Urbanization as a Social Determinant of Health

Marilyn Rice, MA, MPH, CHESSenior Advisor in Health PromotionCoordinator, Urban Health & Health Determinants TeamArea for Sustainable Development and Environmental Health (SDE)

• What: a body of non-medical factors that affect individual health status– Examples: ethnicity, socioeconomic

status, employment, food access, housing

• Why: integrating SDH into health programs addresses root causes of health issues– Why treat someone only to return

them to the situation that caused the illness in the first place

Social determinants of health (SDH): what and why?

Why urban health matters• Urban populations are

increasing• Cities concentrate assets

and solutions as well as risks and health hazards

• Cities can promote well being or unhealthy lifestyles

• Poverty is exacerbated in cities

Urbanization is associated with many health challenges

• Communicable diseases• Non-communicable chronic

diseases and their risk factors • Violence • Harmful use of alcohol, tobacco

and other drugs • Mental health, stress and social

isolation• Road safety• Infant mortality

Key Challenges for Cities

WHO Kobe Centre “Our cities, our health, our future: acting on social determinants for health equity in urban settings” 2008, Kobe Japan

Some causes of challenges:• Different SDHs lead to

individual inequalities in access to resources:– Social– Political– Economic– Cultural

– Environmental

• Perceived vs. real benefits of living in an urban setting

Crime in the last two weeks: a large proportion of crime occurs in a 5-6 block cluster in San Francisco.

Incidence of STIs, 2004

12.6

647.5

279

3

332.5

115.6

Syphilis Chlamydia Gonorrhea

Urban Rural

Incidence of STIs by ethnic group, 2004

16.4

172.3

66.627.9

1253.1

715.2

13.1

645.3

153.5

12.6

647.5

279

Syphillis Chlamydia Gonorrhea

White Black Hispanic Average

Poverty and health in the city

• Targeting SDH also addresses other endemic social issues

• Health promotion is cost-effective

• Local governments– Have the power to create and

lead intersectoral partnerships at low costs and combine resources across sectors

– Are able to influence policies, laws, and provision of human services

Why should local governments get involved in urban health?

What can be done to make cities healthier?

• Attend to the needs of the vulnerable population and include them to reduce inequality

• Participate in urban planning that promotes safe, clean spaces and healthy environments

• Creating laws and municipal politics that reduce violence, the degradation of the environment, and that promote healthy living

• Investing in improving urban living conditions that attend the needs of living, social protection, and conditions of employment

• Building adaptable, accessible, and comprehensive cities for the elderly

• Cultivate networks to create and sustain social capital

• Mobilize existing community capacities & resources

• Permit the intervention of the civil society in making decisions by governing urban participation

• Construct buildings and infrastructures that are safe and can support disasters and emergencies

• Adopting equal health as a fundamental objective shared among the different sectors: government, NGOs, private sector and citizens

• Integrate health actions with income generating activities

• Make available ongoing training for professionals on new topics

• Move forward an urban health research agenda

How can PAHO help?

Tools and instruments:– HMC Network – linking members and experiences

– Economic impact of health promotion efforts

– Mayor’s Guide to MDGs

– Mayor’s Guide to HMC

– Urban HEART and HIA/HEIA

– Participatory evaluation of HMC

– PAHO Documentation Template

URB

AN H

EART

Assessment an indicator guide

Response a guide to plan action

• Contribute to PAHO’s documentation template

• Join PAHO’s SDE listserv: http://www.bvsde.ops-oms.org/sde/ops-sde/bvsdeeng.shtml

• Participate in Urban HEART and Health Impact Assessment workshop in Bogotá (9-13 May 2011)

• Organize events during Wellness Week on NCDs (12-17 September 2011)

How can we work together?

Marilyn Rice, MA, MPH, CHES

ricemari@paho.org Area for Sustainable Development and Environmental Health (SDE)

Pan American Health Organization

SDE site: http://www.bvsde.ops-oms.org/sde/ops-sde/bvsdeeng.shtml

Thank you!

Play Street (78th St), NYC: car-free on weekends for physical activities, performance, markets; collaborative work of neighborhood groups and Dept. of Transportation