Secondary Cities and Slum Health: Long Term Connections

The Secondary Cities Project of the U.S. State Department has been organized by Dr. Debbie Fugate, Chief of the U.S. State Department's Humanitarian Information Unit (and a former PhD student of mine). This morning I listened in to a webinar about the project which will be archived online in a few days, but the overview of which is available here. By the middle of this century, the UN projects that nearly 6 out of every 10 humans will be living in a city of some kind or another, but more of them will be in smaller (i.e., secondary) cities than in the huge metropolises of the world. The latter get most of the attention, but the greatest needs are likely to be in the former.

Among the needs are those related to health. In less developed nations, the typical resident lives in a slum and health issues are bound to be more intense in those parts of town, as I and my colleagues have demonstrated in our research in Accra, Ghana (go here for an overview paper). Another of my former PhD students, Dr. Justin Stoler at the University of Miami (and a co-author on the paper just mentioned), recently sent me a link to a paper from the latest issue of The Lancet, which is the first in a series of papers about slum health (and the paper is available without a subscription, although you have to register with the journal to read it). 

In the first paper in this Series we assessed theoretical and empirical evidence and concluded that the health of people living in slums is a function not only of poverty but of intimately shared physical and social environments. In this paper we extend the theory of so-called neighbourhood effects. Slums offer high returns on investment because beneficial effects are shared across many people in densely populated neighbourhoods. Neighbourhood effects also help explain how and why the benefits of interventions vary between slum and non-slum spaces and between slums. We build on this spatial concept of slums to argue that, in all low-income and-middle-income countries, census tracts should henceforth be designated slum or non-slum both to inform local policy and as the basis for research surveys that build on censuses. We argue that slum health should be promoted as a topic of enquiry alongside poverty and health.

Our own research has led us to similar conclusions, reinforcing the views of these authors, several of whom we have referenced in our publications, that where you live is as important to your health as are your own personal characteristics. Capturing this kind of spatial variability is an important part of the Secondary Cities Project, since resilience and emergency preparedness (the foci of that project) are closely associated with poverty and health in urban areas. Nothing less than the sustainability of human society is at stake here.