Health and sustainable development

Urban health equity

Poor favela next to the rich Murumbi area in Sao Paulo, Brazil.
WHO/Anna Kari

Determinants of health equity in urban settings include a wide range of factors in the political/economic, physical and social environment. Deficiencies in any of these can lead to health inequities, and greater health risks for minorities, women, migrants, the poor, the elderly, children or disabled, and other vulnerable groups.

  • The political and economic environment of a city is influenced by factors such as the quality of urban governance, employment, health services, education, social support networks, safety and security, and gender equality.
  • The physical environment includes natural and human-made aspects of cities which contribute to health. Related determinants of health include urban geography and climate, urban built environments, housing conditions, access to safe water and sanitation, food security transport systems, and air quality. Socially vulnerable groups are more likely to live in neighbourhoods that are near natural or manmade hazards (e.g. flood plains, chemical plants); in areas with poor water/sanitation, energy or transport services, or in poor housing conditions.
  • Finally, social and personal characteristics, such as the age or gender balance of an urban population, a large proportion of urban migrants, unemployed, slum-dwellers, or other socially vulnerable groups; and cultural factors. For instance prevalence of heavy alcohol consumption, can also interact with other health determinants and exacerbate health risks.

Although urban residents, on average, enjoy better health than rural populations, urban health risks are distributed unequally among social groups, with most of the burden concentrated among vulnerable segments. Those living in slum areas are particularly affected. Other health inequities may also be clustered by neighbourhood, e.g. areas with significant populations of migrants, elderly, or children.

Poverty is perhaps the most defining determinant of health equity with cross-cutting impacts. New urban dwellers living within informal settlements are often those mostly likely to lack decent work, as well as access to safe and durable housing, clean energy sources, improved drinking water and sanitation. These settlements may often be located in proximity to heavily-trafficked roads, polluted industrial areas, power plants or waste dumps – and thus exposed to higher levels of outdoor air pollution as well as toxic exposures in soil or water supplies. About 25% of households in low-income cities still rely on inefficient coal or biomass stoves for cooking, which cause household air pollution, also associated with significant health impacts.


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