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why URBAN HEALTH JUSTICE now?

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Prof Haim Yacobi

Programme Leader | Health in Urban Development (HUD)

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h.yacobi@ucl.ac.uk

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The historic dream of public health... is a dream of social justice.”

D.E. Beauchamp “Public Health as Social Justice,” in New Ethics for the Public’s Health, ed. D.E. Beauchamp and B. Steinbock (New York: Oxford University Press, 1999 ), 105–114

• Education, employment and cultural opportunities
• Tolerance and diversity (religious, gender, celebrating difference)
• Density and hence services, social support
• Linking the global into the local

MSc Health in Urban Development

“Cities were more porous, open to flows of people, capital, communication and ideas. Without this dynamism, liberalism’s insistence on human autonomy and choice would have been merely speculative. …Liberalism and the city… have been deeply intertwined for centuries” (Katznelson 1995: 57)

London Freetown Paris

HOWEVER…

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• Cities are also about inequalities, conflicts, violence, segregation, health disparities
• Morbidity and mortality are rising in both global north and global south urban territories

London Belfast Cali

In an urbanizing world, the health of urban dwellers is becoming a central concern, especially since social gaps are growing between cities and regions. Consequently, the first session aims to present the centrality of social justice discourse to urban health, in general, and in the Global South, in particular. Urban health will be defined according to various approaches, with an emphasis put on the transition from the clinical approach to the health-just approach and to the social determinants of health. Health will be discussed as an integrative component in the analysis of the urban as a social, political and spatial entity, looking at the effects of urbanisation on both physical and mental health.

MSc Health in Urban Development

MSc Health in Urban Development

Life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations effectively determines length and quality of life:

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• Access to health care
• Access to resources
• Education
• Employment
• Environment
• Income/Poverty
• Insurance Coverage
• Housing
• Racism/Discrimination
• Segregation
• Transportation

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What affects our health?

MSc Health in Urban Development

If urban space matters for health and well being, why there is an over-emphasis on treating people for a specific disease of risk, and then sending them back into their place of living where conditions made them in the first place?

Health Inequities: Systematic and unjust distribution of social, economic, and environmental conditions needed for health.

• Unequal access to quality education, healthcare, housing, transportation, other resources (e.g., grocery stores, car seats)
• Unequal employment opportunities and pay/income
• Discrimination based upon social status/other factors

According to the Africa Public Health Information Services:

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• Lack of clean water, sanitation and hygiene costs Sub-Saharan African countries more in lost GDP than the entire continent gets in development aids

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• The 25 countries globally with least access to safe water (19 of them African) dominate the top 50 countries with highest child mortality

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• 1.6 people die every year from diarrheal diseases (including cholera) attributable to lack of access to safe drinking water, and basic sanitation (90% are children under 5)

Addis Ababa

As we are witnessing, the pandemic is praying on pre-existing health disparities in the global South and North, especially in low-income and informal settings.

What is clearly illustrated is the fundamental role of urban space, infrastructure, planning and policy, in shaping health inequities in our cities, neighbourhoods and homes.

The lack of just planning expressed in the provision of infrastructure (water and sanitation for example), in the deficiency of housing, and in the privatisation of health services renders the most vulnerable urban populations at higher risk.

• Focuses on health justice based on resource allocation and recognition of rights. It is a pro-active, interventionist approach.
• Not only a space that provides physical infrastructure but should have an urban governance where public health is contributing to human well-being and urban justice.
• Public health and urban planning should be understood as complementary practices as both focus on the policies, practices and processes that influence the well-being of urban dwellers.

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So, what is urban health justice?

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Global

Local

Medical

Policy

Human Right

Identity: Race, ethnicity, gender

Immigration\

refuge\citizenship

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Institutions

Government

Local and Intl. NGOs

Municipalities

Private sector

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Conditions

Housing

Infrastructure

Education

Employment

Environment

Behavior

Smoking

Physical activity

Nutrition

Violence

Diseases

Communicable

and Non Communicable

Mortality

Mortality

Life expectancy

Climate change

Poverty

Violence

Discplacement

Ideology

Knowledge

Geopolitics

Borders

Refuge

Power

Participation

MSc Health in Urban Development

Policy Development planning Bio- Medical knowledge