Slum Upgrading and Health Equity

Abstract

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

“…An equitable approach to arresting the COVID-19 pandemic must change standard ways of treating the urban poor, create more participatory governance, improve the delivery of essential services including health care, and invest new resources to ensure urban informal settlements benefit in the long term [13]. However, governments have already begun to impose draconian quarantine and physical distancing measures for the urban poor without also ensuring that those residing in urban slums can meet their everyday needs, such as food and clean water [14].…”

Slums, Space, and State of Health—A Link between Settlement Morphology and Health Data

“…The literature on the relationship between slums and health has produced some reviews in recent years. The connection between slums and health was generally pointed out [2,3,47], as well as the connection between slum upgrading and health [5]. It was also shown that the physical environment and infrastructure intervention, such as road paving or water supply, have significant effects on the health of slum dwellers [48].…”

“…The inhabitants of these settlements form a separate social group [27] that is exposed to increased health risks [2], and is associated with insufficient access to infrastructures such as sanitary facilities or water supply and inadequate housing situations. These settlements are often self-built and rarely recognized by the local or national governments [5].…”

“…For this reason, several of the United Nations Sustainable Development Goals mention the inhabitants of slums and the necessary improvement of their living conditions both explicitly (Goal 11-sustainable cities and communities) and implicitly (Goal 3-good health and well being; Goal 6-clean water and sanitation; Goal 9-industry, innovation, and infrastructure). To improve the health situation of the inhabitants of these settlements, studies repeatedly refer to slum upgrading, in which the slum settlements are progressively connected to the infrastructure of the respective city [3,5]. However, before these countermeasures can be initiated, the current situation and developments of these settlements must first be adequately assessed.…”

Urban Health Education: Global Challenges and Opportunities

“…Today's cities are too often characterized by stark inequality, between the wealthy and poor and different racial/ethnic groups, among other differences. Urban informal settlements are some of the starkest manifestation of the failure of urbanization to create equitable and healthy living conditions [4]. Epidemiologists and others continue to measure population differences in health status, and urban health education will need to link these analyses to emerging methods that capture multiple and cumulative exposures in urban settings.…”