Informal Settlements and Human Health: A Framework

Informal settlements or slums dominate the urban landscape and in 2016 were the home to almost 900 million people. Global health is now slum health. The determinants of health for slum dwellers are multi-factorial and can vary from country to country and even within the same city. This chapter reviews the definitions of informal settlements or slums and highlights the key drivers of health, disease and well-being in urban informal settlements, including: spatial segregation, insecure residential status, poverty and employment, housing structural quality, water and sanitation, energy, transport, violence, climate change and services. We highlight the evidence supporting the links between these key factors and infectious and non-communicable diseases (NCDs). The chapter also links the health issues facing informal settlements with the Sustainable Development Goals (SDGs). The chapter concludes with a discussion of how slum upgrading—a community-based process that aims to improve built and social environments, as well as economic and social conditions in slums—can be a key approach for improving the health of those living in informal settlements. We suggest that multiple features of the upgrading process, including community engagement, women’s empowerment, shelter and infrastructure improvements, tenure security, political recognition, and enhanced social and health care services, can combine to reduce the disease burden and premature mortality so frequently experienced by those living in informal settlements.