Date Published: October 23, 2007
Publisher: Public Library of Science
Author(s): Alon Unger, Lee W Riley
Abstract: The defining physical and legal characteristics of slums profoundly affect the health of these communities and may also serve as potential targets for immediate intervention.
Partial Text: This year, 2007, marks the first time in human history that the majority of the world’s population will live in cities . The United Nations (UN) projects the world’s urban population to grow by 2 billion before 2030. More than 90% of this growth will take place in the least developed countries , and will be concentrated in the bleakest parts of the city—human settlements known as slums. Already nearly a third (32%) of the world’s population and more than three-fourths (78%) of the least developed countries’ urban population live in slums . Today’s slums are unprecedented in their sheer magnitude, their rapidity of growth, and their worldwide distribution [1,5]. They represent a fundamental transformation of the physical and social environment of urban life and human health.
In 2002, the UN operationally defined slums as those communities characterized by: insecure residential status, poor structural quality of housing, overcrowding, and inadequate access to safe water, sanitation, and other infrastructure  (Table 2). The 2003 UN report, The Challenge of Slums, is the most comprehensive account of the demographic and socioeconomic indicators of slums worldwide . It details not only the high concentration of poverty and substandard living conditions in slums, but also the insecurity of tenure and marginalization from the formal sector, including basic health services.
Slums are areas of “concentrated disadvantage” . The physical and legal characteristics enumerated by the UN are intimately related with population composition and dynamics, social environment, poverty, and marginalization. Health comparisons of rural versus urban areas, or emphasis on the urban health “penalty” or “advantage,” do not highlight the specific health determinants of slums . Here, we use the UN operational criteria to show that the conditions of slum life have a direct impact on the health and well-being of these communities (Table 2).
The determinants of slum health are too complex to be defined by any single parameter. Yet, they arise from a common physical and legal pedigree that concentrates the ill effects of poverty, unhealthy environments, and marginalization from the formal sector. The promotion of urban health in the 21st century must take neighborhood-centered as well as person-centered approaches. We recognize that broad economic, social, and political forces play an important role in the creation and growth of slums, and addressing these forces will take time. However, we represent clinicians and public health specialists, and therefore, our approach focuses on immediate solutions that can dramatically improve health and health disparities (Box 1).
We describe the challenges to good health and health care presented by the physical and legal characteristics of slums. It will take time to address underlying political, economic, and social forces that create and perpetuate slums. Yet many interventions and services can be implemented immediately with life-saving effect. Our approach to slum health is neither comprehensive nor exclusive. It is our simple goal to direct the attention and efforts of health professionals to the characteristics of slum life that profoundly affect health. Together we can move from understanding to action, and improve the lives of people who live in slums right now.