The location of a home in Latin America according to the zip code can predict the life expectancy of its inhabitants; Cities such as Bogotá, San Salvador, Lima, Mexico City, Santiago de Chile or Buenos Aires, to name a few, indicate differential health risks and therefore mark life expectancy, which can vary for more than a decade.
The social strata and the ways in which Latin American cities developed offer for some ideal spaces to have a higher quality of life, but for others in the peripheries, without basic services and housing in minimum conditions such as -the vast majority- the conditions they are adverse. This population must also overcome kilometer journeys during public transport hours to get to work in the city.
Along these lines, an investigation presented in documentary format in recent days by the Inter-American Development Bank (IDB) under the title ‘Health and City’ offers a look at a widespread problem that is addressed from different perspectives from the urban environment.
“When talking about chronic non-communicable diseases in Latin America, the first thing that comes to mind is diet, physical activity, and risk and genetic factors; but in reality the most important determinants, even of chronic diseases, have to do with the environment,” says Ana Diez Roux, an epidemiologist and dean of the Drexel University School of Public Health in Pennsylvania.
This expert, who has participated for five years in the Urban Health in Latin America (Salurbal) study, which covers 11 countries in the region, “and almost 400 cities” on the continent in which work is being done “to better understand what factors affect the Salud en las ciudades latinoamericanas” says that the methodology has led to the comparison between different cities and also their zip codes, and as a result they have discovered notable differences.
The compiled data -according to Diez Roux- lead them to state that “inequality is a determinant factor of health and inequalities” on the continent, and comparing cities and neighborhoods of the same city have found the differences that mark the environments of living place.
The researcher exposes data from cities such as San José, Costa Rica, from a wealthy neighborhood and therefore with higher life expectancy than for men, it is estimated at 80 years, the less favored areas of that same Central American city have low life expectancy to 74 years. The same can be seen in cities like Santiago, in Chile, that the lowest life expectancy is 70 years and in poor areas, but a few streets away in higher-income areas, life expectancy rises to the range of “between 79 and 85 years “According to the expert in this case “one can speak of a difference of up to 15 years”.
Carolina Piedrafita, coordinator of the IDB Cities Network, and part of the documentary project, comments to the voice of america that this research focuses on a key and little-studied aspect to understand the problem at the regional level on how urban environments are determinant.
He explains that other disciplines related to medicine have delved into “environments” and have come to determine that “more than half of a person’s health outcomes are defined by the environment; where do you live and how do you live”, but it was not an issue that had been explored in its broad dimension from a multilateral organization such as the IDB.
“This whole framework of where your neighborhood is, how safe your neighborhood is, how accessible the city is, how stigmatic it is to live in an informal settlement, and what is your access to health and quality education, all those factors that affect the quality of life and the health of a person are not so clear”, explains Piedrafita.
This expert says that this research opens a window to call for reflection on structural problems, but also to understand the dynamics in Latin American cities that have experienced accelerated growth and migration from the countryside to the city in the last 50 years.
Pidrafita maintains that seeing the entire problem in a transversal way and how it impacts health “should be better known” for all the people who work in urban development policies.
Daily trips “from the third world to the first world”
The architect Alejandro Aravena, Pritzer Prize 2016, part of the experts interviewed for film production, tells the VOA that Latin American cities “reflect in a concrete, daily and brutal way” social inequalities.
He gives his city Santiago as an example, where he assures that approximately 75% wakes up in “the third world, travels to the first world during the day” to do activities such as education, shopping and even entertainment and “returns to that third world at the end of the day world” characteristic of Latin American cities, where inequality and segregation are added.
For this expert, this passage through the different segments “accumulates a kind of anger and injustice” that accumulates and ends in social outbursts Like the seen in various South American cities in recent years “and this has consequences for mental health,” he points out.
If we add to this the public transport systems that “are very inefficient” due to the pollution they emit, another risk factor enters, such as respiratory diseases that “lead hospitals to collapse” due to these diseases, especially in children.
“To move from that third world city to the first world with enormous masses of people, we have consequences on pollution that is not a problem of some, it is a problem of all and that cannot be solved individually,” Aravena points out.
mental health in cities
Neuroscientist Agustín Ibánez, director of the Latin American Institute of Brain Health, at the Adolfo Ibáñez University, in Chile, speaks with VOA about research and indicators of brain health and how housing conditions impact quality of life and promote diseases due to overexposure to stress, among other factors.
