Urban Life And Health Research Paper

1. Understanding Urban Health Disadvantages

1.1 Methodological Limitations

Social scientific consensus on the underlying reasons for apparent urban health disadvantages remains elusive. Part of the ambiguity stems from methodological issues. Empirical estimates generally suggest urban residents are worse off than others, at least in terms of mortality, yet the body of research is largely descriptive. Most research on this topic has been cross-sectional, much of it ecological, and investigators have had to make unfortunate trade-offs between analyzing samples with national scope and focusing on important subgroups of the urban population. This data limitation along with another—the inability to control for many potential confounders of the association between urban life and health—severely restrict causal inference making.

1.2 Early Theories

Conceptually, the study of urban life and health has changed markedly over the past century. Initially, rapid urbanization in the early twentieth century stimulated theories reflecting broader societal concern that city life was dangerous and unhealthy compared to pastoral country life. Wirth (1938), posited that characteristics of cities—such as their size and population density, their fast pace, their heterogeneity— were negative influences on psychological well-being and group life. The requirements of urban industrial organization and technology were also viewed as deleterious. In these theoretical perspectives, urban life alienated individuals from one another, their roots in nature, their labor, and their core values; it promoted superficial and transitory relationships; and it provoked anomie, alienation, and insecurity. These influences devalued community, threatened social cohesion, and placed individuals in peril.

Empirical studies often found weak endorsement for the working hypotheses that followed from this conceptual emphasis (Fischer 1976). Researchers continuing in the sociopsychological tradition in the mid-to late twentieth century saw urban characteristics in a new light. Milgram (1970) reasoned that brusque behavior and anonymity might demonstrate an adaptive response to the sensory overload produced by urban population density and a fast-paced life, rather than imply that urban residents were without intimate, supportive relationships within their personal social networks. Studies documented the existence and salience of local social bonds within cities among ‘urban villagers’ (Gans 1962) embedded in kin ‘networks’ (Stack 1974). Cities were reinterpreted more positively as mosaics of individual and cultural differences, even a refuge for individuals who faced stigma or persecution in small parochial towns (Fischer 1976). House and Wolf (1978) observed that the effects of urban residential environments on behavior grew out of particular social settings at different historical times, not necessarily urbanism, per se. This observation was consistent with their empirical findings and with the variation in magnitude of urban health disadvantages in different time periods.

1.3 Recent Developments

In the 1980s, as urban homicide rates increased and were highly publicized, urban life again became viewed as unhealthy and dangerous. By this time, poverty was concentrated in central cities, urban decay left poor neighborhoods as staging grounds for drug trafficking and related homicide deaths, while infectious diseases such as tuberculosis, and in specific cities HIV AIDS, re-emerged as important causes of death (Geronimus 2000). Though less publicized, some environmentally induced and stress-related diseases also were increasing, such as asthma, reproductive disorders, some cancers, and cardiovascular disease. Variations on early sociopsychological theories took shape in scholarship on urban life and health. For example, the 1990s witnessed renewed interest in the effects of depleted social cohesion or social capital on health, with social epidemiologists joining social psychologists in studying these topics, particularly among urban residents. The actual significance of social capital to health disparities is currently subject to debate (Lynch et al. 2000) and agreement has grown that it alone cannot explain the severely disproportionate ill health and early mortality experienced by some segments of the post-industrial urban populace. In addition, as the growth of edge cities and globalization has shrunk the urban labor market, the notion that the impersonal nature of industrial organization is a key cause of urban health disadvantages has been superseded by new concerns about the health effects of unemployment, segregation, poverty, ambient psychosocial stresses, and the physical environmental hazards of urban life.

1.4 Social Inequality

Evidence suggests that urban areas confer some disadvantages, at least in terms of mortality, on all of their residents, but this penalty is inequitably divided among the haves and have-nots within cities (Geronimus et al. 1996, Shaw et al. 1998). This is unsurprising since the social and psychosocial factors that have been linked to morbidity and mortality, including material hardships, acute and chronic stress, and overburdened or disrupted social supports, are suffered disproportionately by those in poverty ( Williams and Collins 1995). Those living in poverty also have more difficulty accessing information, services, medical care or technologies that could abate health risks (Link and Phelan 1996). Much current research is informed by this social patterning of the distribution of health risks or protective factors. Even the ambient stressors to which all residents of major cities are exposed are not equitably distributed among urban neighborhoods. Household crowding and environmental toxicity are more severe in poor, ethnic enclaves than in affluent segments of cities, for example (Mohai and Bryant 1992). Such findings signal the need to broaden the intellectual context for the study of urban life and health by looking at the socioeconomic and demographic landscape of modern cities, and coming to understand the historical and structural underpinnings of that landscape. For example, some investigators now seek to describe how economic restructuring combined with the segregation of ethnic minority groups into urban enclaves served to concentrate poverty in neighborhoods characterized by urban decay, with housing stock, municipal services, and public spaces all substandard (Massey and Denton 1993, Kelley 1997). This new context will permit examinations of how social and economic policies affect the physical, social, and built environment in ways that impact health.

