• Urban environment

Urban environment

This paper examines urban health in low- and middle-income countries, in relation to two sets of environmental issues:

• persistent local environmental health burdens, and most notably the water, sanitation and housing deficiencies prevalent in the poor neighbourhoods of so many urban settlements
• emerging global environmental burdens that will be experienced in urban areas, and most notably those associated with climate change

The paper situates these issues within a policy-relevant framework that can help to reveal the sorts of strategies best able to address them. The paper has four sections:

• the first section considers how a health perspective can provide an alternative or complement to the dominant economic perspective on urban well-being. This is relevant to both local and global environmental issues, and to urban planning more generally.
• the second section turns to some of the transitions commonly associated with “development”, including not only the economic and urban transitions, but also the demographic, health and environmental transitions. These transitions are presented as politically and socially contingent, and not as laws of development
• the third section examines in more detail the environmental health risks associated with deficient water, sanitation and housing
• the final section focuses on climate change

While the challenges of urban housing, water and sanitation are clearly very different from those of cities and climate change, there are also important similarities particularly when it comes to health vulnerabilities and the need for action. The urban groups most vulnerable to the health impacts of climate change are likely to be within the deprived urban populations that currently suffer from environmental health risks due to inadequate housing, water and sanitation.

This reflects a broader generality: the urban populations most vulnerable to global environmental pressures are those already facing the greatest health risks as the result of local environmental burdens. Alternatively, even in low- and middle-income countries, settlements that have managed to address their local environmental challenges efficiently and equitably are likely to be in a better position to adapt to the challenges of global environmental change.

Thus, urban settlements that have already addressed the water and sanitation challenges of their most vulnerable populations are likely to be in the best position to cope with increasing water scarcity. Similarly, urban settlements that have already addressed the land and housing challenges of their most vulnerable populations are likely to be in the best position to cope with increasing flood risks.

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