Urban health: evidence, challenges, and directions.
Urbanization is one of the most important demographic shifts worldwide during the past century and represents a substantial change from how most of the world's population has lived for the past several thousand years. The study of urban health considers how characteristics of the urban environment may affect population health. This paper reviews the empirical research assessing urban living's impact on population health and our rationale for considering the study of urban health as a distinct field of inquiry. The key factors affecting health in cities can be considered within three broad themes: the physical environment, the social environment, and access to health and social services. The methodologic and conceptual challenges facing the study of urban health, arising both from the limitations of the research to date and from the complexities inherent in assessing the relations among complex urban systems, disease causation, and health are discussed.
Galea
Sandro
S
Center for Urban Epidemiologic Studies, New York Academy of Medicine, Columbia University, NY 10029, USA. sgalea@nyam.org
Vlahov
David
D
D015984:Causality; D002980:Climate; D004781:Environmental Exposure; D004782:Environmental Health; D019317:Evidence-Based Medicine; D005544:Forecasting; D014943:Global Health; D006297:Health Services Accessibility / Q000458:organization & administration; D006304:Health Status; D006801:Humans; D020380:Needs Assessment; D009937:Organizational Objectives; D011157:Population Dynamics; D011634:Public Health / Q000379:methods* / Q000639:trends; D012107:Research Design; D012111:Residence Characteristics; D012499:Sanitation; D012660:Semantics; D012931:Social Environment; D014504:Urban Health / Q000706:statistics & numerical data / Q000639:trends; D019037:Urban Health Services / Q000458:organization & administration*; D014507:Urbanization / Q000639:trends; D014881:Water Supply