Informal Settlements and Human Health

  • Jason CorburnEmail author
  • Alice Sverdlik


Informal settlements or slums dominate the urban landscape and in 2016 were the home to almost 900 million people. Global health is now slum health. The determinants of health for slum dwellers are multi-factorial and can vary from country to country and even within the same city. This chapter reviews the definitions of informal settlements or slums and highlights the key drivers of health, disease and well-being in urban informal settlements, including: spatial segregation, insecure residential status, poverty and employment, housing structural quality, water and sanitation, energy, transport, violence, climate change and services. We highlight the evidence supporting the links between these key factors and infectious and non-communicable diseases (NCDs). The chapter also links the health issues facing informal settlements with the Sustainable Development Goals (SDGs). The chapter concludes with a discussion of how slum upgrading—a community-based process that aims to improve built and social environments, as well as economic and social conditions in slums—can be a key approach for improving the health of those living in informal settlements. We suggest that multiple features of the upgrading process, including community engagement, women’s empowerment, shelter and infrastructure improvements, tenure security, political recognition, and enhanced social and health care services, can combine to reduce the disease burden and premature mortality so frequently experienced by those living in informal settlements.


  1. African Population and Health Research Centre (APHRC). (2014). Population and health dynamics in Nairobi’s informal settlements: Report of the Nairobi cross-sectional slums survey. Nairobi: APHRC.Google Scholar
  2. Agarwal, S., & Srivastava, A. (2009). Social determinants of children’s health in urban areas in India. Journal of Health Care for the Poor and Underserved, 20(Suppl. 4), 68–89.CrossRefGoogle Scholar
  3. Agarwal, S., Bhanot, A., & Goindi, G. (2005). Understanding and addressing childhood immunization coverage in urban slums. Indian Pediatrics, 42, 653–663.Google Scholar
  4. Barcellos, C., & Zaluar, A. (2014). Homicides and territorial struggles in Rio de Janeiro favelas. Revista de Saúde Pública, 48(1), 94–102. Scholar
  5. Bartlett, S., & Satterthwaite, D. (Eds.). (2016). Cities on a finite planet: Towards transformative responses to climate change. London: Routledge.Google Scholar
  6. Bartram, J., & Cairncross, S. (2010). Hygiene, sanitation, and water: Forgotten foundations of health. PLoS Medicine, 7(11), e1000367.CrossRefGoogle Scholar
  7. Boonyabancha, S. (2009). Land for housing the poor—By the poor: Experiences from the Baan Mankong nationwide slum upgrading programme in Thailand. Environment and Urbanization, 21(2), 309–329.CrossRefGoogle Scholar
  8. Cerda, M., et al. (2012). Reducing violence by transforming neighborhoods: A natural experiment in Medellín, Colombia. American Journal of Epidemiology, 175(10), 1045–1053. Scholar
  9. Cervero, R. (2013). Linking urban transport and land use in developing countries. Journal of Transport and Land Use, 6(1), 7–24.CrossRefGoogle Scholar
  10. Chant, S., & McIlwaine, C. (2016). Cities, slums and gender in the global south: Towards a feminised urban future. London: Routledge. 9780415721646.Google Scholar
  11. Chen, M. A., & Sinha, S. (2016). Home-based workers and cities. Environment and Urbanization, 28(2), 343–358.CrossRefGoogle Scholar
  12. Cheng, J. J., Schuster-Wallace, C. J., Watt, S., Newbold, B. K., & Mente, A. (2012). An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environmental Health, 11.
  13. Corburn, J., & Riley, L. (2016). Slum health: From the cell to the street. Berkeley: University of California Press. ISBN: 9780520281073.Google Scholar
  14. Corburn, J., & Sverdlik, A. (2017). Slum upgrading and health equity. International Journal of Environmental Research and Public Health, 14(4), 342. Scholar
  15. Corburn, J., Asari, M., Makua, J., et al. (2017). Mukuru situational analysis: Existing conditions in Nairobi’s informal settlement. Berkeley: University of California.Google Scholar
  16. De Snyder, V. N., Friel, S., Fotso, J. C., Khadr, Z., Meresman, S., Monge, P., & Patil-Deshmukh, A. (2011). Social conditions and urban health inequities: Realities, challenges and opportunities to transform the urban landscape through research and action. Journal of Urban Health, 88, 1183–1193.CrossRefGoogle Scholar
  17. Dye, C. (2008). Health and urban living. Science, 319(5864), 766–769.CrossRefGoogle Scholar
  18. Egondi, T., Kyobutungi, C., Ng, N., Muindi, K., Oti, S., van de Vijver, S., Ettarh, R., & Rocklöv, J. (2013). Community perceptions of air pollution and related health risks in Nairobi slums. International Journal of Environmental Research and Public Health, 10(10), 4851–4868. Scholar
  19. Egondi, T., Muindi, K., Kyobutungi, C., Gatari, M., & Rocklöv, J. (2016). Measuring exposure levels of inhalable airborne particles (PM2.5) in two socially deprived areas of Nairobi, Kenya. Environmental Research, 148, 500–506. Scholar
  20. Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y. F., Ndugwa, R., Sartori, J., Mberu, B., Melendez-Torres, G. J., Haregu, T., Watson, S. I., et al. (2016). The history, geography, and sociology of slums and the health problems of the people who live in slums. Lancet.
