Image: Upgraded slums in Sao Paulo, Brazil. Photo courtesy Cities Alliance.
College of Environmental Design Professor of City & Regional Planning Jason Corburn and Ph.D. candidate Alice Sverdlik (Ph.D. City & Regional Planning ‘20) recently co-authored an article for the International Journal of Environmental Research and Public Health titled “Slum Upgrading and Health Equity” that looks deeper at the impact that improving slums has on health equity across the globe.
Almost one in seven people on the planet is expected to reside in urban informal settlements, or slums, by 2030. While informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, its potential to improve health equity is usually overlooked. Professor Corburn and Sverdlik’s paper evaluates urban slum upgrading from cities across Asia, Africa and Latin America and concludes that few capture the multiple health benefits of upgrading because they fail to consider the interrelated social and medical determinants of health.
Professor Corburn and Sverdlik establish that upgrading settlements improve health outcomes via enhanced access to shelter, water and clean energy, but they fail to explicity improve, nor are they evaluated for, how well they have positively shaped the social determinants of slum health. The social determinants of health (SDOH) are factors outside medical care that shape health outcomes, such as safe housing, food access, political and gender rights, education and employment status. In urban informal settlements, residents are often burdened with multiple and overlapping challenges that can undermine the SDOH, from entrenched poverty, to overcrowded shelter, to inadequate infrastructure and tenure insecurity, all of which can combine to contribute to increased risk of exposures to environmental pathogens that increase infectious and non-communicable diseases in urban poor areas.
Slum-dwellers also experience spatial, political, and economic exclusion when compared to wealthier urban residents, and these too are recognized as powerful determinants of who gets sick, suffers more and dies early. Professor Corburn and Sverdlik analyzed slum upgrading projects and published evaluations of these projects or policies for whether and how they captured the influence of upgrading on the SDOH.
Furthermore, their research looked at completed slum upgrading projects from a dozen different countries and performed content analyses to determine if the projects included explicit measures of any SDOH and/or specific disease outcomes. They focused their review on upgrading projects and policies that took an “integrated” (i.e., multi-sectoral) approach to upgrading, since they determined that these aimed to influence the SDOH through interventions focused on more than one physical, social and/or political issue facing the urban poor.
Professor Corburn and Sverdlik conclude that more work is ultimately needed to integrate clear social determinant criteria into slum upgrading projects’ design and evaluations. When health is included in urban slum upgrading, it is often limited to a single disease, exposure or risk factor, rather than the multiple criteria for health recognized by the World Health Organization’s findings on the social determinants of health. The global community’s failure to recognize urban slum upgrading as an environmental health equity intervention is a lost opportunity and one that, if it continues, may hinder the ability to meet sustainable development goals.
You can read the article in full here.