Ibáñez points out that answering the question of how cities and urban life “impact brain and mental health” cannot be attributed to a single origin, but is made up of a set of situations and disciplines that have come close to addressing it. Among these, says this neo-scientist, are “the social determinants of health” posed by structural determinants.
These conditions of where you live, what you eat, how much you sleep, have already been shown in advance that they “impact the levels of response to stress and toxicity”, and to this is added environmental pollution that has been shown to “have pathological effects on demania “and for the development of diseases of neuronal deterioration.
The most recent according to Ibáñez in this trend of studies is the impact that “nature and green contexts have on feeling good and on brain health.”
“Exposure to nature, the development of green spaces is associated with feeling better in a fairly systematic way, and among these, exercising in the open air stands out as a health prevention; but to exercise, paradophically you have to have time and resources “, something unattainable for a great majority of Latin Americans.
In a large part of the urban settlements in the peripheral areas of Latin American cities, green spaces are estimated at one square meter for each inhabitant. The World Health Organization (WHO) recommends between seven and nine square meters; in the wealthy neighborhoods of Latin American cities such as Santiago it is estimated at 18 meters per inhabitant, the regional average according to IDB data is 3.5 meters per inhabitant.
In European cities like London, that proportion increases to 40 square meters of green area per inhabitant.
pressure on housing
The architect Alejandro Aravena adds that factors such as overcrowding have escaped the capacities of Latin American States to solve the problem due to a growing demand for travel from rural areas to cities.
“The process of urbanization of the planet in Latin America began perhaps earlier than in other parts of the world, there is an urbanization of more than 80% from the 70s onwards,” he points out, which surpass Asia and Africa in this type of displacement and growth of cities, which has compounded the problem.
He says that these massive mobilizations “on a very large scale and at high speed and with few resources” put pressure on the quantity of houses built and the quality of those.
“If you cannot respond in a coordinated manner from the States and even from the markets at that scale, your alternative is informal settlement, it is not that people stop coming to the cities, they come the same, but they live in a very bad way” , point.
And there comes a key question -says Aravena- such as why people come to the cities, -according to this expert- because even if the quality of life is very bad, “the expectation of improvement, of having access to opportunities for work, education, health, transportation or recreation is higher than if it is not in them”, commented the architect to the VOA.
The architect explains that even under pressure, the city should be seen as “a powerful vehicle for wealth creation” and in principle it would make it easier for States to “level the playing field” for the delivery of basic services by having the population in greater concentration, and that would have an effect on health.
The challenge of the nearby city
Ideas to bring sources of work closer to citizens or facilitate mechanisms for workers in the peripheries to improve mobility acquire incalculable value that would determine a substantial change in the quality of life, comments the neuroscientist Agustín Ibáñez to the VOA.
“If one looks at the large numbers, the bulk of the working population in the cities loses between two and five hours a day “just traveling from where they live to where they have to work” and this has a tremendous impact first because it is wasted time,” in addition to impose a sedentary lifestyle when sitting in a bus and the most difficult thing for people is to put up with lost time during those times on public transport.
The idea of the “15-minute city is very healthy”, as it allows the use of alternative transportation such as bicycles, walking, and also reduces energy consumption costs in times of sustainability.
“With new technologies you can reorganize cities to make them healthier, on some levels there are issues of structural inequality that already go through long-term investment and government regulations, but there are a lot of things that can be done today” to advance, comments the Ibáñez.
Studies also show that there is a increase in cases of mental health problems in Latin American cities, compared to rural environments, those that would be consistent with the challenges of citizens to live in those spaces under strong pressure for different reasons.
The documentary “Health and City” With the voices of experts and citizens of the Americas, it explores crucial issues such as poverty, marginality, overcrowding, habitability, transportation, and stress, among others.
It is estimated that 85% of premature deaths occur in low- and middle-income countries such as Latin America, which are considered within the range of non-communicable diseases, especially in areas where poverty predominates.
[Las imágenes que ilustran las entrevistas a los expertos realizadas por la Voz de América son parte del documental “Salud y Ciudad” por cortesía del BID]
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