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Examining the precarious status of informal settlements in Kigali at a time of large-scale planning-induced expropriation, this article considers urban contestation in the context of the city’s changing spatial-legal regime. We analyse the case of one informal settlement’s expropriation and relocation – the settlement of Bannyahe – and the contestation that has ensued as resident property owners take the District of Gasabo to court. Through interviews with settlement residents, we follow the fates of these displaced urban citizens and consider their struggles to remain in their homes. Finally, we suggest that such contestation over legal procedural regularity and negotiation over property valuation at the neighbourhood level forms the limit of overt opposition to the city’s masterplan. Terming these limits to contestation “silent boundaries” that circumscribe contestation for property owners in the Bannyahe settlement, we offer perspectives on contestation and compromise amidst urban socio-spatial reordering in the “new Kigali”.

Background: The expansion of urban slums is a key challenge for public and social policy in the 21st century. The heterogeneous and dynamic nature of slum communities limits the use of rigid slum definitions. A systematic and flexible approach to characterize, delineate and model urban slum structure at an operational resolution is essential to plan, deploy, and monitor interventions at the local and national level.Methods: We modeled the multi-dimensional structure of urban slums in the city of Salvador, a city of 3 million inhabitants in Brazil, by integrating census-derived socioeconomic variables and remotely-sensed land cover variables. We assessed the correlation between the two sets of variables using canonical correlation analysis, identified land cover proxies for the socioeconomic variables, and produced an integrated map of deprivation in Salvador at 30 m × 30 m resolution.Results: The canonical analysis identified three significant ordination axes that described the structure of Salvador census tracts according to land cover and socioeconomic features. The first canonical axis captured a gradient from crowded, low-income communities with corrugated roof housing to higher-income communities. The second canonical axis discriminated among socioeconomic variables characterizing the most marginalized census tracts, those without access to sanitation or piped water. The third canonical axis accounted for the least amount of variation, but discriminated between high-income areas with white-painted or tiled roofs from lower-income areas.Conclusions: Our approach captures the socioeconomic and land cover heterogeneity within and between slum settlements and identifies the most marginalized communities in a large, complex urban setting. These findings indicate that changes in the canonical scores for slum areas can be used to track their evolution and to monitor the impact of development programs such as slum upgrading. © 2013 Hacker et al.; licensee BioMed Central Ltd.

The San Francisco Department of Public Health recently completed a 2-year collaborative process, the Eastern Neighborhoods Community Health Impact Assessment (ENCHIA), to evaluate the potential positive and negative health impacts of land use development. ENCHIA resulted in a number of outcomes, including (1) a vision of a healthy San Francisco; (2) community health objectives to reflect the vision; (3) indicators and data to assess and measure the objectives and vision; (4) a menu of urban development strategies to advance the objectives; and (5) the Healthy Development Measurement Tool, an evidence-based tool to support accountable, comprehensive, evidence-based, and health-oriented planning. This case study describes the 18-month ENCHIA process, key outcomes, and lessons learned. The case study also provides an overview of the Healthy Development Measurement Tool and examples of its first applications to urban planning. Given the growing understanding of built environmental influences on health, ENCHIA illustrates the ability of a local public health agency to effectively engage in land use policy as a health promotion strategy. [ABSTRACT FROM AUTHOR]

Local governments working in partnership with communities can institutionalize practices that promote health equity. We offer a case study of how one city in the US is implementing Health in All Policies (HiAP) with the explicit aim of promoting health equity. We use participant observations, original document reviews and interviews to describe how Richmond, California, is building new partnerships, programs and practices with community-based organizations and within government itself as part of the implementation of its HiAP Ordinance. We also report on indicators that were identified by community and government stakeholders for tracking progress toward improving place-based determinants of population health. We find that the responsibility for implementing Richmond's HiAP Ordinance rests on a new institution within local government and this entity is building new partnerships, promoting innovative policies and augmenting practices toward greater health equity. We also reveal how city governments and community partners can collaboratively track progress toward health equity using locally gathered data., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The years 2020-2021 during the COVID-19 pandemic witnessed increases in firearm violence in many cities across the USA. We present data from Sacramento, Stockton, and Richmond, California that suggests firearm homicides during the pandemic did not increase in all communities or disproportionately burden the African American community. More specifically, we found that in these cities, there was a 5-52% decrease in gun homicides during the 2020/2021 period compared to the 2018/2019 period for neighborhoods with a gun violence prevention program operating there. We also found a 24-83% reduction in gun homicides in census tracts with > 20% Black populations in Sacramento and Stockton during the 2020/2021 period compared to the 2018/2019 period. In two cities, there was a 15-42% decrease in the number of African American men under 35 years old that were victims of a gun homicide in 2021 compared to 2018. We also found that the gun violence program operating in these cities called Advance Peace interrupted 202 street-level conflicts where guns were present across the three cities in 2020/2021 compared to 178 of the same conflicts in 2018/2019. These interruptions likely saved hundreds of lives and we estimate contributed to between US $65 and $494 million in savings. Advance Peace is a program that engages those at the center of gun violence, frequently young, Black men under 35 years old, and offers them the Peacemaker Fellowship, an intensive, 18-month program of 24/7 mentorship, social services, and life opportunities. The program is delivered by community resident "credible messengers," who conduct the mentorship and interrupt conflicts in the streets. While these findings are descriptive and preliminary, we know of no other program that was in operation before and during the pandemic in each of these cities that engaged the hard-to-reach but highly influential population at the center of gun violence., (© 2022. The New York Academy of Medicine.)

