Urban Health

Urban health is a multidisciplinary field that encompasses a wide array of social, built, and physical factors of cities that influence individual and community health. Among these are secure and affordable housing and neighborhoods, affordable and culturally appropriate health services, food security, economic opportunity, adequate transportation, and a healthful physical environment. The roots of urban health as a field of study extend back to the mid-nineteenth century.

The dire living and working conditions in newly industrializing cities in Europe and the United States contributed to rates of disease and death in urban areas that often exceeded those in rural areas. These conditions also served to mobilize social and health reformers of the mid-nineteenth and early twentieth century. Unventilated and overcrowded housing, the absence of building and sanitary code, sewage-contaminated drinking water, and dangerous industrial workplaces precipitated the major epidemics and injuries of the day. These same conditions are endemic [Page 877]in the rapidly urbanizing developing world, where the rural poor are migrating to cities for jobs and live in self-built and public housing, with compromised sanitary conditions, overcrowding, and poor air quality.

The work of early urban health reformers helped institutionalize land use zoning, housing codes, and drinking water and wastewater treatment. It also generated the professions of urban planning, public health, and sanitary engineering, the precursor of environmental engineering and science. Once these reforms had been achieved, however, interest in urban health waned in public and professional consciousness through much of the twentieth century. As the fields of public health, urban planning, and environmental protection modernized and professionalized, they grew apart from each other, particularly during the latter half of the twentieth century, and would increasingly function in separate professional domains.

A recent resurgence of research, policy, and action focused on urban neighborhoods and people is evident across disciplines and within diverse sectors, and it offers the promise of new interdisciplinary approaches to urban health. Among these are the recent healthy cities initiatives pursued by U.S. mayors; the growing focus within municipal health departments on reducing racial and ethnic health disparities by improving health services for minority residents; a national healthy housing movement that includes focus on affordability, neighborhood safety, the links between the indoor environment and health, and housing code reform; growing attention to nutrition and exercise programs in public schools to address the epidemic of childhood obesity; and the revival of farmers' markets, community gardens, and farms in cities to promote improved nutrition and food security. The link between poor health and the inequalities of housing, income, and social status has been most strongly established by British social science and social epidemiology researchers in studying council housing and myriad hierarchical income and occupational settings in cities.

The environmental justice movement has redefined environment as the place where people live, work, play, and pray. This reconception of environment has generated urban environmental health initiatives with a focus on issues most relevant for low-income and minority populations, such as lead poisoning, asthma, obesity, nutrition and exercise, healthy housing and access to green-space, studies of toxic waste and race in metropolitan areas throughout the United States, the restoration of brownfields for economic redevelopment, and green technologies.

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