································· 8 2.4 The economics of urban health development ······················································· 9 2.5 Poverty, deprived urban living conditions and health vulnerability ·························· 11 2.6 Healthy urban governance ················································································ 12 3. THE URBAN HEALTH SITUATION ············································································· 14 3.1 Burden of disease and communicable diseases ····················································· 14 3.2 Injuries and violence ······················································································· 16 3.3 Mental health and substance abuse ···································································· 18 3.4 Noncommunicable diseases and nutritional disorders ············································ 19 4. KEY ISSUES AND CHALLENGES IN ACHIEVING HEALTH EQUITY ····································· 21 4.1 Environmental health threats in the home and neighbourhood ······························· 21 4.2 Environmental health threats in the wider urban area ·········································· 25 4.3 Health threats at work ···················································································· 25 4.4 Urban health impacts of global resource depletion and environmental change ·········· 26 4.5 Health care systems and emergency services ······················································· 28 4.6 Gender and women’s health equity issues ··························································· 29 4.7 Other vulnerable groups ·················································································· 30 5. A BROAD SPECTRUM OF INTERVENTIONS ································································· 31 5.1 Building trust, social capital and social cohesion ·················································· 31 5.2 A range of specific interventions ······································································· 32 5.3 Interventions through primary health care ·························································· 36 5.4 Conditional cash transfers: global social welfare support ······································· 37 5.5 Healthy Settings and Healthy Cities approaches to interventions ···························· 38 5.6 Urban development planning and investment to avoid new slum formation ·············· 39 5.7 Good governance bringing together all interventions ············································ 41 6. APPROACHES AND POLICIES TO MAKE INTERVENTIONS HAPPEN ·································· 42 6.1 Toward an integrated approach to reducing health inequity ··································· 42 6.2 Health, a rallying point for achieving improved life quality ···································· 43 6.3 Microfinance and local investment ····································································· 43 6.4 The global investments required for health equity ··············································· 44 6.5 A fairer distribution of resources for health ························································· 47 7. CONCLUSIONS AND RECOMMENDATIONS ·································································· 48 7.1 The urban setting as a health determinant ·························································· 48 7.2 The urban health situation ··············································································· 49 7.3 Key issues and concepts of health equity impacts ················································· 50 7.4 A broad spectrum of interventions ····································································· 51 7.5 Approaches and policies to make interventions happen ········································· 55 ENDNOTES ·············································································································· 58 BIBLIOGRAPHY ········································································································· 66 LIST OF TABLES Main Report 1 Infant and under-five mortality rates in Nairobi, Kenya, Sweden and Japan ··············· 2 2 Five steps in developing interventions for health equity in urban settings ·················· 13 3 Proportion of people without adequate provision for water and sanitation in urban areas, 2000 ·································································· 22 4 Major risk factors of unhealthy living conditions ················································· 24 5 Estimated annual additional cost (above current foreign aid) of implementing the MDGs by 2015 ····························································· 45 Endnotes A1 Population living in slums, 2001 estimates ······················································ 58 A2 Infant mortality for the years 1950 and 2000 in Chile, rural versus urban ················· 60 A3 Deprivations associated with urban poverty and their immediate external causes ································································ 61 A4 Ten leading causes of burden of disease, by region, 2001 ···································· 62 A5 Infant and child mortality rates for urban and rural populations in selected countries ························································ 62 A6 Homicide rates per 100 000 population in cities of Latin America ·························· 63 LIST OF FIGURES Main Report 1 Urban slum incidence in countries, 2001 ·························································· 2 2 Under-5 mortality rates in Africa ··································································· 6 3 Percentage of urban population living in slums, 2001 ··········································· 7 4 Annual growth rate of urban people living in slums, 1990–2001 ······························· 8 5 A conceptual framework for urban health ························································ 9 6 Association between nations’ level of urbanization and average per capita income, 2000/2001 ························································ 10 7 HIV prevalence (%) by urban/rural residence for selected sub-Saharan African countries ····················································
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