200_slumhealthSlum Health: From the Cell to the Street
Jason Corburn and Lee Riley, editors
University of California Press
155 Grand Avenue, Suite 400,
Oakland, CA 94612; www.ucpress.edu.
315 pages. Paperback. $34.95.

In Slum Health, University of California, Berkeley, professors Jason Corburn and Lee Riley show that poor health in slums cannot be addressed separately from the social conditions that bring it about. Poverty, racism, and poor access to medical care and services have a major influence on residents’ health. Environmental, social, and political forces must all be considered.

Corburn and Riley use the United Nations definition of slums: human settlements with inadequate access to safe water, sanitation, and other basic infrastructure needs; housing of poor structural quality; overcrowding; and insecure residential status.

The urban poor historically have been separated from other groups in and around the city, at first because of public health concerns. The elite believed that the unsanitary living conditions—and the fact that the urban poor often were a dark-skinned race—meant that they should be segregated from the wealthier, whiter residents. The segregation and overcrowding of the poor resulted in more socioeconomic problems, which led to more infectious diseases and created a vicious cycle. The legacy persists today.

In the 1940s under urban renewal, cities carried out slum clearance—in other words, decimation. Suburban-style development was seen as the way to improve health and was backed in the United States by federal mortgage policies. But urban renewal severed neighborhoods and eroded trust and social ties. A better approach, the editors write, is participatory slum upgrading.

It is participatory because it engages the community, avoiding the top-down approach that has not worked well. Upgrading means providing infrastructure and basic services, including sanitation and water, and improving the quality of housing. An important point: making these changes implies that the slum dwellers have a right to live there—a recognition that can shift the attitude of both the local government and residents.

The book discusses three case studies—in Salvador, Brazil; Nairobi, Kenya; and urban India. Researchers in Salvador initially focused on leptospirosis, a rat-borne, life-threatening infectious disease. They discovered that the highest rate of infection was in Pau da Lima, an area on the outskirts of the city where nearly half the housing structures had open sewers and inadequate refuse collection. They soon realized that their study of the disease could not be separated from questions of inequality and social justice.

Corburn and Riley also address the importance of community involvement and of scientific and medical professionals working with laypersons. Grassroots involvement by residents made the Pau da Lima project more successful. In a Nairobi slum, residents suffered from a lack of safe, clean, dignified toilets. After a lot of work, a coalition of residents, nongovernmental organizations, and academics developed a plan for upgrading infrastructure. The local water board and the water and sewer company now provide piped water to homes in the area.

Of the three areas discussed in the case studies, India may have the fastest population growth in its cities. The poorest India residents share the same problems found in Pau da Lima and Nairobi—inadequate sanitation and water supply, and houses constructed with low-quality materials. Exacerbating these problems is the voicelessness of the urban poor. These people should be encouraged and trained to make changes on their own when they can and to demand changes when government help is needed, researcher and physician Siddharth Agarwal writes.

The editors conclude that slum upgrading and national health services must work together. As they write: “[H]ealth services often account for a large national expenditure but frequently ignore the living and working conditions that are making populations ill in the first place.”