Urban Health: Latin America and the Caribbean

Several urban features, while not unique to Latin America, characterize the specific health challenges facing cities in this region, including the growth of midsize cities and, especially, the growth of periurban spontaneous settlements where sanitation, education, employment, health services, and links to the formal urban economy are often precarious. Health issues in cities include infectious diseases and the increase in the risk of chronic disease (such as obesity), but accidents and injuries (motor vehicle collisions, homicide and violence) are increasingly accounting for a substantial proportion of morbidity and mortality in Latin American cities. To address these issues, “urban health best practices” need to be identified and developed in Latin America and the Caribbean. Belo Horizonte, Brazil, is a city has that has taken a proactive approach to public health; four programs (participatory budgeting, Family Health Centers and physical academies, community mobilization against crime and violence, Dengue control) demonstrate a range of activities that overlap and interact in a cohesive approach to urban health. Some general lessons from these model urban health programs and the supporting literature are the following: 1) Citizens can and should be called upon to actively engage in urban planning and improvement efforts. 2) Health determination is multifactorial; thus, efforts to improve health should be multisectoral and targeted at macro, structural levels as well as at individual determinants. 3) Efforts should be long-term and iterative, and should capitalize on mobilization stemming from completion of a successful project. 4) Routinized monitoring, surveillance, and analysis of program impact are key elements in assessing and improving upon urban health best practices. Executive Summary Several urban features, while not unique to Latin America, characterize the specific health challenges facing cities in this region. First is the growth of midsize cities. Providing clean water, sanitation, adequate housing, and accessible health care to existing residents as well as new migrants poses a significant test for municipal and public-health officials. A related problem is the growth of periurban settlements, such as those known as favelas in Brazil, pueblos jovenes in Peru, or ranchos in Venezuela. In Mexico City, almost half the city’s population lives in such spontaneous settlements, where sanitation, education, employment, health services, and links to the formal urban economy are often precarious. Second, while infectious diseases such as tuberculosis, HIV, and malaria remain critical health issues in the cities of developing countries, the epidemiologic transition has been accompanied by an increase in the risk of chronic disease (such as obesity). Furthermore, accidents and injuries (motor vehicle collisions, homicide and violence) are increasingly accounting for a substantial proportion of morbidity and mortality in Latin American cities. Programs can be identified and described that may be intriguing examples to consider “urban health best practices” for development in Latin America and the Caribbean. Belo Horizonte, Brazil, is informative as a multiple case study as the city has taken a proactive approach to public health, and four programs (participatory budgeting, Family Health Centers and physical academies, community mobilization against crime and violence, Dengue control) demonstrate a range of activities that overlap and interact in a cohesive approach to urban health. Some general lessons from these model urban health programs and the supporting literature are the following: 1) Citizens can and should be called upon to actively engage in urban planning and improvement efforts. 2) Health determination is multifactorial; thus, efforts to improve health should be multisectoral and targeted at macro, structural levels as well as at individual determinants. 3) Efforts should be long-term and iterative, and should capitalize on mobilization stemming from completion of a successful project. 4) Routinized monitoring, surveillance, and analysis of program impact are