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When visiting a doctor, we are often asked a series of routine questions. What is our diet like? How much sport do we do? Are there key diseases in our family? But perhaps there could be another question on this list that could give healthcare workers clues as to how we are doing: where and in what neighborhood do we live?
From the fabric of our home to the city we live in, everything is important to health. “A dirty floor, poor ventilation or poor hygiene in a home are associated with gastrointestinal or respiratory diseases,” recalls Carolina Piedrafita, coordinator of the Inter-American Development Bank (IDB) urban laboratory and senior housing specialist, América Futura. “Likewise, the environment around your home has an impact, such as the availability of green space, proximity to public transport, air quality, and distance to health centers, schools, and even supermarkets,” he adds.
And all of these factors have something in common: they are driven by inequality, a growing phenomenon in Latin America that has left our cities unhealthy. In the region, says the expert, two phenomena are coming together. On the one hand, we live concentrated in the cities. “In Latin America, 80% of the population lives in cities, it’s the most urbanized region in the world,” he says. On top of that, we also have some of the most unequal places. “Of the 20 most unequal countries, eight are in the region.”
It is a mixture of symptoms that was reflected in what happened with Covid-19. “When we looked at city maps, we saw that the most segregated and poorest arts were those that were infected the most and died the most. And it’s no coincidence that 27% of the deaths were recorded in a region that is home to 8.4% of the world’s population,” is one of Piedrafita’s most poignant sentences in an IDB documentary entitled “Health and the City” – Your zip code is more important than your genetic code, which should draw attention to this type of relationship.
City and Health: A Great Latino Study
Ana Diez Roux, epidemiologist and dean of Dornsife Public School at Drexel University, USA, has come to several conclusions after leading Urban Health in Latin America (Salurbal); A study launched in 2017 that collects information from 11 countries and around 400 cities in the Region to find out how cities relate to our health. Since then there are some things he dares to say.
“Cities are heterogeneous in terms of health. “There is a tendency to generalize and say that the city is better or worse than the rural, but there are many differences between cities,” he clarifies first. It is also noted that city size is not exclusively related to health status and that there may even be differences between neighborhoods in the same city. But if there’s something unique that runs through them all, it’s that social inequalities are related to life expectancy. And the greater the inequality, the greater the negative health impact.
For example, in 2019, Salurbal published a study in The Lancet in which they analyzed whether there was a gap in life expectancy depending on place of birth, using six major cities as a reference: Buenos Aires (Argentina), Belo Horizonte (Brazil), Santiago ( Chile), San Jose (Costa Rica), Mexico City (Mexico) and Panama City (Panama). After examining multiple factors such as mortality, population, indicators of socioeconomic status, overcrowded homes, and level of education, they found some indications of how these are related.
Within the same cities, the publication says, there are differences in life expectancy of up to 20 years, depending on these factors. And “for males, the average life expectancy at birth varies from a minimum of 69 years in Mexico City to a maximum of 76 years in San Jose,” is one of his conclusions. The study also ensures that “higher socioeconomic status in the region is associated with higher life expectancy, particularly in Santiago,” to name just other examples.
Plan healthy cities
The doctor is responsible for our health. This is something irrefutable. However, he should not only watch over it, because architects and urban planners are also part of the solution. Both experts agree on this, assuring that when planning cities, politicians, urban planners, sociologists, social workers and those responsible for public health should sit together. All of this helps create a mystery about how our cities affect our lifestyles and, in turn, our health.
Therefore, when asked what the top three urgent steps for healthier Latino cities are, Diez doesn’t hesitate to give his answer. “You have to reduce the dependency on using the car and think about a means of transport that is firstly active and secondly public.” This is not just about the air quality affected by cars, but about a transport in which people walk walk, take the bike and feel safe. “It also has to do with a transport that doesn’t take people hours” because it shows that even long daily journeys can affect mental health.
Second, he cites improving social inequality: “improving access to health, decent work, and income distribution.” Finally, he talks about sanitation in the poorest and poorest neighborhoods, “from overcrowded homes to parks with green spaces to lighted public spaces where people feel safe”. And the thing is that cities are like a body, they have to be looked after by different experts and viewed as a system.