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India has the world’s second largest urban population (after China). This paper shows the large disparities within this urban population in health-related indicators. It shows the disparities for child and maternal health, provision for health care and housing conditions between the poorest quartile and the rest of the urban population for India and for several of its most populous states. In the poorest quartile of India’s urban population, only 40 per cent of 12 to 23 month-old children were completely immunized in 2004—2005, 54 per cent of under-five year-olds were stunted, 82 per cent did not have access to piped water at home and 53 per cent were not using a sanitary flush or pit toilet. The paper also shows the large disparities in eight cities between the poorest population (the population in the city that is within the poorest quartile for India’s urban areas), the population living in settlements classified as “slums” and the non-slum population. It also highlights the poor performance in some health-related indicators for the population that is not part of the poorest quartile in several states — for instance in under-five mortality rates, in the proportion of stunted children and in the proportion of households with no piped water supply to their home. [ABSTRACT FROM PUBLISHER]

This paper reviews the literature on health in the informal settlements (and “slums”) that now house a substantial proportion of the urban population in Africa, Asia and Latin America. Although this highlights some important gaps in research, available studies do suggest that urban health inequalities usually begin at birth, are reproduced over a lifetime (often reinforced by undernutrition), and may be recreated through vulnerabilities to climate change and a “double burden” of communicable and non-communicable diseases. The review begins with a discussion of papers with a life-course perspective on health, poverty and housing, before considering recent literature on chronic poverty and ill-health over time. It then discusses the literature on the cost, quality and access to care among low-income groups, and the under-recognized threat of unintentional injuries. This includes recent literature that discusses where low-income residents may suffer an “urban penalty” rather than benefiting from urban bias — although there are also studies that show the effectiveness of accessible, pro-poor health care. The concluding section examines emerging risks such as non-communicable diseases and those associated with climate change. It notes how more gender- and age-sensitive strategies can help address the large inequalities in health between those in informal settlements and other urban residents. With greater attention to the multi-faceted needs of low-income communities, governments can create interventions to ensure that urban centres fulfil their enormous potential for health. [ABSTRACT FROM PUBLISHER]

This paper highlights the role of community prevention in improving overall health and in supporting health equity. By addressing the underlying causes of illness and injury, community prevention efforts can prevent illness and injury before they occur. The paper presents three frameworks that support quality community prevention efforts. The first, Taking Two Steps to Prevention, analyzes the underlying causes of illness, injury and health inequities and helps identify key opportunities for intervention and prevention. The second framework, the Spectrum of Prevention, guides users in thinking through the elements of a comprehensive community prevention strategy: strengthening individual knowledge and skills; promoting community education; educating providers and leaders (in all sectors); fostering coalitions and networks; changing organizational practice (within government, health institutions and workplaces, among others); and influencing policy and legislation. Both Taking Two Steps and the Spectrum are explained through the demonstration of two successful and ongoing community prevention efforts: first, preventing smoking; and second, promoting breastfeeding. The third framework, Collaboration Multiplier, focuses on developing sustainable interdisciplinary partnerships capable of addressing a variety of health and social problems. Collaboration Multiplier provides a matrix that clarifies the contributions that different sectors bring to a particular health or social problem and helps develop a shared language and understanding for working together. [ABSTRACT FROM PUBLISHER]

This paper considers how the subject of urban inequalities has come to be given more consideration within the discussions of urban poverty and urban health. It suggests a need for more precision in understanding and acting on such inequalities — and discusses how measurement and policy response are influenced by whether the focus is on urban poverty, differentials, inequality or inequity. Many authors fail to clarify the difference between a differential, an unequal and an unjust distribution of services or resources, or health outcomes. This paper discusses what aspects of inequality can and cannot be addressed through conventional local government interventions (for instance, in upgrading informal settlements or public transport, or water pricing). It argues that to change urban inequalities at root, we have to recognize and address unjust distributions of power and control of resources. [ABSTRACT FROM PUBLISHER]

