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Cities and the Health of the Public

Edited by Nicholas Freudenberg, Sandro Galea, and David Vlahov

Publication Year: 2006

The essays commissioned for this book analyze the impact of city living on health, focusing primarily on conditions in the United States. With 16 chapters by 24 internationally recognized experts, the book introduces an ecological approach to the study of the health of urban populations. This book assesses the primary determinants of well-being in cities, including the social and physical environments, diet, and health care and social services. The book includes chapters on the history of public health in cities, the impact of urban sprawl and urban renewal on health, and the challenges facing cities in the developing world. It also examines conditions such as infectious diseases, violence and disasters, and mental illness.

Published by: Vanderbilt University Press

Table of Contents

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pp. ix-xii

Several global trends make the early twentieth-first century an opportune time to revisit the connections between city living and health. First, more and more people are living in cities. By 2007, more than half the world’s population and by 2030 more than three-quarters will be in urban areas. Moreover, cities are growing, sprawling into suburbs, dominating cultures, exporting disease but also...

Part I. Introduction

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pp. 1

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1. A Framework for the Study of Urban Health

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pp. 3-18

Today, city life is the norm for an ever-growing proportion of the world’s population, and recent projections estimate that half of the world’s population will live in urban areas by 2007 and three-quarters by 2030. Much of this growth will be in the developing world: By 2030, all of the world’s largest cities are projected to be in Africa, Asia, and Latin America. This international expansion of cities reflects ...

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2. Changing Living Conditions; Changing Health: U.S. Cities since World War II

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pp. 19-45

In the previous chapter, we proposed a framework for the study of the determinants of the health of urban populations. Here, we use this framework to examine changing patterns of health and disease in U.S. cities in the six decades since World War II, calling attention to the key elements of the framework and discussing how these processes and factors have affected the health of urban populations ...

Part II. Determinants of Health in Cities

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pp. 47

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3. The Urban Social Environment and Its Effects on Health

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pp. 49-60

Do the places where people live make a difference to their health? An awareness of community variations in health status has existed since at least the 19th century.

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4. The Urban Physical Environment and Its Effects on Health

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pp. 61-84

This chapter explores the relationship between characteristics of the urban physical environment and health. An understanding of the relationship between the urban physical environment and health must be ecological, taking into account issues of multilevel causality, reciprocity, social inequality, and change. In Chapter 1 of this volume and elsewhere, urban and public health scholars1, 2 have proposed ...

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5. Access to High-Quality Health Care in U.S. Cities: Balancing Community Need and Service System Survival

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pp. 85-105

For decades, health care in the urban United States has been a study in contrasts. Hospitals in many U.S. cities are renowned for providing the best quality of care in the world. The term centers of excellence has come to represent mostly urban-based academic medical centers and other facilities that have developed a reputation for providing emergency services, trauma care, and complex specialty care. ...

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6. Food, Nutrition, and the Health of Urban Populations

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pp. 106-125

In the past century, Western nations have witnessed a dramatic transformation in the impact of nutrition on the health of the public. In the early decades of the 20th century, and before, food and nutrient deficiencies were the prevailing scourges. Now the problem of nutritional excess has overtaken deficiency as a leading threat to health in the United States and increasingly throughout much of ...

Part III. Local and Global Perspectives on Changing Cities

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pp. 127

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7. Public Health in U.S. Cities: A Historical Perspective

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pp. 129-142

In the United States, as elsewhere, the health of urban populations has been shaped by the shifting nature of the country’s economic, social, and political life. From early in U.S. history, health status and social development have been intimately connected. In the 16th and 17th centuries, most Americans lived in rural areas. Many studies of Colonial New England written in the 1970s reveal an...

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8. Cities, Suburbs, and Urban Sprawl: Their Impact on Health

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pp. 143-175

All would agree that Harlem, Piccadilly Circus, the Latin Quarter, and the Ginza are parts of cities, and all would agree that Yosemite, Ayers Rock, and the African savannah are not. But in the vast middle ground—the transitional zones between the urban and the rural, the regions known as “suburbs” and “exurbs”—the boundaries are not so...

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9. Fifty Ways to Destroy a City: Undermining the Social Foundation of Health

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pp. 176-193

On the short list of factors that are fundamental to health are adequate food, proper sanitation, clean water, clean air, and social order, the topic of this chapter. Social order does not produce health in the way that Vitamin C prevents scurvy: it is not a silver bullet. Instead, social order produces health by organizing people to work together to solve their common problems. Social order—which links people with ...

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10. A Developing World Perspective: Health and Deficiencies in Provision for Water and Sanitation in Urban Areas of Africa, Asia, and Latin America and the Caribbean

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pp. 194-205

Water and sanitary improvement rose to international prominence when health in the industrializing cities of the 19th century was far worse than in their rural surrounds, and reformers claimed to have found the means to counter this urban penalty: clean piped water and sewered toilets. While there have been enormous improvements since the mid 19th century, according to the most recent global bur-...

Part IV. Health Outcomes and Determinants

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pp. 207

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11. Cities and Infectious Diseases: Controls and Challenges

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pp. 209-224

The burden of infectious disease in the United States underwent a marked decrease in the 19th and 20th centuries, producing a dramatic reduction in population mortality. Although many of the infectious diseases that were a problem in the 19th century have been controlled, some remain endemic, others appear in more sporadic outbreaks or reappear, and novel infections emerge. City characteristics ...

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12. Traumatic Stressors in Urban Settings: Consequences and Implications

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pp. 225-246

Violence, disasters, terrorism, and other potentially life-threatening events present serious challenges to health in urban settings. Such events, which affect most urban residents at some time in their lives, can produce extreme stress reactions and raise the risk of a wide range of mental and physical health problems.1–9 Also, these events are responsible for an enormous economic burden at the national, ...

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13. Mental Health in the City

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pp. 247-273

Mental and behavioral disorders affect more than 25% of people during their lifetime and are estimated to be present in 10% of the adult population at any time.

Part V. Next Steps: Research and Intervention

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pp. 275

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14. Methodological Considerations in the Study of Urban Health: How Do We Best Assess How Cities Affect Health?

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pp. 277-293

In this chapter we discuss research methods that may be applicable to the study of urban health and consider some methodological challenges that arise in urban health research. Several research questions may be considered pertinent to the study of urban health, and as the discipline continues to evolve, it is inevitable that the range of questions considered important will expand and become ...

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15. Interventions to Improve Urban Health

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pp. 294-326

The goal of public health is to “assure the conditions of health” for populations. Thus, the highest priority for urban health professionals is to plan and implement interventions to improve the health of people living in cities.¹ As discussed in previous chapters, such interventions occur within a particular social, economic, and political context and operate at multiple levels of social organization....

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16. Creating Healthier Cities: Where Do We Go from Here?

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pp. 327-343

In this book and in other recent publications¹⁻³ we have proposed an ecological approach to urban health that suggests that the urban environment influences health and behavior at multiple levels. The focus of this approach is on “urban living conditions,” which are viewed as the day-to-day life circumstances of city dwellers that can either promote or damage health. This approach views health in cities ...


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pp. 345-347


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pp. 349-364

E-ISBN-13: 9780826592064
Print-ISBN-13: 9780826515117
Print-ISBN-10: 0826515118

Page Count: 374
Publication Year: 2006