Among the initiatives of the IDB Cities Lab, a now widely spread documentary has circulated a provocative phrase: “Your zip code affects your health more than your genetic code.” But what does that mean? A zip code is a number assigned to identify and locate a given geographical area. The genetic code is the set of information and rules that determine cell reproduction. How can locality be more important than heredity? Let’s look at a simple example.
Inequity is a living concept
Antonio has just been born. Given the neighborhood he belongs to, we expect him to live at least 85 years. Mikel, another newborn baby, lives in the same city, but in a completely different neighborhood. Just with that data, we assume that he will live about 70 years. Can we imagine the differences in the environments in which both children were born? In the first case, housing is solid, spacious, with adequate basic services, there are squares and parks and people can safely walk to shops and services. In the second case, the scenario is very different: housing solutions are made of light material, self-constructed, smaller, with more occupants, do not have drinking water, and the nearest service centers are 13 kilometers away.
Is this enough to explain the 15-year difference in life expectancy at birth for Antonio and Mikel? No. The physical design of the urban space, the materiality of the surroundings, the built environment, have a significant influence on people’s quality of life. But so do the socioeconomic conditions of its inhabitants.
Let’s go back to our two children. In Antonio’s case, his parents have more than 12 years of education, they attended preschool early on, and they already know which center they want to take their child to in a few months. In Mikel’s case, neither of his parents finished high school, they have not considered the possibility of seeking a childcare center for their son and, if they did, they would have to travel to another part of the city and at a high cost that would be difficult to assume.
This dramatic example of sharp differences in situations and contexts represents what is happening in many cities in Latin America and the Caribbean where residential segregation and spatial inequalities generate significant gaps in quality of life and health.
The burden of the city on children’s health
Health inequities —those undesirable differences that can be avoided and that notably affect the most vulnerable populations— result from several factors that, taken as a whole, create adverse conditions and environments for development, particularly for children. Let’s think, for example, about the 5 most common ways urban environments can impact the living conditions of the very young:
1. Children living in urban environments with high levels of air pollution are in greater risk of developing respiratory problems, such as asthma and bronchitis. High levels of pollution can also lead to cognitive development problems and behavioral disorders.
2. Children with access to green spaces—ideal for play, physical activity, and connection with nature—may experience better physical and mental health than those without access to such spaces.
3. Children who live in urban environments with poor speed regulation, less infrastructure for safe pedestrian movement, and fewer paths for cyclists are particularly vulnerable to traffic accidents.
4. Children who are consistently exposed to environmental noise may have poorer sleep quality and, consequently, concentration difficulties, learning problems, and lower school performance.
5. Children living in remote areas and facing difficulties in accessing education and health facilities are less likely to have good health and opportunities to reach their full developmental potential.
Thinking about child health from the design of cities
Working towards greater health equity means generating conditions for everyone to have a fair opportunity to reach their maximum development potential and reversing the disadvantages that can affect that possibility. Urban environments and the living conditions created for their inhabitants are full of possibilities but also numerous obstacles that can affect health, particularly that of children, and from a very early age.
The call to action is clear: to build healthy socio-environmental living conditions and, therefore, to consider inclusive urban development policies as policies favorable to child development.
The challenge is not easy when we consider that, in addition to integrating services and cities to overcome the inequalities generated by segregation, we think in terms of climate change: this phenomenon accentuates health inequalities by introducing new risks. And this is particularly acute in children in poor households or vulnerable neighborhoods.
Why do we keep coming back to this circle that links child development, poverty, and now climate change? Simple: extreme temperatures, droughts and floods have significant health consequences, and both the risk of exposure and the effects of these phenomena affect communities with fewer resources to cope with these risks. Why do we add urban development to this equation? Inadequate housing, lack of green spaces, and polluted air are more concentrated in the most impoverished neighborhoods.
Measures to mitigate the impacts of climate change thus become crucial policies for reducing health inequities. Similarly, addressing the socio-environmental determinants of health inequities can be a powerful ally in alleviating the impacts of climate change. Do you think that urban development policies in your country take into account the needs of children? Do you know of any child health initiatives related to the development of cities?
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