Pandemic Influenza as Urban Health Crisis | CDC EID

EID Journal Home > Volume 15, Number 12–December 2009

Volume 15, Number 12–December 2009
Policy Review
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)

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Abstract
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 25 persons lives in a megacity; in Latin America, the ratio is 1 in 7. In central Tokyo, the population density is 5,847 persons/km2 (1). Cities are increasing in developing countries and often have slums that lack basic services (2). The accelerating global trend toward megacities is a new paradigm of human existence and poses profound public health challenges. New approaches for surveillance, preparedness, and response will be needed because current strategies may not be easily scalable upward to address huge, densely populated areas, especially in developing countries.

In 2008, the World Health Organization (WHO) International Health Regulations (IHR) Coordination Department, in collaboration with Lyonbiopole (Lyon, France), held a consultation, Cities and Public Health Crises (1). Consultants stated that WHO and national guidance does not always adequately address the challenges their cities face, and they could learn much from each other. This article summarizes these challenges, illustrated by the initial appearance of influenza A pandemic (H1N1) 2009 virus during spring 2009 in Mexico City, Mexico, and New York (NYC), New York, USA (metropolitan area populations 20 million and 19 million, respectively). These megacities may not be representative of cities in low-income countries, which face more daunting problems.

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