The 12th Annual IHMEC Conference
March 6 - 8, 2003
New York City

Globalization and projected trends for urban expansion have created new health risks for cities around the world. September 11 and the subsequent intentional release of deadly germs highlight the urgency for large urban centers across the world to examine their public health preparedness and capacity to respond to emerging global health threats. International health/Medical education and research are key elements in the development of integrated and coordinated strategy towards global forces impacting world cities.

By 2025, 61 percent of humanity will live in large cities (UN,1999). The combination of population growth and steady migration from rural to urban areas is responsible for this expected increase in the size of the global urban population. Cities have a disproportionate burden of diseases chiefly because they concentrate the poorest and most vulnerable sectors of the population.

In a world where people and economies are increasingly interdependent, health risks are not self-contained. Consequently the health in both high and low-income countries is increasingly dependent on how global health issues are managed around the world (IOM, 1998.) These issues include control of infectious and chronic diseases, rising social inequalities and humanitarian crises caused by warfare, biochemical terrorism, environmental hazards and mass-migration to urban areas.

Health around the globe will therefore be increasingly determined by the health of our cities, particularly cities in the developing world where 80 percent of urbanites will live. The plight of urban populations in low-income countries is particularly alarming as rapid urbanization threatens already overstretched public health infrastructures.

Today, in both the developed and developing countries the urban poor have the highest health risks. Poverty, a cause of rapid population growth and environmental degradation is the strongest predictor of mortality and morbidity Urban risk factors such as insufficient water and sanitation services, overcrowded housing and pollution not only cause ill health but also exacerbate global health risks such as infectious diseases. This is especially true in the developing world. For example, over 2 million urban children under the age of five died last year from diarrheal diseases. Cholera epidemics threaten many cities in Africa and Latin America. Diseases such as Malaria and Dengue, both more frequent in rural area, are increasingly encountered in urban settings. Dengue has reached epidemic proportions in Central American cities and traditionally rural parasitic diseases are emerging in cities in the southern United States as a result of urban migration and proliferation of mosquito breeding sites.

In addition, the urban poor residing in the developing countries are increasingly threatened by diseases more typically encountered in the developed world: cancer, cardiovascular diseases, chronic lung disease and asthma, conditions that are also environmentally related.

Social factors in urban environments such as alienation, unemployment, acculturation, ethnic tensions, and violence impact health as well. (World Resources Institute, 1997).

The population of Western cities such as New York, London and Paris are becoming more diverse ethnically, culturally and socio-economically. The changing demographics of industrialized societies and the integration of immigrant communities, require linguistically and culturally appropriate provision of health care. It also calls for a deeper understanding by health practitioners of determinants of health and health behavior that differ from the general population.

Emerging urban health problems world-wide are a formidable challenge for medical education. While solving urban health issues is beyond the ability of the medical establishment, the medical practitioner is key in the implementation of public health interventions. Medical students and practitioners need to know more than the virulence of pathogens, the mechanisms of diseases and their treatment. Understanding the dynamics of the health care system and of diseases, their relationship with lifestyles and social interactions needs to become part of medical school curricula. In addition, the urban research agenda needs to include closer linkage between bio-medical research and community health issues.

The urban health future presents many socio-political and economic challenges. As urban economies grow, they are threatened by the deepening gap between the haves and have-nots. But the future offers also vast opportunities for human development through social transformation and technology. And better trained medical professionals are part of the solution.

There is a need for exchanging information, experiences and lessons learned with other world cities. Through international collaboration, our shared responses to global health threats and urban humanitarian disasters will grow to be more comprehensive and effective.

The events of September 11, 2001 and subsequent bio-terrorism incidents revealed our vulnerability and lack of preparedness for internal and external health threats. They are a warning sign for cities across the globe to upgrade their public health infrastructure, and for health professionals to be better trained to meet these new challenges.