Persons with disabilities (PWDs) living in cities during the COVID-19 pandemic response may be four times more likely to be injured or die than non-disabled persons, not because of their "vulnerable" position but because urban health policy, planning and practice has not considered their needs. In this article, the adverse health impacts on PWDs during the COVID-19 pandemic reveals the "everyday emergencies" in cities for PWDs and that these can be avoided through more inclusive community planning, a whole-of-government commitment to equal access, and implementation of universal design strategies. Importantly, COVID-19 can place PWDs at a higher risk of infection since some may already have compromised immune and respiratory systems and policy responses, such as social distancing, can lead to life-threatening disruptions in care for those that rely on home heath or personal assistants. Living in cities may already present health-damaging challenges for PWDs, such as through lack of access to services and employment, physical barriers on streets and transportation, and smart-city technologies that are not made universally accessible. We suggest that the current pandemic be viewed as an opportunity for significant urban health reforms on the scale of the sanitary and governance reforms that followed ninetieth century urban epidemics. This perspective offers insights for ensuring the twenty-first century response to COVID-19 focuses on promoting more inclusive and healthy cities for all.

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

Urbanized river basins usually suffer from anthropogenic pressure, compromising the quality of water. Unsafe water is a risk to public health, especially when there are occurrences of HABs (Harmful Algae Blooms) as in the case of cyanobacteria, which cause different human health problems. In this paper, we aimed to review the scientific literature documenting what has been studied in the scope of the stratified reservoirs of urbanized basins. The mapping review method was used to categorize existing literature on urbanized watersheds and eutrophic reservoirs. Using the keywords "Eutrophic Reservoir" and "Urban" and selecting all the years of open publication on the Science web page, we obtained 69 results, 53 of them meeting the requirements established for the search. Many of the studies mention as the most important determinant for eutrophication of reservoirs and the proliferation of algae, the anthropogenic influence through the diffuse load of streets, domestic and industrial sewage, and even drainage water from agricultural areas in the basin. The results of this study reinforce that informal settlements without sanitary infrastructure are aggravating the deterioration of water quality in urban water sources and therefore posing many risks to public health.

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Purpose of Review: This paper offers research frameworks for understanding and acting to address urban environmental justice. Urban neighborhoods tend to concentrate and colocate vulnerable people and toxic environments. Cities are also where the poor and people of color tend to be disproportionately exposed to environmental hazards, such as air pollution, lead in paint and water, and polluting industries., Recent Findings: Researchers and government agencies are increasingly recognizing the need to document cumulative exposures that the urban poor and people of color experience in addition to environmental hazards. These "toxic stressors" can exacerbate the health impacts of pollution exposures and include such social and economic factors as discrimination, racism, linguistic isolation, and political exclusion. Urban environmental justice research can benefit from a structural racism approach, which requires documenting the historical decisions, institutions, and policies that contribute to today's cumulative exposures. Key research frameworks and methods utilizing this approach for urban environmental justice include community-based participatory research, measuring cumulative stressors, and community-based asset and hazard mapping.

Urban places and health equity are two of the most challenging concepts for 21st century environmental health. More people live in cities than at any other time in human history and health inequities are increasing. Health inequities are avoidable differences in the social, environmental and political conditions that shape morbidity and mortality, and disproportionately burden the poor, racial, ethnic and religious minorities and migrants. By linking urban place and health inequities, research and action brings into sharp relief the challenges of achieving urban environmental justice. This article briefly reviews the complex definitions of urban places and how they can shape health equity in cities. I suggest that a more relational or integrated approach to defining urban places and acting on health equity can complement other approaches and improve the ability of public health to meet 21st century challenges. I close with suggestions for research and practice that might focus environmental public health on healthy urban place making. The practices include community driven map making, Health in All Policies (HiAP), promoting urban ecosystem services for health, and participatory and integrated approaches to urban slum upgrading. I conclude that if the global community is serious about the sustainable development goals (SDGs), greater attention must be paid to understanding and acting to improve urban places, living conditions and the social and economic conditions that can promote health equity.

