title: Beyond urban penalty and urban sprawl: back to living conditions as the focus of urban health.
abstract: Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.
authors.affiliation: Program in Urban Public Health, Hunter College, City University of New York, 425 East 25th Street, New York, New York 10010, USA. nfreuden@hunter.cuny.edu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Freudenberg
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
mesh_terms: D003153:Community Health Services / Q000458:organization & administration; D006293:Health Promotion / Q000458:organization & administration; D008962:Models, Theoretical; D011203:Poverty; D011634:Public Health / Q000379:methods; D012111:Residence Characteristics; D012924:Social Conditions; D014504:Urban Health