  21. Fox, S. (2014). The political economy of slums: Theory and evidence from Sub-Saharan Africa. World Development, 54(2), 191–203.CrossRefGoogle Scholar
  22. Galiani, S., & Schargrodsky, E. (2004, July). Effects of land titling on child health. IDB Working Paper No. 194. Available at SSRN: or
  23. Galiani, S., & Schargrodsky, E. (2010). Property rights for the poor: Effects of land titling. Journal of Public Economics, 94, 700–729.CrossRefGoogle Scholar
  24. Gilbert, A. (2007). The return of the slum: Does language matter? International Journal of Urban and Regional Research, 31, 697–713.CrossRefGoogle Scholar
  25. Haines, A., Bruce, N., Cairncross, S., Davies, M., Greenland, K., Hiscox, A., Lindsay, S., Satterthwaite, D., & Wilkinson, P. (2013). Promoting health and advancing development through improved housing in low-income settings. Journal of Urban Health, 90, 810–831.CrossRefGoogle Scholar
  26. Harpham, T. (2009). Urban health in developing countries: What do we know and where do we go? Health & Place, 15, 107–116.CrossRefGoogle Scholar
  27. Hasan, A. (2010). Participatory development: The story of the Orangi Pilot Project-Research and Training Institute and the Urban Resource Centre, Karachi, Pakistan. Oxford: Oxford University Press.Google Scholar
  28. Home, R. (2013). Of planting and planning: The making of British colonial cities (2nd ed.). Abingdon: Routledge. 272 pages.CrossRefGoogle Scholar
  29. Ibarrarán, P., Kluve, J., Ripani, L., & Rosas Shady, D. (2015). Experimental evidence on the long term impacts of a youth training program. Inter-American Development Bank.Google Scholar
  30. Jaitman, L., & Brakarz, J. (2013). Evaluation of slum upgrading programs: Literature review and methodological approaches. IDB Technical Note, 60.
  31. JMP. (2017). Progress on drinking water, sanitation and hygiene: Joint Monitoring Programme 2017 update and SDG baselines. Geneva: WHO and UNICEF.Google Scholar
  32. Khayesi, M., Monheim, H., & Nebe, J. M. (2010). Negotiating “streets for all” in urban transport planning: The case for pedestrians, cyclists and street vendors in Nairobi, Kenya. Antipode, 42(1), 103–126.CrossRefGoogle Scholar
  33. Kimani-Murage, E. W., Muthuri, S. K., Oti, S. O., Mutua, M. K., van de Vijver, S., & Kyobutungi, C. (2015). Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. PLoS ONE, 10(6), e0129943. Scholar
  34. Kinney, P., et al. (2011). Traffic impacts on PM2.5 air quality in Nairobi, Kenya. Environmental Science & Policy, 14(4), 369–378.CrossRefGoogle Scholar
  35. Lilford, R. J., Oyebode, O., Satterthwaite, D., et al. (2016). Improving the health and welfare of people who live in slums. Lancet.
  36. Lund, F., Alfers, L., & Santana, V. (2016). Towards an inclusive occupational health and safety for informal workers. New Solutions: A Journal of Environmental and Occupational Health Policy, 26(2), 190–207.CrossRefGoogle Scholar
  37. Manda, M., & Wanda, E. (2017). Understanding the nature and scale of risks in Karonga, Malawi. Environment and Urbanization, 29(1), 15–32.CrossRefGoogle Scholar
  38. Marco Gonzalez-Navarro & Climent Quintana-Domeque. (2016, May). “Paving streets for the poor: Experimental analysis of infrastructure effects,” The Review of Economics and Statistics, MIT Press, vol. 98(2), 254–267.CrossRefGoogle Scholar
  39. Massey, K. (2011). Insecurity and shame: Exploration of the impact of the lack of sanitation on women in the slums of Kampala Uganda, LSHTM and SHARE Briefing Note, 11 pages.Google Scholar
  40. Meth, P. (2017). Informal housing, gender, crime and violence: The role of design in urban South Africa. The British Journal of Criminology, 57(2), 402–421.Google Scholar
  41. Muggah, R. (2014). Deconstructing the fragile city: Exploring insecurity, violence and resilience. Environment & Urbanisation, 26(2), 345–358. Scholar
  42. Niehaus, M., Moore, S., Patrick, P., Derr, L. L., Lorntz, B., Lima, A. A., et al. (2002). Early childhood diarrhoea is associated with di- minished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. American Journal of Tropical Hygiene and Medicine, 66, 590–593.CrossRefGoogle Scholar
  43. Obduho, R. A. (1997). Nairobi: National capital and regional hub. In C. Rakodi (Ed.), The urban challenge in Africa: Growth and management of its large cities. Tokyo: UN University Press.Google Scholar
  44. Prüss-Ustün, A., Wolf, J., Corvalán, C., Bos, R., & Neira, M. (2016). Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. WHO.Google Scholar
  45. Riley, L. W., Ko, A. I., Unger, A., & Reis, M. G. (2007). Slum health: Diseases of neglected populations. BMC International Health and Human Rights, 7.
