How does the city I live in affect my health?

Este artículo está también disponible en / This post is also available in: Spanish

Latin American and the Caribbean (LAC) cities are spaces of contrasts and inequality. We have recently explained how the place of residence within a city can affect the chances of finding a job, or of being more successful in studies. In today’s blog, which is part of a series on Healthy Cities, we will try to answer the following question: why are people healthier in some cities or neighborhoods than in others?

Why are people healthier in some places than in others?

Health inequalities caused by place of residence are present throughout the region, both between and within cities.

A recent study found, in a sample of 286 LAC cities, that 57% of the variation in infant mortality rates could be attributed to differences in urbanism among those municipalities. Health outcomes can also vary significantly between neighborhoods within the same city.

There are several factors that explain why some people are healthier than others based on spatial factors in their place of residence. Five of these are discussed below:

1. Location of place of residence:

The natural environment in which cities are located affects health conditions. For example, temperatures and precipitation levels, for example, can influence a location’s vulnerability to tropical diseases. Also, the location of a city affects its exposure to natural disasters, which in turn can have negative effects on public health.

2. Water infrastructure:

Various research has found that, in LAC as well as in other countries around the world, access to safe drinking water reduces infant mortality.

3. Sanitation and waste disposal:

Access to sewerage can also reduce child mortality, but when construction of such projects is left incomplete, they can have the opposite effect.

4. Public transportation:

Public transportation projects can also have important health benefits by reducing air pollution and promoting healthy lifestyles.

5. Access to medical care:

A study in four large Latin American cities found that while in Montevideo 82% of respondents reported getting a medical appointment in the same week, in Santiago and Buenos Aires that rate was 67%, and in São Paulo it was 59%. These differences correlate with variations in access to health insurance, but physical connectivity to health care facilities and to places that promote healthy lifestyles is also important. Mortality tends to be higher in neighborhoods farther away from doctors and hospitals. Similarly, having access to parks and other recreational spaces can improve cardiovascular health.

Is there any correlation between location and COVID infections?

There is no doubt that COVID-19 has been and is one of the major public health problems worldwide. It is therefore necessary to know to what extent spatial factors in a neighborhood or city are determinants of COVID infection.

As the graph illustrates, the incidence of COVID-19 cases per capita at the end of the first year of the pandemic varied significantly between cities within the same country. In Brazilian cities, for example, the top 25% of cities reported about four times as many cases per capita as the bottom 25%. Large differences can also be observed between neighborhoods and when looking at other measures, such as deaths attributed to COVID-19.

Figure 2: Confirmed COVID-19 cases per 100,000 persons during the first year of the pandemic in six Latin American countries.

Note: Cumulative cases per capita are restricted to 1,904 LAC cities with a population greater than or equal to 10,000. There are 240 observations from Argentina, 388 from Brazil, 615 from Colombia, 17 from Costa Rica, 463 from Mexico and 182 from Peru. COVID-19 data are updated to the latest available date per city, revised February 10, 2021. The city definition is not necessarily comparable across countries. For each country, the respective unit of analysis is: municipalities in Brazil, Colombia and Mexico; departments for Argentina; cantons in Costa Rica; and districts in Peru. Source, here. 

These results reflect that the local incidence of COVID-19 has been influenced by the location of those infected. Recent studies show that, between cities, socioeconomic vulnerabilities explain differences in the impact of the pandemic, with municipalities with slums and overcrowded housing being more affected.

Within-city evidence also points in this direction. For example, in the Santiago metropolitan area, pre-COVID-19 health inequities have increased. Analysts anticipate that, because of these disparities, the pandemic is likely to worsen inequalities in the region.

Public Policies to Reduce the Spatial Health Gap

Spatial disparities in health reflect broader structural inequalities in our societies. Thus, there is an opportunity for policymakers to address them, not only at the national level but also at the local level.

Ultimately, water and sanitation projects in underserved communities are likely to have a substantial impact. Investments in public transportation, in addition to their economic benefits, can help reduce pollution, improve geographic access to health care, and promote healthier lifestyles. And there are many other low-cost interventions that can also help reduce spatial health gaps. Some of these include building recreational infrastructure, or using zoning to protect vulnerable communities from health risks from vehicle-generated emissions and biohazards from waste disposal.

.

.