Can the Urban Health Advantage be Maintained?

For most of human history, cities had higher death rates than rural places because crowding people together in an unsanitary environment increased the spread of disease. The public health revolution that began in the 19th century changed all that, and for the last 100 or more years, urban places have held the health advantage over rural populations. But can that hold up as more and more people crowd into cities in developing countries? That question drives much of my own current NIH-funded research and it is the topic of a Scientific American online article:

“While cities have the potential to be healthier places for their citizens, this requires active planning,”Yvonne Rydin, of the University College London’s Bartlett School of Planning, said in a prepared statement. The authors conclude that urbanization alone will not automatically help everyone lead healthier, happier lives. Already about 1 billion , and that number could double in the next 18 years. The tide of urbanization is not going to raise all proverbial ships. “Economic growth cannot be assumed to lift all urban citizens into a zone of better health,” Rydin said. “In many urban areas, rich people and poor people live in different epidemiological worlds, and the burden of ill-health is highest in the poorest groups. The double burden of communicable and non-communicable disease is borne predominantly by poor people.” To improve the health of all urban dwellers present and future concerted planning will be necessary, but global payoffs will be great.

The article unfortunately speaks to simple things like walkable neighborhoods and urban gardens. Those are the luxuries of the rich. In cities of poor countries, the health issues revolve around basic infrastructure such as clean water, sewerage, adequate housing, access to health care facilities, along with basic education about health issues, and the ability of people living on very little money to have an adequate diet that increases their chances of resisting both communicable and non-communicable disease.