On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The health and well-being of rapidly growing urban populations is a global health issue. Cities in the global north and south are faced with rising health inequities - or avoidable differences in health determinants and outcomes based on place, social status and ethnicity. This commentary suggests that focusing only on treatment interventions in cities is likely to fail because populations will be forced to go back into the urban living and working conditions that likely made them sick in the first place. City planning as preventive medicine includes taking a relational and systems approach to urban health, requiring health assessments for all urban policy making, promoting neighborhood health centers as engines of community economic development and gathering place-based health indicator data to track progress and adapt interventions over time as conditions change., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Inadequate urban sanitation disproportionately impacts the social determinants of women's health in informal settlements or slums. The impacts on women's health include infectious and chronic illnesses, violence, food contamination and malnutrition, economic and educational attainment, and indignity. We used household survey data to report on self-rated health and sociodemographic, housing, and infrastructure conditions in the Mathare informal settlement in Nairobi, Kenya. We combined quantitative survey and mapping data with qualitative focus group information to better understand the relationships between environmental sanitation and the social determinants of women and girls' health in the Mathare slum. We find that an average of eighty-five households in Mathare share one toilet, only 15% of households have access to a private toilet, and the average distance to a public toilet is over 52 meters. Eighty-three percent of households without a private toilet report poor health. Mathare women report violence (68%), respiratory illness/cough (46%), diabetes (33%), and diarrhea (30%) as the most frequent physical burdens. Inadequate, unsafe, and unhygienic sanitation results in multiple and overlapping health, economic, and social impacts that disproportionately impact women and girls living in urban informal settlements.

Poor and minority residents of Richmond, California, have faced a host of place-based hazards and stressors such as pollution, gun violence, and a dearth of economic opportunities, all of which have likely contributed to their poor health outcomes. In this article we describe the city's efforts to reverse its fortunes by embracing a health-in-all-policies strategy for community development. Starting in 2007, the city organized a series of participatory planning projects with residents, community activists, school officials, and other stakeholders to ensure that the city took health equity into account when devising each phase of its new community development strategy. The result was an approach designed to address the social determinants of health by directing development resources toward vulnerable communities and by adopting a health-in-all-policies ordinance. Specific projects focused on improving the built environment and community safety and redirecting government funds to areas of social need. The process has contributed to rising levels of resident satisfaction about personal health, the direction the city is taking, and the quality of neighborhood development. Richmond's experience suggests that adopting a health-in-all-policies strategy is one way to promote health equity in distressed cities., (Project HOPE—The People-to-People Health Foundation, Inc.)

In April, 2014, the City of Richmond, California, became one of the first and only municipalities in the USA to adopt a Health in All Policies (HiAP) ordinance and strategy. HiAP is increasingly recognized as an important method for ensuring policy making outside the health sector addresses the determinants of health and social equity. A central challenge facing HiAP is how to integrate community knowledge and health equity considerations into the agendas of policymakers who have not previously considered health as their responsibility or view the value of such an approach. In Richmond, the HiAP strategy has an explicit focus on equity and guides city services from budgeting to built and social environment programs. We describe the evolution of Richmond's HiAP strategy and its content. We highlight how this urban HiAP was the result of the coproduction of science policy. Coproduction includes participatory processes where different public stakeholders, scientific experts, and government sector leaders come together to jointly generate policy goals, health equity metrics, and policy drafting and implementation strategies. We conclude with some insights for how city governments might consider HiAP as an approach to achieve "targeted universalism," or the idea that general population health goals can be achieved by targeting actions and improvements for specific vulnerable groups and places.

Urban informal settlements are often under-recognized in national and regional surveys. A lack of quality intra-urban data frequently contributes to a one-size-fits-all public health intervention and clinical strategies that rarely address the variegated socioeconomic disparities across and within different informal settlements in a city. The 2010 Brazilian census gathered detailed population and place-based data across the country's informal settlements. Here, we examined key socio-demographic and infrastructure characteristics that are associated with health outcomes in Rio de Janeiro with the census tract as the unit of analysis. Many of the city's residents (1.39 million people, 22 % of the population) live in informal settlements. Residents of census tracts in Rio de Janeiro's urban informal areas are younger, (median age of 26 versus 35 years in formal settlements), and have less access to adequate water (96 versus 99 % of informal households), sanitation (86 versus 96 %), and electricity (67 versus 92 %). Average per household income in informal settlement census tracts is less than one third that of non-informal tracts (US\$708 versus US\$2362). Even among informal settlements in different planning areas in the same city, there is marked variation in these characteristics. Public health interventions, clinical management, and urban planning policies aiming to improve the living conditions of the people residing in informal settlements, including government strategies currently underway, must consider the differences that exist between and within informal settlements that shape place-based physical and social determinants of health.

