As our world, our country, and our states become more urban and understanding of urban health becomes more important. Health inequities within urban areas are often hidden by city or county averages. The World Health Organization points out that good urban governance is key to creating healthy urban environments through addressing social determinants of health. The health sector’s voice is important to creating supportive social and physical environments for both health and health equity. This is an important challenge as we move forward in the 21st century.
According to the World Health Organization the “key to improved health equity lies in optimizing urban settings for health” (WHO, 2008). This goes toward an approach where we attempt to address the “causes of the causes” of ill health. Poorly planned urbanization is a structural determinant of health and creates social stratification. In some countries this is seen as large informal and poorly built neighborhoods on the edges of cities. In the US this manifests as places such as colonias in the southwest. Poverty, and the concentration of poverty, leads to the development of neighborhoods with different environments and different health outcomes. These inequities tend to impact people of color, working-class people, and immigrants most clearly.
Issues that are important to consider for urban health are communicable diseases, HIV/AIDS, traffic injuries (pedestrian, bicycle, and vehicle), violence and crime, mental health, substance abuse, food insecurity, environmental pollution, low-income jobs with health hazards, housing, neighborhood safety, and more. The distribution of these issues has a huge impact on health equity. In the US it is often poor, working-class, and people of color neighborhoods which face the largest inequities in resources for health.
WHO recommends healthy urban governance as an approach to bring together interventions. This is another important place for urban health extension workers to participate. Urban governance is more than government but all of the different sectors which impact public life. The development of an integrated approach will require strong health promotion work, including that of urban health extension workers. Creating fair health opportunities for all people is an important point from which to rally. Healthy public policy is defined in the Ottawa Charter and provides a good foundation from which to move from.
Urbanization itself is a major determinant of health. We should work toward improving urban settings for health and health equity. Improving the quality of living environments are an important step in improving health and addressing health equity. If all of the cities, towns, and villages health extension reaches were to make health a priority we would likely have many models for others to follow.