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This KNUS report summarizes the findings concerning structural and intermediate social determinants of health that are of importance in the urban setting. The framework of the Commission on Social Determinants of Health guided the work and while unmasking the health inequities and inequalities in urban settings, it was decided at an early stage to make a strategic focus on slums and informal settlements. One billion people live in these deplorable conditions, a number that may double in coming decades unless policies for economic, social and health equity are developed and implemented. An example of the health inequalities in these circumstances is the strong gradient in infant and child mortality rates within Nairobi, Kenya, with rates in the slums more than three times higher than the city average and possibly ten or more times higher in the richer parts of the city. Other data from Africa shows that these mortality rates among the urban poor are, on average, almost as high as the rates among the rural poor, while among the richer urban groups the rates are the lowest.
The key to improved health equity lies in optimizing urban settings for health. Urbanization can be a positive determinant of health in the appropriate circumstances. Social systems based on democracy and strong equity policies have been successful in creating more equitable urban areas in a number of countries. The KNUS process has assembled a wealth of evidence, facilitated by the fact that there is a current international focus on urbanization. However, quantitative evidence of health inequalities within cities is seldom available and more research on this topic is needed to underpin policy development.
Health Equity and Social Justice Toolkit