Elliott D. Sclar

Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities.

The overarching goal of this article is to make explicit the multiple pathways through which the built environment may potentially affect health and well-being. The loss of close collaboration between urban planning and pulic health professionals that characterized the post-World War II era has limited the design and implementation of effective intervention and policies that might translate into improved health for urban populatons. First, we present a conceptual model that developed out of previous research called Social Determinants of Health and Environmental Health Promotion. Second, we review empirical research from both the urban planning and public health literature regarding the health effects of housing and housing interventions. And third, we wrestle with key challenges in conducting sound scientific research on connections between the built environment and health, namely: (1) the necessity of dealing with the possible health consequences of myriad public and private sector activities; (2) the lack of valid and reliable indicators of the built environment to monitor the health effects of urban planning and policy decisions, especially with regard to land use mix; and (3) the growth of the “megalopolis” or “super urban region” that requires analysis of health effects across state lines and in circumscribed areas within multiple states. We contend that to plan for healthy cities, we need to reinvigorate the historic link between urban planning and public health, and thereby conduct informed science to better guide effective public policy.

The 21st century health challenge of slums and cities

2Starting in 2007, and for the first time in human history, the majority of the world’s population will live in urban areas. According to the latest UN projections, 3 by 2030, the world’s urban population will increase by more than two billion, while the rural population will decline by about 20 million. This shift is largely the culmination of a rapid global urbanisation process that has been underway for more than 250 years. Rapid urbanisation first became manifest in the countries undergoing industrialisation in the developed world, and then in Latin America. Today its prime locus is the poorer parts of Asia and Africa. More than 90% of the world’s urban population growth by 2030 will be in less developed regions. Any effort to measurably improve global health outcomes, especially in these regions, will need to address urban reform. According to estimates prepared by the UN Human Settlements Programme (UN-HABITAT), about a third of the world’s estimated 3 billion current urban residents dwell in slums, or places characterised by one or more of these shortcomings: insecurity of tenure, poor structural housing conditions, deficient access to safe drinking water and sanitation, and severe overcrowding. 4 All these factors have direct

A Joint Urban Planning and Public Health Framework: Contributions to Health Impact Assessment

A joint urban planning and public health perspective is articulated here for use, in health impact assessment. Absent a blueprint for a coherent and supportive structure on which to test our thinking, we are bound to fall flat. Such a perspective is made necessary by the sheer number of people living in cities throughout the world, the need for explicit attention to land use and transportation systems as determinants of population health, and the dearth of useful indicators of the built environment for monitoring progress. If explicit attention is not paid to the overarching goals of equality and democracy, they have little if any chance of being realized in projects, programs, and policies that shape the built environment and therefore the publics health.

Slums, Slum Dwellers, and Health

Although this issue of the Journal is focused on the connections between the built environment and health in the developed world these links are even more relevant in the developing world where billions of the world’s poor live in precarious housing submarkets known as slums. (excerpt)

Urban Health: An Overview

For the first time in history, over half the worlds population resides in urban areas. The challenge of urban health is already central to the social development of cities and this challenge will continue to grow as the urbanization trend continues. Urban health, particularly in the worlds most rapidly urbanizing regions – the low- and middle-income countries referred to as the Global South – is largely determined by social and environmental factors, which are strongly interrelated. These include but are not limited to access to basic services and amenities associated with urban living, such as health care, transport, clean water, sanitation, education, and safe places to live and work. Climate change-related events, such as severe storms and floods, are interacting with and compounding existing urban health risks. Transport-related injuries and deaths are expected to increase as more vehicles are added to the already-chaotic fray of urban traffic. Addressing the urban health challenge will require an approach that focuses on the social and environmental determinants that drive health outcomes and understanding the complex interactions among them in the urban context.

Economic fall-out of failing urban transport systems: an institutional analysis

This chapter describes how a good public transport system is essential to the creation and sustainability of economically, socially and environmentally successful cities. Good public transport systems share one important characteristic: a widespread acceptance of the socially diverse populations that comprise contemporary cities. Acceptance requires that systems are to be as safe, affordable, speedy, convenient and reliable as possible for all users. The success of global cities such as New York, London, Paris, Rome, Moscow and Tokyo rests in no small measure on the fact that they have public transport systems that tend to meet these criteria with varying degrees of success. While none of the cities get a perfect score, it is still the case that all of them, along with many other similar systems in the cities of the Global North, get sufficiently high marks that they contribute immeasurably to the well-being and prosperity of these cities. The same generalization cannot be made for cities of the Global South. Most of the largest cities in middle- and low-income countries do not come close to meeting the above criteria. Instated, and especially in the poorest cities, public transport, to the extent that is exists at all, is largely an improvised system.