Session 64: Influence on urban health in the global south: Identifying the challenges
Global Change is affecting urban health through direct and indirect pathways. The fast growing urban agglomerations of the Global South often witness a severe deterioration of ecosystems, living conditions and consequently human health. Demographic shifts, health transitions and the adequate response of health systems to these problems pose severe challenges. This session mapped out major determinants shaping the health vulnerabilities of urban populations in the Global South and link these to global change as one of the root causes.
Determinants of health can be broadly categorized as social and environmental. A third dimension of health pertains to health systems as they respond to emerging health transitions. For the urban agglomerations in the South, determinants such as poverty, predominance of informal settlements, the deterioration of air and water quality, degraded ecosystems and associated health services, growing inequities and vulnerabilities complicate and create health challenges. Poor health services (public and private) and restricted access for the poor and other vulnerable groups further sharpens the prevailing health inequities. Understanding the major influences of urban health and providing solutions for generating the necessary knowledge for decision makers was a major aim of this session.
Keywords: health, Global South, transitions, determinants
Key Discussion Points
- Urban spaces in the Global South are unhealthy places due to the process of the rapid urbanization, the lack of skills and resources of local authorities, and external influences like global change.
- We need a differentiation of vulnerability within cities to know who needs to be targeted by public health interventions, i.e., who is the most vulnerable.
- Health costs are rising because of ecological degradation, exposure to hazards, and lack of salutogenetic ecosystem services i.e., people more exposed to unhealthy environments and the capacity to cope with stress through exposure to nature etc., is greatly reduced.
- Urban areas in low- and middle-income countries are simultaneously home to the healthiest and the unhealthiest populations.
Key Research Priorities
- Understanding the complexity of institutions, actors and processes related to urban health.
- The influencing mechanisms between EC and health outcomes, both negative and positive, focusing on how to make cities healthier places, not only what affects health negatively (salutogenetic perspective).
- What is the effect of global change on health?
- Understanding the multiplicity of health systems and the interactions between the public and private and different health care systems, user behaviors and what it means for health monitoring, i.e., Ayurvedic vs. some other forms.
- How can we generate data under the conditions given in agglomerations of the South (informality, lack of reporting etc.)? How can we analyze and disseminate information about health problems to decisionmakers in a more timely fashion? How can we respond to outbreaks? How can health monitoring better inform city planning?
- Research must develop smart strategies to identify social and spatial differences (and perceptions) of health risks.
- Develop innovative ways of disseminating and of building awareness of urban health issues.
- We need better governance of rapid urbanization to build more inclusive and healthier cities.
- We need to look at urban form and how we can build healthy urban spaces (understood to some extent, but not completely); this affects urban planning at all scales: the buildings, healthy neighborhoods (inclusion of urban green and urban blue as salutogenetic elements of cities) and a master plan in which health issues are a crosscutting issue).
- Empowerment of the people affected, and empowerment of women is important in this context.
- There is a great need for more participatory planning processes and increase of health care knowledge throughout the population – not only planners, but also local people.
- Targeted health services for vulnerable and provision of accessible preventive and curative services are needed.
- Increase resources for the local health care sector, i.e., people who are most aware of local health situations should have the most resources (subsidiarity vs. top down planning; requires also financial empowerment of local administrations).
- Reorganization of the health care sector, with more transparency and increased quality of services.
- Knowledge-based and demand-oriented services (non-communicable diseases on the rise as well as communicable diseases).
- Influences of extreme events on health; this is related to disaster preparedness and planning.
Carsten Butsch, University of Cologne, Cologne, Germany
Frauke Kraas, University of Cologne, Cologne, Germany
Humphrey Ngala Ndi, University of Yaounde I, Yaounde, Cameroon
Presentation Title: Environmental change and the relapse of malaria in Maroua, far north of Cameroon
Joshua Sperling, Urban Futures, National Center for Atmospheric Research, Boulder, USA
Presentation Title: Exploring health outcomes, inconveniences, and perceived risks associated with infrastructure, pollution and extreme weather events in Mumbai, India
Mareike Kroll, University of Cologne, Cologne, Germany
Presentation Title: Challenges for monitoring non-communicable diseases in Pune, India
Tabea Bork-Hueffer, National University of Singapore, Singapore
Presentation Title: Governance challenges in China's urban health care system: Effects for the domestic and international migrant population
Surinder Aggarwal, University of Delhi, Delhi, India
Presentation Title: Acting on social determinants of health to promote healthy urban settings