The Case for Comprehensive, Integrated, and Standardized Measures of Health in Cities

Abstract

By 2050, more than 75 % of the world’s population is expected to live in cities. Cities in lower-income countries will absorb 95 % of population growth and will be home to 80 % of the world’s urban population. The health of a city’s residents depends on critical infrastructure, the maintenance of water and sanitation systems, the availability of affordable housing, the protection of spaces for physical activity, the extent of pollution, and the strength of the economy, among many other conditions. The relationships between health and city conditions are increasingly complex and entangled—social cohesion, safety, security, and stability are being challenged by social exclusion, inequities, and shortfalls in basic services. The governance of a city has a profound impact on the health of its inhabitants. Yet little information is available for assessing the character and quality of a city’s governance system and its impact on urban health. This paper seeks to make the case for integrated assessments of the relationship between health and urbanization. The core of our argument is that the evolution of cities has introduced new complexities in governing cities and new research challenges to measure and monitor health in cities. How do we account for the unique health circumstances of each city while exporting best practices and fostering mutual learning across city boundaries? We argue that we can only obtain answers to this and related questions through a much broader and more comprehensive framework for assessing health than is available today, and we highlight a leading initiative along these lines based at the University of Toronto—the Global City Indicators Facility (GCIF).

Keywords

Population growth Urbanization Health metrics City governance Health systems Health governance Social determinants of health Pollution Health inequities Access to healthcare 

Notes

Acknowledgement

Thanks to Kerry Paterson for capable and thoughtful research assistance.

References

  1. 1.
    UN. Population ageing. New York: Department of Economic and Social Affairs, Population Division. United Nations; 2006.Google Scholar
  2. 2.
    Dillon K, Prokesch S. Global challenges in health care: is rationing in our future? HBR Blog Network. http://blogs.hbr.org/cs/2010/04/global_challenges_in_health_ca.html (April 5, 2010). Accessed 9 May 2013.
  3. 3.
    Widdus R, White K. Combating diseases associated with poverty: financing strategies for product development and the potential role of public-private partnerships. August 2004. http://www.globalforumhealth.org/filesupld/ippph/CombatingDiseases.pdf
  4. 4.
    Feinstein L. Quantitative estimates of the social benefits of learning, 2: Health (depression and obesity). London: Centre for Research on the Wider Benefits of Learning; 2002. http://www.learningbenefits.net/Publications/ResReps/ResRep6.pdf#search=%22quantitative%20estimates%20of%20the%20social%20benefits%20of%20learning%22
  5. 5.
    Benoit C, Shumka L. Gendering the health determinants framework: why girls’ and women’s health matters. Vancouver: Women’s Health Research Network; 2009. p. 9–11.Google Scholar
  6. 6.
    Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104.CrossRefPubMedGoogle Scholar
  7. 7.
    Centre for Research on Inner City Health. Housing vulnerability and health: Canada’s hidden emergency. Toronto: St. Michael’s Hospital; 2010. p. 1–3.Google Scholar
  8. 8.
    WHO. Health Impact Assessment. Housing and health. 2010. http://www.who.int/hia/housing/en/. Accessed 9 May 2013.
  9. 9.
    Public Health Agency of Canada. What makes Canadians healthy or unhealthy?—population health approach. Government of Canada. 2013. http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#employment Accessed 9 May 2013.
  10. 10.
    WHO. Health impact assessment. The determinants of health. http://www.who.int/hia/evidence/doh/en/index.html. Accessed 9 May 2013.
  11. 11.
    WHO. The Ottawa Charter for Health Promotion, Ottawa. 1986. http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index.html. Accessed 9 May 2013.
  12. 12.
    WHO. Health Impact Assessment. The Determinants of Health; Food and Agriculture. http://www.who.int/hia/evidence/doh/en/index3.html. Accessed 9 May 2013.
  13. 13.
    Doctors Without Borders. How we work. http://www.doctorswithoutborders.org/aboutus/activities.cfm. Accessed 9 May 2013.
  14. 14.
    Orbinski J. An imperfect offering; humanitarian action in the twenty-first century. Toronto: Anchor Canada; 2008. p. 262–3.Google Scholar
  15. 15.
    Council on Health Research for Development. Beyond aid: research and innovation as key drivers for health, equity and development, Forum 2012, South Africa. 2012. p. 6–7.Google Scholar
  16. 16.
    Brasilia Declaration on Ageing. World Health Organization. 1997, No. 4:21.Google Scholar
  17. 17.
    Leithäuser G. A city for all generations—focusing on ageing population. World Urban Forum IV—Dialogue 6. Nanjing, China. 2008.Google Scholar
  18. 18.
    UN. United Nations Madrid international plan for action on ageing. New York: Department of Economic & Social Affairs, Division for Social Policy and Development. United Nations; 2002.Google Scholar
  19. 19.
    UN-Habitat. Living conditions of low-income older people in human settlements. A global survey connection with the International Year of Older People 1999. Nairobi: UN-Habitat; 1999.Google Scholar
  20. 20.
    Nadalamba A, Chikoko M. Aging population challenges in Africa. AFDB Chief Economist Complex. 2011;1(1). www.afdb.org/fileadmin/uploads/afdb/Documents/Publications/Aging%20Population%20Challenges%20in%20Africa-disribution.pdfGoogle Scholar
  21. 21.
    McCarney P, Stren R. Metropolitan governance: Governing in a city of cities in UN-HABITAT, state of the worlds cities 2008/200. London: Earthscan; 2008.Google Scholar

Copyright information

© Springer New York 2015

Authors and Affiliations

  1. 1.Department of Political Science, Global Cities Institute, John H. Daniels Faculty of Architecture, Landscaping, and DesignUniversity of TorontoTorontoCanada
  2. 2.Rotman School of ManagementUniversity of TorontoTorontoCanada

Personalised recommendations