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Urbanization Puts Public Health at Growing Risk

Health risks associated with 21st century city living include overcrowding, poor air quality, indoor air pollution, respiratory problems, high population density, dampness and the simple lack of water and sanitation.

Policymakers, health care professionals from the world's cities confer in New York

Public health is at growing risk from urban conditions such as pollution, noise, overcrowding and stress, according to experts who met in New York for the Ninth International Conference on Urban Health.

More than half of the world's population lives in cities today, and the United Nations predicts that number will rise to 70 percent by 2050.

Urban health challenges

Health researchers, practitioners, policymakers and academics from 45 countries came to the New York Academy of Medicine to discuss a wide and growing array of urban health challenges. The issues included cholera treatment in Port au Prince, Haiti, condom distribution for sex workers in Bangladesh, pedestrian traffic fatalities in Nairobi, Kenya, and research into the relationship between illicit drug control policies and public health in New York City.

Experts at the conference agreed that the health risks associated with 21st century city living are many and complex, but often include overcrowding, poor air quality, indoor air pollution, the use of fuels that cause respiratory problems, high population density, dampness and the simple lack of water and sanitation.

"In many areas, there are still communal standpipes, latrines that literally hundreds of families have to share," said Trudy Harpham of the London School of Hygiene and Tropical Medicine. "Sometimes no latrines and there is open defecation in some of these areas. So housing and health are a big issue."

The relationship between health, housing and other urban issues is a pressing concern in the United States as well, where 85 percent of the population now lives in cities, according to Adolfo Carrion, a senior administrator at the U.S. Department of Housing and Urban Development.

Money matters

"When you go to the challenges of trash management, of traffic management, of health care delivery systems, of access to jobs of economic opportunity, the quality, when you think of noise levels and pollution levels, we have to deal with all those issues," said Carrion.

A key to promoting urban health is encouraging preventive health care with recommendations for proper diet and exercise routines, for example. Still, many of New York's poorest residents cannot readily act on those recommendations.

"You can give people information about how to live healthy lives," said New York Academy of Medicine President Dr. Jo Ivey Bufford, "but if they can't buy the green vegetables, if they can't exercise because the streets aren't safe, they can't act on the information. That's the kind of environmental issue that's very important for us."

Indeed, in many cities in both the developed and the developing worlds, access to quality health care varies widely between the rich and the poor. Danielle Ompad, an epidemiologist with the New York Academy of Medicine, said that the homeless, substance abusers, and undocumented immigrants are particularly vulnerable. Ompad often imagines what it is like for such people to get a simple flu vaccination.

"You need to have sick leave, or you need to take off work. And we know that a lot of people who live in poverty have multiple jobs that often don't have sick leave or vacation leave. So often they are going to lose money by trying to take off work for preventative health care."

Grassroots approach

Urban Americans mostly rely on hospitals and clinics for their basic medical care. That is not so in many parts of the developing world, where druggists, for example, often prescribe and dispense prescription medications. This grassroots approach is a key part of the Indian government's tuberculosis eradication program.

Dr. Aparna Srikantam of LepraIndia, an NGO that partners with the Indian government, was at the conference to tout its so-called DOTS program, which screens for TB, provides TB medicine when needed, and allows people in the patient's personal circle to follow up.

"Any person can be a DOT provider and need not be a doctor," said Srikantam. "A grocery shop owner or a priest or any person can hold the drugs with them and see that the patient takes the entire treatment so that adequacy will be maintained." She added that each effective DOTS intervention means that as many as 15 other TB transmissions can be prevented.

Trudy Harpham of the London School of Hygiene and Tropical Medicine, believes that such partnerships between centralized authorities and grassroots health care providers will be the key to future advances in urban medicine."It has to be a two-way thing," said Harpham. "Communities have to have the power and the confidence to speak up about their needs and government has to listen."

It's a dialogue that promises to become increasingly urgent, as migration to the planet's urban centers continues to accelerate in the years ahead.