Urbanization as a Social
Determinant of Health
Marilyn Rice, MA, MPH, CHES
Senior Advisor in Health Promotion
Coordinator, Urban Health & Health
Determinants Team
Area for Sustainable Development and
Environmental Health (SDE)
Social determinants of health (SDH):
what and why?
• 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
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
Urban
Rural
647.5
332.5
279
115.6
12.6
3
Syphilis
Chlamydia
Gonorrhea
Incidence of STIs by ethnic group, 2004
White
Black
Hispanic
Average
1253.1
715.2
645.3 647.5
279
172.3
153.5
66.6
16.4 27.9 13.1 12.6
Syphillis
Chlamydia
Gonorrhea
Poverty and health in the city
Why should local governments
get involved in urban health?
• Targeting SDH also
addresses other endemic
social issues
• Health promotion is costeffective
• 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
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
URBAN HEART
Assessment an indicator guide
Response a guide to plan action
How can we work together?
• Contribute to PAHO’s documentation
template
• Join PAHO’s SDE listserv:
http://www.bvsde.ops-oms.org/sde/opssde/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)
Thank you!
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.opsoms.org/sde/opssde/bvsdeeng.shtml
Play Street (78th St), NYC: car-free on weekends for physical
activities, performance, markets; collaborative work of
neighborhood groups and Dept. of Transportation