We all know what cities are; or at least we think we do. However, it is more likely that each of our personal experiences has shaped what we think of when we discuss "cities" and that each of us has a different image of "city" in our own head. We may be in good company. Saul Bellow, the novelist and Nobel Prize laureate, in discussing how Americans think of New York City, suggested: " That is perhaps like asking how Scotsmen feel about the Loch Ness monster. It is our legendary phenomenon, our great thing, our world-famous impossibility . . . New York is stirring, insupportable, agitated, ungovernable, demonic. No single individual can judge it adequately" (New York Times, 1970). Indeed, cities can defeat definition and challenge the imagination. Cities are elegant, sophisticated places. Think of Piccadilly Circus in London, the Arc de Triomphe in Paris, or the Copacabana in Rio De Janeiro. But cities are also dense, teeming, and dangerous places. Think of the squatter colonies of Lagos and parts of Los Angeles or New York City. Cities can be distinctive (there is only one Paris) or can look monotonously alike (think of any number of North American mid-size cities). Cities can be small, compact areas that are immediately walkable, and can be vast, extensive, automobile-dependent metropolitan areas that are disconnected, homogenous, and pedestrian-hostile. In short, cities, and by extension the urban experience, can represent diverse conditions within which people live, and represent a range of human experiences.
What then do we mean when we write about "urban health"? In its broadest sense urban health refers to the study of the health of urban populations. We consider urban health inquiry to include two principal aspects: the description of the health of urban populations, both as a whole and as particular subgroups within cities, and an understanding of the determinants of population health in cities, with particular attention to how characteristics of cities themselves may affect the health of urban populations. The practice of urban health can then include a range of clinical, planning, or policy work that aims to improve the health of urban populations. While both aspects suggested here are broad, they arguably represent a distinct body of inquiry that builds on a long tradition of interest in the role of cities in shaping the health of urban populations. We suggest in this chapter and throughout the book that the study of urban health, nested within the larger parameters of "public health," has much to contribute, both in terms of helping us understand population health, but also in guiding local and global interventions that can improve the health of the public.
There are two primary reasons why we suggest that we should concern ourselves with thinking of urban health as a field of inquiry and practice. First, there is the growing importance, and influence, of cities worldwide. As we discuss in the next section of this chapter, city living is becoming the norm for an ever growing proportion of the world's population. Second, after more than two centuries of organized public health as an intellectual and practical discipline, we are in many ways returning to the roots of the profession and understanding once again that context, including the social, physical, political, or policy environments within which we live, matters. As such, as cities increasingly shape the context within which we live, understanding the urban context, and its possible role in shaping population health, becomes imperative. It is the role of this book to bring together work from different disciplines that can contribute to different aspects of urban health inquiry and practice.
This chapter aims to set the stage for the book. First we discuss the growing importance of cities worldwide and the role they play in shaping population health. Second, we will summarize what we think can be achieved by considering urban health as a cogent field of inquiry and practice, what that field of inquiry can look like, and the challenges it might face. We conclude this chapter by orienting readers to the book itself, discussing its structure and what each of the three principal sections have to offer. We note that we do not attempt to offer either a broad theoretical framework for urban health, nor to be comprehensive in our discussion of the determinants of the health of urban populations. Other work, and the rest of this book, fill these functions (Northridge and Sclar, 2003; Vlahov and Galea, 2002; Galea and Vlahov, 2004; Freudenberg et al., in press). Rather, we intend this chapter to summarize the rationale behind this book and to summarize the gap this book aims to fill. We hope that the chapters that follow will provide the reader with a basis on which to make up her or his own mind about the role of urban health research and practice and how this may contribute to healthier urban populations.
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