The availability of big data as well as life in an urban age has created expectations about the prediction and control of diseases. And yet, at the same time, cultural and gender nuances have made it necessary to reconceptualise wellbeing. In this chapter we bring together arguments presented throughout this volume about expectations and limitations when addressing health in the city. What has been demonstrated throughout this volume is that public health is a common good as much as it is an individual choice. The balance between ‘my body, my rules’ and the shared space that connects everything and everyone is one that demands constant negotiation. The trade offs and instability between the individual and communities are also a discussion of the availability of resources such as individually tailored treatments and the epidemics of city life. In this complex system of connected individuals living across different urban realities, we have contributed by concluding that medical knowledges demand a new urban imaginary: thinking experimentally about optimising public health interventions in global processes of urban transformation.
Transnational reflections from Brazilians in London and Maré, Rio de Janeiro
Cathy McIlwaine, Miriam Krenzinger, Yara Evans and Eliana Sousa Silva
This chapter examines the ways in which violence against women and girls (VAWG) affects women’s health and wellbeing in cities. In a context whereby one in three women globally experience such violence, with arguably higher incidence in cities, it explores these processes in relation to wider debates on the gender-blindness of right to the city discourse and the importance of considering gender justice in cities from a relational perspective. The chapter draws empirically on the transnational nature of urban VAWG among Brazilian migrant women in London and those residing in the marginalised slums of one of Rio de Janeiro’s largest favelas, Complexo da Maré. It shows how VAWG is diverse across multiple spaces of the city and how it fundamentally undermines women’s wellbeing and health outcomes. However, it also illustrates that although the roots of VAWG lie in unequal gendered power relations, the challenges of living in cities can both exacerbate and ameliorate such violence.
Analysing the linkages and exploring possibilities for improving health and wellbeing
The ‘food environment’ of a city can be defined as the location and type of food sources found in an urban area, as well as the broader environmental factors that affect the production, retail and consumption of food in the city. The food environment of cities has an enormous impact on food security and on the health and wellbeing of residents, but this relationship has been under-recognised and under-studied, particularly in the global south. Drawing on work undertaken as part of an ESRC-funded project, Consuming Urban Poverty, on governing food systems to alleviate poverty in secondary cities in Africa, as well as other work undertaken by the African Centre for Cities, this chapter explores the multi-faceted ways in which the food environment of cities can impact on human health and wellbeing. First, the chapter examines the food environments of African cities, with a focus on the built environment, highlighting the diverse range of food outlets and complex patterns of food access. Second, it explores the multi-faceted ways in which the food environment of cities can affect human health and wellbeing. Finally, the chapter discusses possibilities for how food environments that are more conducive to health and wellbeing can be created and sustained.
Urban transformation and public health in future cities
Michael Keith and Andreza Aruska de Souza Santos
Social scientists, data scientists, epidemiologists, zoologists and other scholars have delved into the co-variables of class, transport patterns, housing conditions, age, migration, nutrition, climate change and sanitation as well as access to health centres to determine the probability, duration and extent of disease outbreaks. Such studies have shown that the separation of the body from what surrounds it, ‘the flesh’ from ‘the stone’, is of little help if one shapes the other. With most of the world’s population now living in cities, this chapter discusses healthy living in changing metropolises. We consider in this chapter how cities may circumscribe access to health centres, the factors that determine housing choices and how these in turn may determine health outcomes. We also consider how individuals and communities may reshape cities recursively, all too often meaning that urban health is not only a study that intertwines people and space, but also does so under a temporal matrix. Historical legacies and path dependencies, migration, adaptation and change are thus conceptualised and discussed when the ethics, the access, the definitions and the transformations of public health initiatives and the demands of the twenty-first century are examined.
Epidemiological research has repeatedly pointed to the increased prevalence of both ‘common’ and ‘severe’ mental disorders in cities, and proposed a range of competing hypotheses to account for this relationship. Recent research on the social determinants of mental ill health has identified correlations between social disadvantage and mental disorder, but attempts to identify the pertinent dimensions of adversity have proved inconclusive. Many contemporary researchers suggest that the disadvantages experienced and the adversities undergone must in some way be instantiated neurologically, and returned to an old idea that ‘stress’ is the mediating mechanism. Recently, in the face of arguments about the prevalence of mental ill health in their own cities, urban policy makers have attempted to make their city a place where individuals and communities can ‘thrive’. This chapter brings together research on urban mental health and emerging programmes for healthy cities, and examines the extent to which we are seeing ‘evidence-based’ programmes and policies for mental health in urban settings.
