Cities and the Health of the Public (review)
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Reviewed by
Cities and the Health of the Public. Edited by Nicholas Freudenberg, Sandro Galea and David Vlahov. Vanderbilt University Press, Nashville, 2006.

Cities and the Health of the Public is written and edited by public health scholars with extensive experience in urban health. The rationale for this book, and for interest in urban public health, is the fact that the majority of people in the world live in urban areas. Furthermore, better understanding and appreciation of the full scope and uniqueness of urban health will foster public health interventions with positive affects across racial, ethnic and income strata. The authors point out that remediation of inequalities must be an explicit objective of public health planners.

Tailored towards a diverse audience, this book foremost targets students, but is also an essential primer for practitioners and researchers of urban public health. Each chapter is an introductory review of a specific topic linked to the editors' framework for the study of urban public health. This framework places public health in the center of a dynamic continuum affected by multiple influences. Upstream influences include such factors as major global and national trends and municipal level structures while downstream influences are what the editors refer to collectively as "urban living conditions." The four principal components of urban living conditions, in this framework, are population, social and physical environments, and the system of health and social services. Cumulatively, these influences affect health outcomes; each chapter in the book subsequently elucidates more specific topics within these dimensions. Given this framework, students can easily understand how each topic fits in and ultimately affects health outcomes.

The text consists of 16 chapters, which read like essays on a particular topic, and are written by academic experts in each area. Citations from the literature are extensive, with some chapters exceeding 200 references. In addition to providing excellent integration of the pertinent literature about the topic, many chapters could serve as succinct literatures reviews.

The book is organized into five thematic sections. Part I, the introduction, relates staggering statistics on the distribution of the global population into urban areas, and provides central definitions and the overall framework. Chapter 2 uses the framework to outline how events in post–World War II U.S. cities have contributed to modern health issues. It identifies the major trends affecting each component of the framework since the mid-20th century, highlighting the impact of global and national phenomena such as immigration, globalization, decentralization of government, as well as the [End Page 320] changes unique to urban settings such as suburbanization, concentration of racial/ethnic minorities and poverty, and population density.

Part II, Determinants of Health in Cities, expands on the central ideas introduced in the earlier chapters. Chapter 3 introduces the social environment, which affects health through pathogenic and salutogenic influences, and provides a compelling argument to address it as a necessary component of any health intervention. Chapter 4 gives a comprehensive review of how the physical environment of cities affects health, and expands on how underlying community level/proximate level factors affect health. This chapter would ideally generate discussion among students about defining the physical environment, and the conceptual difficulty with the somewhat abstract distinction between the two levels. Chapter 5 presents a useful overview of the crisis of the uninsured in the context of the challenge-ridden urban safety net by exploring access to care for vulnerable urban populations. The final chapter in Part I consists of a summary of how nutrition affects the health of urban populations, touching on basic themes such as food insecurity, obesity, and lack of exercise.

Part II, Local and Public Perspectives on Changing Cities, includes chapters on a wide range of topics unique to urban health, expanding on the more controversial themes of the field. Chapter 7, Public Health in US Cities, vividly and persuasively paints a historical picture of the inherent interconnection between disease, urban filth, and social corruption, the transition from predominance of infectious to lifestyle related disease in cities, and the time-immemorial concept of the stigmatization of the poor as vectors of disease and immorality. Chapter 8, Cities, Suburbs and Urban Sprawl, like its predecessor...


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