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BU Launches Urban Health Initiative

Global summit pools research from New York to New Delhi


The future of public health is urban health. That was the consensus among researchers at the Global Urban Health Summit hosted by BU’s Center for Global Health & Development (CGHD) October 28. Public health experts from universities in the United States and abroad explored strategies to meet the overwhelming health challenges of the urban poor, from New York City to the slums of New Delhi and Nairobi. The meeting, held at the Hotel Commonwealth, also marked the launch of BU’s Global Urban Health program, which will add new talent and an expanded research agenda to the center.

“This is not a typical academic meeting,” said Jonathon Simon, CGHD director and chair of the School of Public Health international health department. “We’re here to think out loud.” As Jean Morrison, University provost, put it, “We’ve established an incubator in this room” for many of the world’s leading thinkers on urban health. Simon said the seed for the summit was planted by University President Robert A. Brown, who believes that as a major urban research university, BU should make great contributions to global health.

The timing could not have been more appropriate. This week the world population hit the seven billion mark. Half of that population now lives in urban areas, and that contingent is expected to grow to 75 percent by 2050. As several speakers at the conference pointed out, the move toward city living will exacerbate the health problems of the poor—while urban dwellers live within reach of health providers, hospitals, and clinics, city poor lack clean water, waste management, livable housing, affordable health care, and jobs, and are generally sicker than their rural counterparts. In many African cities, life expectancy is half that of rural areas in the same country, an equation seen in Europe in the 1800s, before advances in housing and infrastructure. Like CGHD, which is active in 24 countries and has field-based centers in India, South Africa, Kenya, and Zambia, the institutions at the inaugural summit hope that pooling their research findings will lead to cost-effective changes in urban health care that will increase life quality and life span and battle, and ultimately prevent, the specters of HIV, diabetes, infant mortality, and mental illness.

“Something happens in urban slums that predisposes people to increased morbidity and mortality,” said Ayo Ajayi (SPH’82), vice president for field programs at the Seattle-based global health nongovernmental organization Program for Appropriate Technology in Health (PATH). Ajayi, who studied urban migration in Kenya, said the urban rate of disease and early death outpaces that in rural areas with almost no health care. “Even when the urban poor are provided access to health care, they often prefer not to use it,” he said. “We need to understand these factors better.”

Ajayi’s concerns were reflected throughout the daylong event in questions such as: How can the urban poor be expected to seek care and diligently pursue treatment when they can’t afford to pay even a small amount? In increasingly heterogeneous cities swollen with migrants, what is the best way to teach disease prevention and stem the destructive effects of alcoholism, smoking, and obesity? How realistic are efforts to teach hygiene when clean water is scarce or nonexistent?

“We told a slum community to wash their hands four times a day,” said Sainath Banerjee of the India Population Council. “A woman said, ‘You are talking about water. Where is the water?’”

When it comes to public health statistics, urban slums are worse in every way but one: they have a fertility level comparable to rural communities and urban populations at large.

The summit’s speakers and panelists touched on a range of urban public health scourges beyond the widely recognized risk of parasitic diseases from poor sanitation or illnesses caused by malnutrition. Jonathan Levy, an SPH professor of environmental health, estimated an urban death toll of two million a year from respiratory disease caused by indoor air pollution from cooking stoves and the burning of dung. Levy has researched the effects of emissions from coal-fired power plants in the urban sprawl of Shanghai, and he believes that 12,000 lives a year could be saved there by eliminating sulfur dioxide from coal emissions.

Judith Gonyea, a School of Social Work professor and chair of social research, whose work has focused on low-income and homeless older urban Americans, noted that by 2030 a billion people worldwide will be over 65, foretelling a population of poor older adults vulnerable to mental illness and neglect.

Katherine Fritz, director of global health at the International Center for Research on Women, studies alcohol abuse, the world’s third highest cause of death and disability. Focusing on southern Africa, Fritz and her team of community-based assistants went to the ubiquitous beer halls of Harare, Zimbabwe, to test interventions against alcohol abuse. While the interventions had no effect, Fritz noted at least one success story: Botswana, where the government has imposed a 40 percent levy on alcohol, with all funds going to social programs. Botswana is “leading the way in the world,” said Fritz, who is now directing her research toward home brewers in the slums of Windhoek, Namibia.

Fritz’s Botswana anecdote reflected one of the main themes of the day—the need for a shared vision among governments, NGOs, and universities to work to promote urban health. “I’ve spent 25 years in urban health, and it’s tough to gain traction,” said Trudy Harpham, a London South Bank University emerita professor of urban, environment, and leisure studies. “There are gaps to fill, cutting edges to sharpen,” she said of BU’s new urban health initiative.

Addressing media perceptions, former NECN television anchor R. D. Sahl, a College of Communication visiting professor, said global urban health “is about access, and governments. Today we refocus the lens—not just to study, but to fix.”

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