Pandemic influenza as 21st century urban public health crisis

DOI: 10.3201/eid1512.091232
Suggested citation for this article: Bell DM, Weisfuse IB, Hernandez-Avila M, del Rio C, Bustamante X, Rodier G. Pandemic influenza as 21st century urban public health crisis. Emerg Infect Dis. 2009 Dec; [Epub ahead of print]

Pandemic Influenza as 21st Century Urban Public Health Crisis
David M. Bell, Isaac B. Weisfuse, Mauricio Hernandez-Avila, Carlos del Rio, Xinia Bustamante, and Guenael Rodier

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.M. Bell); New York City Department of Health and Mental Hygiene, New York, New York, USA (I.B. Weisfuse); Ministry of Health of Mexico, Mexico City, Mexico (M. Hernandez-Avila); Emory University Rollins School of Public Health, Atlanta (C. del Rio); Pan American Health Organization, San Jose, Costa Rica (X. Bustamante); and World Health Organization, Geneva, Switzerland (G. Rodier)

The percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion) in 2025. Crowded urban areas in developing and industrialized countries are uniquely vulnerable to public health crises and face daunting challenges in surveillance, response, and public communication. The revised International Health Regulations require all countries to have core surveillance and response capacity by 2012. Innovative approaches are needed because traditional local-level strategies may not be easily scalable upward to meet the needs of huge, densely populated cities, especially in developing countries. The responses of Mexico City and New York City to the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 illustrate some of the new challenges and creative response strategies that will increasingly be needed in cities worldwide.

According to United Nations estimates, the percentage of the world’s population living in urban areas will increase from 50% in 2008 to 70% (4.9 billion persons) in 2025. During 2007–2025, the number of cities with population 1–5 million will increase from 382 to 524, and the number of megacities (>10 million population, comprising the core city, suburbs, and continuously settled commuter areas) will increase from 19 to 27. Of the 27 megacities, 16 will be in Asia, 4 in Latin America, 3 in Africa, 2 in Europe, and 2 in North America. Currently, 1 in...

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