Cities and population health

Cities and population health Sandro Galeaa,b,, Nicholas Freudenbergc, David Vlahova (journal review)

In this paper we have focused on the US experience as

the source of most of our observations about the

determinants of health in cities.

•For the past 150 years urbanization has been a major

historical trend, driving changes in economic development,

education, criminal justice, transportation and

Housing.

•The urban environment influences

every aspect of health and well-being: what people eat,

the air they breathe and the water they drink, where (or

if) they work, the housing that shelters them, their sex

partners and family arrangements, where they go for health care, the danger they encounter on the street, and

who is available for emotional and financial support.

•Cities may have both positive and negative effects on health, suggesting that a full understanding of urban health needs to tease apart the factors that influence health and evaluate the circumstances, and the contexts, in which one factor may be more or less important than another.

•In this article the proposal of a framework that posits that urban populations are defined by size, density, diversity and complexity, and that health in urban populations is a function of living conditions shaped by municipal determinants, and national and global trends.

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•Migrations:

•People move from the countryside to the city or from a

developing to a developed world city, making immigration

primarily an urban phenomenon .

•Today, more than 140 million people in the world live

outside their country of birth.

In some cases however, this influx of immigrants to cities in search of jobs and health care .

• In some cities, immigration has become a contentious political issue, leading to conflict over public resources, including health care.

•Suburbanization, or the movement of people from city center to surrounding areas, has been one of the hallmarks of growing urban areas in wealthy countries over the past 50 years.

•Residential suburbanization supported a parallel movement of jobs.

•In the decades since, public resources available to meet needs in cities have declined further.

•Sub urbanization:

•Markets allocate housing, food, employment opportunities, medical care, and transportation and, due to privatization, increasingly play a role in education, public safety, and others sectors previously confined to the public realm.

•The urban physical environment includes the built

environment, the air city dwellers breathe, the water they

drink and bathe in, the indoor and outdoor noise they hear, the parkland inside and surrounding the city, and the geological and climate conditions of the site where the city is located.

•

•Population:

•Changes in the characteristics of urban populations

can influence health in two ways.

1.First, changing population characteristics can create unique patterns of vulnerability.

2. Second, changes in the knowledge, skills, culture or behavior of people living in cities can also influence health.

qHighways and streets can pollute water through runoff, destroy green space, influence motor vehicle use and accident rates, and contribute to the urban heat sink, absorption of heat that can increase the temperature in cities by several degrees.

•Expensive infrastructure ages in a period of declining municipal resources, breakdowns may increase, causing health problems related to water, sewage, or disposal of solid waste.

•In addition, the course of urbanization in different cities worldwide may have different implications for health.

 In this paper we have argued that enduring structures,

global and national trends, municipal determinants and

the urban living conditions within different communities

interact to create unique patterns of health and disease.

While urban health research to date has focused on

describing the health-related characteristics of various

urban populations and comparing them to non-urban

ones, this necessary task is not sufficient.