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Urban Health

By Daniel Becker

More green space is as important to the health of urban dwellers as good hospitals, writes Rio-based public health researcher and practitioner Daniel Becker in the Fall 2009 issue of Americas Quarterly.

Cities are crucial to public health. They are sources of cultural, technological and economic innovation, but they can also be breeding grounds for injustice, disease, environmental destruction, and violence.

By 2030, they will be home to seven of every 10 humans on the planet. Through history, urbanization has changed our understanding of public health, and today, there is an emerging paradigm based on human life in cities. We now know that health and well-being are not only a matter of access to medical services, but are determined by the social conditions—dictated by political, social-cultural and economic forces—in which people live, work and age. Building a healthy city therefore requires access to good-quality housing, public transportation, education, work, recreation, and cultural facilities. Social protection and a healthy environment are equally important. Finally, equity—or, the fair distribution of these assets—is crucial to overall urban health.

Urban social injustice is epitomized by shantytowns and squatter settlements. Today, these are home to approximately 1 billion people, and that number may double in the coming decades. But shantytowns are also motors of urbanization. In their constant search for opportunities, residents generate a variety of new enterprises—economic, cultural, educational, and social—as well as strong social support networks.

The urban environment affects human health in three principal ways. The first is related to the social and behavioral impact on individuals—their eating habits, levels of physical activity, sexual practices, safety, and drug use. The urban poor have limited access to information and services, an abundant supply of high-caloric and processed foods, and living conditions that don’t favor healthy behaviors. This results in higher rates of diseases such as obesity, hypertension, heart attacks, diabetes, and cancer. Migrants’ loss of connection to their original cultures affects mental health, which is connected, along with corruption, police brutality and inequality, to high rates of urban violence—the primary cause of death among persons aged 15 to 45 in Brazilian cities. Likewise, vulnerability to AIDS among urban residents is associated with poverty, gender inequality and access to education.

Read the full text of the article at www.americasquarterly.org.

Daniel Becker, MD, MPH, is a public health researcher and practitioner and is a director at CEDAPS, the Center for Health Promotion in Rio de Janeiro, Brazil.

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