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Addressing the Social and Environmental Determinants of Urban Health Equity: Evidence for Action and a Research Agenda

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Abstract

Urban living is the new reality for the majority of the world’s population. Urban change is taking place in a context of other global challenges—economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban–rural divide) and within cities (the rich–poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central policy goals for urban management.

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Notes

  1. A Gini coefficient of 0 indicates perfect equality, whereas a Gini coefficient of 1 indicates perfect inequality. Generally, a Gini coefficient of between 0.2 and 0.39 indicates a relatively equitable distribution of resource. A Gini coefficient of 0.4 denotes moderately unequal distributions of income or consumption; it is the threshold at which cities and countries should address inequality as a matter of urgency—referred to in the graphs as the International Alert Line. Cities and countries with a Gini coefficient of 0.6 or higher suffer from extremely high levels of inequality which puts them at risk of instability.

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Acknowledgments

This work was made possible through funding provided by the Rockefeller Foundation and undertaken as a contribution to the Global Research Network on Urban Health Equity. The views presented herein are those of the author(s) and do not necessarily reflect the decision, policy, or views of our institutions.

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Authors and Affiliations

  1. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia

    Sharon Friel

  2. Department of Epidemiology and Public Health, University College London, London, UK

    Sharon Friel & Michael Marmot

  3. Faculdade de Medicina do ABC, Sao Paulo, Brazil

    Marco Akerman

  4. School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada

    Trevor Hancock

  5. World Health Organisation Centre for Health Development, Kobe, Japan

    Jacob Kumaresan

  6. UN-HABITAT, Nairobi, Kenya

    Thomas Melin

  7. School of Nursing, University of California, San Francisco, USA

    David Vlahov

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  1. Sharon Friel
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Correspondence to Sharon Friel.

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Friel, S., Akerman, M., Hancock, T. et al. Addressing the Social and Environmental Determinants of Urban Health Equity: Evidence for Action and a Research Agenda. J Urban Health 88, 860–874 (2011). https://doi.org/10.1007/s11524-011-9606-1

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