- freely available
Int. J. Environ. Res. Public Health 2017, 14(4), 342; doi:10.3390/ijerph14040342
2. Defining Slums, Upgrading, and Their Relationships to Health Equity
3. Methods: Review of Urban Slum Upgrading Projects
4. Findings: Slum Upgrading Projects and the Determinants of Health
- Health outcome measures were very limited and tended to focus on childhood mortality or morbidity (particularly due to diarrheal or other communicable illnesses);
- Economic impacts were frequently evaluated, but few studies discussed how poverty and/or income influenced the health status of slum-dwellers;
- Infrastructure improvements were measured through such variables as the number of new water-points, sanitary infrastructure or unit costs, but rarely analyzed how infrastructure might positively influence social or economic opportunities, safety, or reduce gender inequities;
- Resident participation, including through micro-savings, was frequently mentioned, but none of the reports attempted to link participation to potential positive or adverse human health impacts, the latter being social stigma and hypertension ; and,
- There was no consistent time frame for when evaluations took place and this varied from immediately after a project was completed to, on average, 18 months after completion.
4.1. National/Municipal Policies for the Urban Poor
4.2. Structural Conditions for Health
4.3. Living and Working Conditions
5. Discussion: Integrating Health Equity into Urban Slum Upgrading
Conflicts of Interest
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|Example Slum Characteristics||Definition and Indicators (Examples)||Community Health Risks (Select)|
|Overcrowding||>2 persons/room or <5 m2 per person||Spread of TB, influenza, meningitis, skin infections and rheumatic heart disease .|
|Low-Quality Housing Structure||Inferior building materials dirt floors & substandard construction||Vulnerability to floods, extreme heat/cold, burns and falling injuries .|
|Hazardous Housing Sites||Geological and site hazards (e.g., industrial waste sites, garbage dumps, railways, wetlands, steep slopes, etc.)||Acute poisoning; unintentional injuries, landslides, flooding, toxic contamination, environmental pollutants, leptospirosis, cholera, malaria, dengue, hepatitis, drowning .|
|Inadequate Water Access||<50% of households have affordable, 24/7 access to piped water/public standpipe||Malaria, dengue and diarrheal diseases, cholera, typhoid, hepatitis; increased HIV/AIDS vulnerability .|
|Inadequate Sanitation Access||<50% of households with sewer, septic tank, pour-flush or ventilated improved latrine||Fecal-oral diseases, hookworms, roundworm; missed school-days during girls’ menstruation; malnutrition and children’s stunting; safety/sexual violence for women from unsafe toilets .|
|Limited Services and Infrastructure||Inadequate healthcare, drainage, roads, energy, transport, schools, and/or refuse collection||Traffic injuries; lack emergency provision; fires; flooding/drowning; waste burning and air pollution; respiratory diseases and cancer .|
|Tenure Insecurity||Lack of formal title deeds to land and/or structure||Fear; increased hypertension; diabetes; low birth weight newborns .|
|Poverty and Informal Livelihoods||Low incomes, few assets, and access to credit; lack of social protection||Increased occupational hazards; maternal health complications; vaccine-preventable diseases ; perinatal diseases; drug-resistant infections;|
|Violence and Insecurity||Elevated crime, including domestic and gender-based violence||Homicides; hypertension; obesity; sexual violence; vulnerability to STIs, esp for young people forced into sex work .|
|Political Disempowerment||Low or no governmental responsiveness to needs and services||Lack of health services; poor education; preventable hospitalizations; typhus, leptospirosis, cholera, chronic respiratory diseases, growth retardation .|
|Project Name and Location (Reference)||Focus of Upgrading||Health and Well-Being Impacts (If Measured)|
|Visakhaptnam, Indore and Vijaywada Upgrading, India [30,31]||Roads, water, lighting, social services and micro-loans||Safety and reduced women’s time burdens|
|Slum Networking Project (SNP), Ahmedabad, India [32,33,34]||Infrastructure, governance, electrification||Reduction in water-borne illness|
|SPARC, the National Slum Dwellers Federation and Mahila Milan, Mumbai and Pune, India [35,36]||Water and sanitation, toilets, community governance||None explicitly measured|
|Baan Mankong, Bangkok, Thailand [37,38]||Housing, tenure, infrastructure, daycare, services for elderly||None explicitly measured|
|Kampong Improvement Project (KIP), Indonesia [39,40]||Piped water, housing improvements, flood risk reduction||None explicitly measured|
|Zonal Improvement Program (ZIP), Manila, Philippines [41,42]||Water, roads, housing, land rights, electricity||Reduced incidence diarrhea|
|Neighborhood Upgrading and Shelter, Indonesia [43,44]||Roads, streetlights, water, toilets, solid waste management||Avoided health costs|
|Karachi, Orangi Pilot Project (OPP), Karachi, Pakistan [45,46]||Water, sanitation, capacity-building||Reduced Infant Mortality|
|PRIMED, Medellín, Colombia [47,48]||Housing tenure, physical infrastructure||Improved safety perceptions|
|Favela Bairro, Rio de Janeiro, Brazil [49,50]||Infrastructure, housing, social programs||Mortality from parasitic or viral vector-born infections; infant mortality; homicides|
|Bairro Legal, Sao Paulo, Brazil [51,52]||Infrastructure, housing, social and economic development||Improved flood control|
|Ribeira Azul and Technical and Social Support Project, Salvador, Brazil [53,54]||Infrastructure, housing, social programs||Self-reported reduction crime|
|Mexico, Piso Firme [55,56]||Cement floors in housing||Children’s parasitic infestations, diarrhea and anemia|
|PRODEL, Nicaragua [57,58]||Housing, infrastructure, microloans, community savings||None explicitly measured|
|Citizen Security in Cali, Bogotá, and Medellín, Colombia [59,60]||Social programs, violence prevention||Homicide and inter-personal violence|
|Huruma Community-Led Upgrading, Nairobi, Kenya [61,62]||Infrastructure, housing, community savings||None explicitly measured|
|Imizamo Yethu Upgrading, Cape Town, South Africa [63,64]||Housing, water and sanitation infrastructure||None explicitly measured|
|Hanna Nassif Upgrading, Dar es Salaam, Tanzania [27,65]||Infrastructure, employment, tenure, transport||Reduced waterborne diseases (unspecified)|
|Kenya Slum Upgrading Program (KENSUP) [66,67,68]||Housing, governance||None specified|
|Slum Upgrading Characteristic (Select)||Health Influences (Examples)|
|Community Empowerment and Political Recognition via Participatory Upgrading||Trust; empowerment; control of life decisions |
|Right to Remain (In Situ Upgrading)||Social connections; collective efficacy; no fear of displacement |
|Housing Improvements and Land Tenure||Reduced anxiety from fear of displacement; address can result in social services, access to banking, etc. |
|Safety and Security||Reduced gender-based violence; reduced physical violence; improved mental health |
|Integration of Slums into Formal City||Transportation and access to employment, education and services; reduced isolation and segregation |
|Poverty Reduction||Income for food, electricity and other services |
|Climate Change Resilience||Reduced health impacts from flooding, heat events, or water scarcity due to drought |
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