Urbanization as a Social Determinant of Health Marilyn Rice, MA, MPH, CHES Senior Advisor in Health Promotion Coordinator, Urban Health & Health Determinants Team Area for Sustainable Development and Environmental Health (SDE)

What: a body of non-medical factors that affect individual health status –Examples: ethnicity, socioeconomic status, employment, food access, housing Why: integrating SDH into health programs addresses root causes of health issues –Why treat someone only to return them to the situation that caused the illness in the first place Social determinants of health (SDH): what and why?

Why urban health matters Urban populations are increasing Cities concentrate assets and solutions as well as risks and health hazards Cities can promote well being or unhealthy lifestyles Poverty is exacerbated in cities

Urbanization is associated with many health challenges Communicable diseases Non-communicable chronic diseases and their risk factors Violence Harmful use of alcohol, tobacco and other drugs Mental health, stress and social isolation Road safety Infant mortality

Key Challenges for Cities WHO Kobe Centre “Our cities, our health, our future: acting on social determinants for health equity in urban settings” 2008, Kobe Japan

Some causes of challenges: Different SDHs lead to individual inequalities in access to resources: –Social –Political –Economic –Cultural –Environmental Perceived vs. real benefits of living in an urban setting Crime in the last two weeks: a large proportion of crime occurs in a 5-6 block cluster in San Francisco.

Poverty and health in the city

Targeting SDH also addresses other endemic social issues Health promotion is cost- effective Local governments –Have the power to create and lead intersectoral partnerships at low costs and combine resources across sectors –Are able to influence policies, laws, and provision of human services Why should local governments get involved in urban health?

What can be done to make cities healthier? Attend to the needs of the vulnerable population and include them to reduce inequality Participate in urban planning that promotes safe, clean spaces and healthy environments Creating laws and municipal politics that reduce violence, the degradation of the environment, and that promote healthy living Investing in improving urban living conditions that attend the needs of living, social protection, and conditions of employment Building adaptable, accessible, and comprehensive cities for the elderly Cultivate networks to create and sustain social capital Mobilize existing community capacities & resources Permit the intervention of the civil society in making decisions by governing urban participation Construct buildings and infrastructures that are safe and can support disasters and emergencies Adopting equal health as a fundamental objective shared among the different sectors: government, NGOs, private sector and citizens Integrate health actions with income generating activities Make available ongoing training for professionals on new topics Move forward an urban health research agenda

How can PAHO help? Tools and instruments: –HMC Network – linking members and experiences –Economic impact of health promotion efforts –Mayor’s Guide to MDGs –Mayor’s Guide to HMC –Urban HEART and HIA/HEIA –Participatory evaluation of HMC –PAHO Documentation Template

URBAN HEART Assessment an indicator guide Response a guide to plan action

Contribute to PAHO’s documentation template Join PAHO’s SDE listserv: sde/bvsdeeng.shtml Participate in Urban HEART and Health Impact Assessment workshop in Bogotá (9-13 May 2011) Organize events during Wellness Week on NCDs (12-17 September 2011) How can we work together?

Marilyn Rice, MA, MPH, CHES Area for Sustainable Development and Environmental Health (SDE) Pan American Health Organization SDE site: oms.org/sde/ops- sde/bvsdeeng.shtml Thank you! Play Street (78 th St), NYC: car-free on weekends for physical activities, performance, markets; collaborative work of neighborhood groups and Dept. of Transportation