The case of community initiatives promoting cycling and walking in São Paulo and London
Tim Schwanen and Denver V. Nixon
Recent years have seen extensive interest in the relationships between urbanisation and city living and wellbeing as a subjectively experienced state. This chapter proposes firstly that for cities characterised by trenchant socio-spatial inequalities, wellbeing is best conceptualised in terms of capabilities, and secondly that capabilities need to be understood in a more dynamic and process-oriented manner and with greater consideration for experience than is common in most research on capabilities. The arguments are first elaborated in conceptual terms for the case of people’s everyday mobility in the city and then illustrated empirically, using a study about how community-led initiatives to support walking and cycling contribute to the wellbeing of marginalised social groups in São Paulo and London. The findings show the importance of focusing attention on the ongoing and dynamic interweaving of capabilities, practices and experiences in research that seeks to understand the relationships between wellbeing and mobility in highly unequal cities.
Reinventing depression among Rio de Janeiro urban dwellers
Leandro David Wenceslau and Francisco Ortega
Recent epidemiological surveys have shown an important prevalence of depressive and anxious symptoms in the Brazilian population, especially in its urban metropolises. In the past two decades, primary health care in Brazil has increased its coverage, becoming the main reference in public mental health care. Social determinants of mental suffering represent a challenge for patients and professionals in search of more comprehensive approaches to mental health. This chapter presents an ethnographic study conducted in the city of Rio de Janeiro with twenty-two patients who presented depressive symptoms and were treated in primary health care. Primary care physicians used the native categories of ‘hill’ and ‘asphalt’ to typify the patients´ depressive presentations. This categorisation has important consequences for the diagnosis and treatment of these symptoms. ‘Hill’ and ‘asphalt’ are analysed as ‘moral economies’ (Didier Fassin), and their meanings are contrasted with the individual therapeutic experiences of two patients. The singularities of these experiences evince that even approaches based on a broader understanding of these problems may hinder a comprehensive approach to the patients' suffering experiences in those expanding therapeutic scenarios.
A Toilet Revolution and its socio-eco-technical entanglements
This chapter examines the role of sanitation in China’s urban transformation and how the recently announced Toilet Revolution is linked with largely unsustainable ideas of progress. The Toilet Revolution is designed as a new driver for economic growth and linked with strategies for the development of the country’s tourism industry. China is now well on the way to complete the transition from largely closed-loop, service-based sanitation to resource-intensive sewage-based sanitation across urban and rural settings. However, the implications of rapid sanitation transitions for human health, social relations and environmental sustainability are largely unclear. Research is urgently needed to inform policy and praxis across all levels of governance, planning and implementation. The theoretical and practical assumptions embedded in the study, design, planning, implementation and use of ‘sanitation’ must be challenged from the ground up in order to develop a rich understanding of sanitation needs, challenges and the possibility for future alternatives to standard sanitation interventions. A systems approach drawing on complexity theory and practice theory is a plausible starting point for the unravelling of sanitation and its socio-eco-technical entanglements.
Urban transformations and public health in the emergent city examines how urban health and wellbeing are shaped by migration, mobility, racism, sanitation and gender. Adopting a global focus, spanning Africa, Asia, Europe and Latin America, the essays in this volume bring together a wide selection of voices that explore the interface between social, medical and natural sciences. This interdisciplinary approach, moving beyond traditional approaches to urban research, offers a unique perspective on today’s cities and the challenges they face. Edited by Professor Michael Keith and Dr Andreza Aruska de Souza Santos, this volume also features contributions from leading thinkers on cities in Brazil, China, South Africa and the United Kingdom. This geographic diversity is matched by the breadth of their different fields, from mental health and gendered violence to sanitation and food systems. Together, they present a complex yet connected vision of a ‘new biopolitics’ in today’s metropolis, one that requires an innovative approach to urban scholarship regardless of geography or discipline. This volume, featuring chapters from a number of renowned authors including the former deputy mayor of Rio de Janeiro Luiz Eduardo Soares, is an important resource for anyone seeking to better understand the dynamics of urban change. With its focus on the everyday realities of urban living, from health services to public transport, it contains valuable lessons for academics, policy makers and practitioners alike.
More than three centuries of slavery have left a painful and visible scar on Brazilian society, and racism continues to shape the deep social and economic inequalities that Brazilians experience to this day. Even after the institution of slavery was abolished, by the end of the nineteenth century class exploitation and rapid urbanisation meant that racism was a structural and permanent feature of Brazil’s cities. Every dimension of society reveals this fracture. Ongoing lethal police brutality and the process of mass incarceration have to be understood within this historic frame.