Income and health in cities: the messages from stylized facts

The benefits of good health to individuals and to society are strongly positive, and improving the health of the poor is a key millennium development goal (MDG). A typical health strategy advocated by some calls for increased public spending on health targeted to favor the poor backed by foreign assistance, combined with an international effort to perfect drugs and vaccines to ameliorate the major infectious diseases prevalent in developing nations. However, if the objective is better health outcomes at the least cost and a reduction in urban health inequity, our research suggests that the four most potent policy interventions are: improving access to clean water and sanitation; widely available primary care and health programs aimed at influencing diets and lifestyles; raising the level of education; and better urban land use and transport planning which contains urban sprawl and minimizes the trend towards sedentary living habits. The payoff from these four, in terms of health outcomes especially for those in low-income categories, dwarfs the returns from new drugs and curative hospital-based medicine, although these certainly have their place in a modern urban health system. We find, moreover, that the resource requirements for successful health care policies are likely to depend on an acceleration of economic growth rates, which increase household purchasing power and enlarge the pool of resources available to national and subnational governments to invest in and maintain health-related infrastructure and services. Thus, an acceleration of growth rates may be necessary to sustain a viable urban health strategy, which is equitable, and to ensure steady gains in health outcomes.