In this paper I examine claims of racial difference in bone density and find that the use and definitions of race in medicine lack a theoretical foundation. My central argument is that the social produces the biological in a system of constant feedback between body and social experience. By providing a different angle of vision on claimed racial differences I hope to move the conversation away from an ultimately futile discussion of nature versus nurture, where time is held constant and place seen as irrelevant, and begin to build a new paradigm for examining the contributions of geographic ancestry, individual lifecycle experience, race, and gender to varied patterns of health and disease. [ABSTRACT FROM AUTHOR]

This paper presents an ethnographic case study of the use of race in two interconnected laboratories of medical genetics. Specifically, it examines how researchers committed to reducing health disparities in Latinos with asthma advance hypotheses and structure research to show that relative frequencies of genetic markers characterize commonly understood groupings of race. They do this first by unapologetically advancing the idea that peoples whom they take to be of the 'Old World', or 'Africans', 'Europeans', 'East Asians', and 'Native Americans', can serve as putatively pure reference populations against which genetic risk for common diseases such as asthma can be calculated for those in the 'New World'. Technologically, they deploy a tool called ancestry informative markers (AIMs), which are a collection of genetic sequence variants said to differ in present-day West Africans, East Asians, Europeans, and (ideally Pre-Columbian) Native Americans. I argue that this technology, compelling as it may be to a range of actors who span the political spectrum, is, at base, designed to bring about a correspondence of familiar ideas of race and supposed socially neutral DNA. This correspondence happens, in part, as the scientists in question often bracket the environment while privileging racialized genetic variance as the primary source of health disparities for common disease, in this case between Mexicans and Puerto Ricans with asthma. With their various collaborators, these scientists represent a growing movement within medical genetics to re-consider race and 'racial admixture' as biogenetically valid points of departure. Furthermore, many actors at the center of this ethnography focus on race as a function of their personal identity politics as scientists of color. This to say, they are driven not by racist notions of human difference, but by a commitment to reduce health disparities and to include 'their' communities in what they describe as the 'genetic revolution'. [ABSTRACT FROM AUTHOR]

While the COVID-19 pandemic's effect on the health of low-income urban communities in the global South has not been insignificant, the results of state responses carried out without full consideration of poverty consequences have been very serious. Vaccination, which supports both health and economic recovery, is one way people can reduce the risk of further exclusion. This field note, drawing on surveys from informal settlements in Harare, Kampala, Lilongwe and Mumbai between August and November 2021 by national affiliates of Slum Dwellers International (SDI), provides a snapshot of how global vaccine inequalities have played out across these cities. We find that access to local vaccine programmes is influenced by both global supply and existing local-level inequities; that a low or unreliable supply, among other factors, limits political will to invest in reaching already underserved communities; and that local context and the heterogeneity of communities are key to understanding low vaccine uptake. [ABSTRACT FROM AUTHOR]

“Don’t teach us what is sanitation and hygiene.” This quote from Maqbul, a middle-aged male resident in Modher Bosti, a slum in Dhaka city, summed up the frustration of many people living in urban poverty to ongoing sanitation and hygiene programmes. In the light of their experiences, such programmes provide “inappropriate sanitation”, or demand personal investments in situations of highly insecure tenure, and/or teach “hygiene practices” that relate neither to local beliefs nor to the ground realities of a complex urban poverty. A three-year ethnographic study in Chittagong, Dhaka, Nairobi and Hyderabad illustrated that excreta disposal systems, packaged and delivered as low-cost “safe sanitation”, do not match the sanitation needs of a very diverse group of urban men, women and children. It is of little surprise that the delivered systems are neither appropriate nor used, and are not sustained beyond the life of the projects. This mismatch, far more than an assumed lack of user demand for sanitation, contributes to the elusiveness of the goal of sanitation and health for all. The analysis indicates that unless and until the technical, financial and ethical discrepancies relating to sanitation for the urban poor are resolved, there is little reason to celebrate the recent global declaration on the human right to water and sanitation and health for all. [ABSTRACT FROM PUBLISHER]