Contextualizing Health: Accounting for the Urban Environment

By Jakab, Zsuzsanna | Harvard International Review, Summer 2012 | Go to article overview
Save to active project

Contextualizing Health: Accounting for the Urban Environment

Jakab, Zsuzsanna, Harvard International Review

Dr. Margaret Chan, Director General of the World Health Organization, begins her foreword to the 2010 WHO/HABITAT report Hidden Cities:

"It is well known by now that half of humanity lives in urban areas - and the proportion is growing. Cities, with their concentration of culture, infrastructure, and institutions have long driven the progress of civilization and have been the focus of opportunity and prosperity."

However, cities are also the nexus of negative economic, environmental, and economic forces jeopardizing the lives and poor health of many inhabitants. The aim of Hidden Cities is to unmask these deprivations, less visible in Europe than elsewhere, often hidden beneath glittering facades and marginalized in prosperous economies. It is our responsibility to overcome the great health inequalities which still prevail between and within the nations of Europe.

The first part of this article highlights some specific challenges facing urban communities in Europe. The second part summarizes how urban institutions and citizens of Europe are meeting these challenges, which is absolutely relevant to the work of the European Region of the WHO. Improving health and reducing health inequities has been the constant first priority of the Region, from the first of our targets for Health for All, published in 1984, through to Health 2020, the new European Strategy for Health. Health 2020 adopts a whole systems approach, acknowledging both the central role of national governments in the provision of health services, as well as the role of local government and its partners in influencing the wider determinants of health.


Part One: Challenges

Urbanization is an irresistible social phenomenon and has been a dominant global demographic trend over the last two centuries. The level of world urbanization today is unprecedented. Cities are currently home to half the world's population, and it is estimated that over the next 30 years, most of the more than two billion person increase in the global population will occur in urban areas. Today, some 400 cities contain one million people or more, and about 70 percent are in the developing world. By 2017, the developing world is likely to be more urban than rural in character.

In the modern era, the European Region was the first of the WHO regions to urbanize, with industrialization inducing exponential population growth in the nineteenth and twentieth centuries. Now, our population of 900 million in 53 countries has stabilized overall, and we are not subject to the intense pressure of population growth experienced by other regions. Nevertheless, Figure 1 shows a divergence in the trajectories of urban populations in groups of European countries. In southern and eastern Europe, migration from rural settlements has been a major reason for population growth in cities. Since 1989 migration flows from eastern to western countries have increased, and some cities have accommodated high numbers of refugees and migrants.

The fragmentation of urban populations, alongside social and economic development, can create a number of serious management issues affecting individual and social life. There is pressure stemming from physical infrastructure, environmental degradation, traffic congestion and pollution, housing shortages, overcrowding, and other stress-related phenomena. These trends have heavily burdened social, health and welfare services in the host cities as well as the housing and employment markets, particularly during times of economic recession, when public authorities have reduced expenditure on housing and urban infrastructure and cutting allowances for welfare, health and community care.



Besides migration, the other salient demographic in Europe is an aging population. The age "pyramid" has become an age "mushroom." In earlier eras of European development, and now in most developing cities in Global South, high fertility rates expanded the base of the age pyramid and limited life expectancy reduced die apex.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Cite this article

Cited article

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Contextualizing Health: Accounting for the Urban Environment


Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?