Our cities, our health, our future

From: ruglucia@PAHO.ORG

Our cities, our health, our future

Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings (KNUS) 2008
Chair and Lead Writer: Tord Kjellstrom

Available online as PDF file [199p.] at: http://www.who.int/social_determinants/resources/knus_final_report_052008.pdf

Which aspects of urban settings influence health equity?
This KNUS report summarizes the findings concerning structural and intermediate social determinants of health that are of importance in the urban setting. The framework of the Commission on Social Determinants of Health (CSDH) guided the work. While unmasking the health inequities and inequalities in urban settings, it was decided at an early stage to make a strategic focus on slums and informal settlements where one billion people live in deplorable conditions.

This number may double in coming decades unless appropriate policies for economic, social and health equity are developed and implemented. An example of the health inequalities in these circumstances is the strong gradient in infant and child mortality rates within Nairobi, Kenya, with rates in the slums more than three times higher than the city average and possibly ten or more times higher than in the richer parts of the city. Other data from Africa shows that these mortality Rates among the urban poor are, on average, almost as high as the rates among the rural poor, while among the richer urban groups the rates are the lowest.

EXECUTIVE SUMMARY
1. INTRODUCTION
2. URBANIZATION AND THE URBAN SETTING AS HEALTH DETERMINANTS
2.1 Urbanization in a global context
2.2 Slum formation with rapid urbanization
2.3 A conceptual framework for urban health
2.4 The economics of urban health development
2.5 Poverty, deprived urban living conditions and health vulnerability
2.6 Healthy urban governance
3. THE URBAN HEALTH SITUATION
3.1 Burden of disease and communicable diseases
3.2 Injuries and violence
3.3 Mental health and substance abuse
3.4 Noncommunicable diseases and nutritional disorders
4. KEY ISSUES AND CHALLENGES IN ACHIEVING HEALTH EQUITY
5. A BROAD SPECTRUM OF INTERVENTIONS
6. APPROACHES AND POLICIES TO MAKE INTERVENTIONS HAPPEN
7. CONCLUSIONS AND RECOMMENDATIONS
7.1 The urban setting as a health determinant
7.2 The urban health situation
7.3 Key issues and concepts of health equity impacts
7.4 A broad spectrum of interventions
7.5 Approaches and policies to make interventions happen
ENDNOTES
BIBLIOGRAPHY