In the USA, low-income African Americans segregated into central cities suffer the worst health disadvantages of any identifiable group (Hart et al. 1998). African American residents of high-poverty urban areas suffer rates of early mortality that are staggering. For example, male youths in Harlem or Chicago’s South Side face a lower chance of survival to age 45 than their counterparts nationwide enjoy of surviving to age 65 (Geronimus et al. 1999). Such mortality profiles are similar to those found in less developed nations (McCord and Freeman 1990). In European cities, minority and low-income populations are often fragmented and dispersed along city peripheries where they, too, suffer demonstrable health disadvantages compared to the more affluent who reside in vital urban centers (Shaw et al. 1998). These observations suggest that any theory that hopes to illuminate the association between urban life and health in the post industrial period must explicate the historical and structural factors that produced modern ghettos with predominantly minority populations (Thompson 1998).

Moreover, although homicide deaths account for an important share of deaths among urban African American men, chronic disease deaths have been the primary influence on these rates for urban African American men and women. Indeed, homicide rates declined in the 1990s for this population, yet the influence of chronic disease on excess urban mortality appears to be growing. No one understands why. However, these findings place new emphasis on under- standing the particular stresses faced by and the coping strategies available to ethnic minority residents of high-poverty urban areas. They also suggest the prospect of intensifying environmental hazards. In-equitable distribution of environmental hazards among neighborhoods may contribute to increasingly excessive rates of cancer, asthma, and reproductive disorders in high-poverty urban areas. Another possibility under consideration is that the adverse health effects of an ambient stressor or environmental toxin may be increased in interaction with other insults to health, as most often occurs in the poorest urban communities where residents face multiple, pervasive, and cumulative exposures, with few mitigating resources.

2. Future Directions Of Theory And Research

As the study of urban life and health progresses, investigators are likely to continue their examinations of social inequality, augmenting research on material conditions and poverty with improved research on the role of race/ethnicity in two fundamental aspects: (1) the role of racial discrimination (in housing, medical care, employment, and environmental exposures, for example); and (2) the ability of ethnic networks and cultures to mitigate adversarial health impacts. The 1990s witnessed the greatest influx of immigrants to the USA in almost 100 years, many into high-poverty urban areas. Documentation that the extent of ill health among low-income urban residents varies by ethnic group and nativity status has stimulated interest in developing dynamic understandings of the potential for ethnic culture to preserve health. James (1993) speculates that as a group’s economic strength diminishes, its ability to supply the protection conferred by mutual aid, social support, and identityaffirming cultural frameworks may be especially critical to preserving the health of its members. According to this model, current urban health problems may derive from a combination of significant material adversity (the result of joblessness, and skyrocketing housing and medical care costs, for example) that is, at least in part associated with racial discrimination, and the concomitant overloading and weakening of protective networks (Geronimus 2000). These remain empirical questions.

More broadly, the question of what exactly it is about living in cities that may adversely affect health remains unanswered. Toward addressing this basic question, several additional empirical directions are anticipated. These include understanding how urban residence affects health across the life course both in terms of its effects on people at different life stages and also the net effect of the accumulation of health insults over time, particularly among those segments of the urban population who are further disadvantaged by race/ethnicity or low income. Another is distinguishing the effects of urban residence on morbidity and life quality separately from mortality, while developing full models of how social background factors and social experience work through physiological processes to exert an impact on morbidity and mortality. Also likely is increased attention to applied research, including demonstration projects, participatory action research, and community-based public health approaches (Freudenberg 1998). The motivations for this are diverse. Current policy interest in the labor force participation of the urban poor prompts an interest in their health and disability status. Similarly, policymakers and citizens concerned about urban sprawl may invite input on the anticipated health impact of social, economic, and urban planning policies meant to revitalize urban centers. The broader environmental movement has become concerned with environmental justice for urban populations. The appeal of applied research in the academic public health community stems from the mandate to reduce as well as understand urban health disadvantages.

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