Health impact assessment is a structured decision support tool used to systematically characterize the anticipated health effects, both adverse and beneficial, of societal decisions. In San Francisco, the use of health impact assessments has not only produced evidence to inform health policy decision making but has also contributed to the political conditions needed to achieve optimal population health. Health impact assessments have helped increase public awareness of the determinants of health, routine monitoring of these determinants, cooperation among institutions, health-protective laws and regulations, and organizational networks for health advocacy and accountability. Drawing on more than a decade of local experience, we identify the direct and indirect effects of the assessments on the politics of governance as well as on health. We demonstrate that health impact assessment is both an analytic tool and a process that helps build the social institutions that can improve health.

Although the intent of community-based participatory research (CBPR) is to include community voices in all phases of a research initiative, community partners appear less frequently engaged in data analysis and interpretation than in other research phases. Using 4 brief case studies, each with a different data collection methodology, we provide examples of how community members participated in data analysis, interpretation, or both, thereby strengthening community capacity and providing unique insight. The roles and skills of the community and academic partners were different from but complementary to each other. We suggest that including community partners in data analysis and interpretation, while lengthening project time, enriches insights and findings and consequently should be a focus of the next generation of CBPR initiatives.

Asthma is now the leading cause of emergency room visits, hospitalizations, and missed school days in New York City's poorest neighbourhoods. While most research focuses on the influence of the indoor environment on asthma, this study examines the neighbourhood effects on childhood asthma, such as housing and ambient environmental hazards. Using Geographic Information Science (GI Science) we identify neighbourhoods with elevated concentrations of childhood asthma hospitalizations between 1997 and 2000 in US census tracts, analyze the sociodemographic, housing characteristics, and air pollution burdens from stationary, land use and mobile sources in these areas. The paper reveals the importance of distinguishing the specific and often different combinations of poor housing conditions, outdoor air pollution and noxious land uses that contribute to the high incidence of asthma in impoverished urban neighbourhoods.

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.

Activists in the environmental justice movement are challenging expert-driven scientific research by taking the research process into their own hands and speaking for themselves by defining, analyzing, and prescribing solutions for the environmental health hazards confronting communities of the poor and people of color. I highlight the work of El Puente and The Watchperson Project--two community-based organizations in the Greenpoint/Williamsburg neighborhood in Brooklyn, New York, that have engaged in community-based participatory research (CBPR) to address asthma and risks from subsistence-fish diets. The CBPR process aims to engage community members as equal partners alongside scientists in problem definition, information collection, and data analysis--all geared toward locally relevant action for social change. In the first case I highlight how El Puente has organized residents to conduct a series of asthma health surveys and tapped into local knowledge of the Latino population to understand potential asthma triggers and to devise culturally relevant health interventions. In a second case I follow The Watchperson Project and their work surveying subsistence anglers and note how the community-gathered information contributed key data inputs for the U.S. Environmental Protection Agency Cumulative Exposure Project in the neighborhood. In each case I review the processes each organization used to conduct CBPR, some of their findings, and the local knowledge they gathered, all of which were crucial for understanding and addressing local environmental health issues. I conclude with some observations about the benefits and limits of CBPR for helping scientists and communities pursue environmental justice.

While risk assessment continues to drive most environmental management decision-making, its methods and assumptions have been criticized for, among other things, perpetuating environmental injustice. The justice challenges to risk assessment claim that the process ignores the unique and multiple hazards facing low-income and people of color communities and simultaneously excludes the local, non-expert knowledge which could help capture these unique hazards from the assessment discourse. This paper highlights some of these challenges to conventional risk assessment and suggests that traditional models of risk characterization will continue to ignore the environmental justice challenges until cumulative hazards and local knowledge are meaningfully brought into the assessment process. We ask whether a shift from risk to exposure assessment might enable environmental managers to respond to the environmental justice critiques. We review the US EPA's first community-based Cumulative Exposure Project, piloted in Brooklyn, NY, and highlight to what extent this process addressed the risk assessment critiques raised by environmental justice advocates. We suggest that a shift from risk to exposure assessment can provide an opportunity for local knowledge to both improve the technical assessment and its democratic nature and may ultimately allow environmental managers to better address environmental justice concerns in decision-making.