A framework for the study of urban health

Sandro Galea, Nicholas Freudenberg, David Vlahov

    Research output: Chapter in Book/Report/Conference proceedingChapter

    10 Scopus citations


    As public health professionals and researchers confront recurrent and emerging urban challenges, they will need new tools, concepts, and theories to study and then reduce the health problems of the 21st-century city. The devastating epidemics of infectious diseases, violence, and drug use that peaked in many U.S. cities in the late 1980s and early 1990s,28 the concentration of social pathologies in some urban populations,19, 29 their dispersion to suburban areas,30 the growing realization that urban sprawl poses threats to both urban and suburban regions,21 and the persistence of a health care system that cannot provide insurance coverage for millions of Americans,1 mostly in urban areas, suggest that a "business-asusual" approach to the health needs of cities is unlikely to lead to improvements in public health. Indeed, it appears that the ability of the United States to achieve the ambitious health goals identified in the U.S. Department of Health and Human Services' Healthy People 2010 report depends in large part on its success in finding better ways to improve health in cities We conclude with a few observations. First, cities continue to grow, and a majority of people in both developed and developing nations will be living in urban areas throughout the 21st century,3 making the question of urban health an urgent priority. Second, though most reliable estimates of the prevalence of various health conditions suggest that the burden of disease in cities is greater than that in nonurban areas, it has not always been so and is certainly not true of all cities and diseases today.31 And though in academic discourse on urban health, cities are often assumed to have a deleterious effect on health, there are also many positive and health-enhancing aspects of cities and urban living. Documenting the health benefits of cities, and developing the interventions to maximize them, is an important priority. Third, to understand urban health we must shift our focus of inquiry from disease outcomes to urban exposures, the characteristics of the urban context that influence health and well-being in cities. Such an approach will enable us to move from description to intervention. Fourth, the study of urban health must acknowledge the reality of complexity. There are no simple solutions for the multidimensional health problems facing cities today. As Perrow32 has shown, this complexity can cause or exacerbate problems; a response to one part of a problem can precipitate an accident or disastrous unintended consequences. Ecological approaches that recognize the importance of studying interactions at multiple levels are a useful tool for the study of urban health.33, 34 Fifth, many disciplines need to contribute to the study of cities. New methodologies in epidemiology, geography, and the quantitative social sciences; insights from anthropologists, psychologists, and historians; and the technical contributions of engineers, architects, and urban planners are among the strands that will contribute to a science of urban health. Finally, improvements in the health of urban populations has always depended and will continue to depend not only on new scientific understanding but also on continuing political mobilization and a commitment to social values that support healthy cities. Advances in all three domains are needed to translate new knowledge about cities into healthier urban communities.

    Original languageEnglish (US)
    Title of host publicationCities and the Health of the Public
    PublisherVanderbilt University Press
    Number of pages16
    ISBN (Print)0826515118, 9780826515117
    StatePublished - Dec 1 2006

    ASJC Scopus subject areas

    • General Social Sciences


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