Urban Planning and Health Disparities: Implications for Research and Practice

In virtually all cities across the world, the worst health problems and premature deaths are highly concentrated in neighbourhoods that also experience a host of other social inequalities, including lack of basic sanitation and water services, high poverty rates, residential segregation, and concentrations of environmentally noxious facilities. Yet, contemporary urban planning practice, which emerged in the 19th century to address public health crises related to inadequate housing, poor sanitation and infectious disease outbreaks impacting the urban poor, is struggling to addresses this spatial concentration of disease. This paper frames the problem of health disparities as an urban planning issue by focusing on the urban asthma epidemic in the United States (US). I review the troubling split between public health and planning in the US, evidence for disparities in American cities and leading explanations for these disparities, and conclude with specific recommendations for urban planning research and practice. Health disparities refer to morbidity and mortality inequalities within and between population groups that are avoidable, unfair and unjust, and systematically burden populations already vulnerable because of inequalities in underlying social, political, economic and legal institutions (Braveman & Gruskin, 2003). Urban planners are increasingly being called on by public health professionals to help address diseases, such as asthma, that appear to concentrate and persist in urban neighbourhoods (Duhl & Sanchez, 1999). In addition, epidemiologists are recognising that place inequities—such as residential segregation, urban divestment and environmental injustice—act as social determinants of health that may help explain inequitable distributions of death and disease across population groups (Fitzpatrick & LaGory, 2000). However, little agreement exists over the causes of health disparities or what role urban planning ought to take to help address these inequalities (Corburn, 2004).