  46. Satterthwaite, D., & Bartlett, S. (2017). The full spectrum of risk in urban centres: Changing perceptions, changing priorities. Environment and Urbanization, 29(1), 3–14.CrossRefGoogle Scholar
  47. Scovronick, N., Lloyd, S. J., & Kovats, R. S. (2015). Climate and health in informal urban settlements. Environment and Urbanization, 27(2), 657–678.CrossRefGoogle Scholar
  48. SHARE (Sanitation and Hygiene Applied Research for Equity (SHARE). (2016). Emergence of community toilets as a public good: The sanitation work of Mahila Milan, NSDF and SPARC in India.
  49. Shetty, P. (2011). Health care for urban poor falls through the gap. The Lancet, 377(9766), 627–628.CrossRefGoogle Scholar
  50. Shonkoff, J., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. Scholar
  51. Singh, R., Wang, X., Mendoza, J. C., & Ackom, E. K. (2015). Electricity (in) accessibility to the urban poor in developing countries. Wiley Interdisciplinary Reviews: Energy and Environment, 4(4), 339–353.CrossRefGoogle Scholar
  52. Sommer, M., Hirsch, J. S., Nathanson, C., & Parker, R. G. (2015). Comfortably, safely, and without shame: Defining menstrual hygiene management as a public health issue. American Journal of Public Health, 105, 1302–1311. pmid:25973831.CrossRefGoogle Scholar
  53. Sovacool, B. K. (2011). Conceptualizing urban household energy use: Climbing the “Energy Services Ladder”. Energy Policy, 39(3), 1659–1668.CrossRefGoogle Scholar
  54. Subbaraman, R., O’Brien, J., Shitole, T., Sawant, K., Bloom, D. E., & Patil-Deshmukh, A. (2012). Off the map: The health and social implications of being a non-notified slum in India. Environment and Urbanization, 24, 643–663.CrossRefGoogle Scholar
  55. Sverdlik, A. (2011). Ill health and poverty: A literature review on health in informal settlements. Environment and Urbanization, 23, 123–155.CrossRefGoogle Scholar
  56. Trujillo, H. R., Siegel, E., Clayton, M., Shapiro, G., & Elam, D. (2015). Securing cities: Innovations for the prevention of civic violence. In R. Ahn, T. F. Burke, & A. M. McGahan (Eds.), Innovating for healthy urbanization (pp. 97–122). USA: Springer.CrossRefGoogle Scholar
  57. Turley, R., Saith, R., Bhan, N., Rehfuess, E., & Carter, B. (2013). Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes. The Cochrane Database of Systematic Reviews.
  58. UN-Habitat. (2014). Streets as tools for urban transformation in slums: A street-led approach to citywide slum upgrading, Nairobi.Google Scholar
  59. UN-Habitat. (2016a). World cities report 2016: Urbanization and development emerging futures. Nairobi, Kenya: UN-Habitat. Scholar
  60. UN-Habitat. (2016b). Slum almanac 2015–2016: Tracking improvement in the lives of slum dwellers.
  61. Violence Prevention Through Urban Upgrading (VPUU). (2011). A manual for safety as a public good. VPUU.
  62. West, B. S., Hirsch, J. S., & El-Sadr, W. (2012). HIV and H2O: Tracing the connections between gender, water and HIV. AIDS Behavior, 17, 1675–1682.CrossRefGoogle Scholar
  63. WHO. (2016). Burning opportunity: Clean household energy for health, sustainable development, and wellbeing of women and children. Geneva: WHO.Google Scholar
  64. WHO and UN-Habitat. (2016). Global report on urban health: Equitable, healthier cities for sustainable development.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of City & Regional Planning, School of Public HealthUC BerkeleyBerkeleyUSA
  2. 2.Institute of Urban & Regional Development, Center for Global Healthy CitiesUC BerkeleyBerkeleyUSA
  3. 3.International Institute for Environment and Development (IIED)LondonUK

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