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Working In Urban Health: What You Need To Know

Industry Advice Public Health & Public Policy

As of 2018, 54 percent of the world’s population—4.2 billion people—live in cities and the metro areas around them. It is estimated that by the year 2050, that percentage will jump to 68 percent. 

By bringing together millions of people from diverse backgrounds, cities often serve as incubators of innovation. The same factors that make cities such powerful innovation engines, however, can also be the source of significant challenges. As cities across the United States and around the world continue to grow, medical professionals and policymakers must bear in mind the role that urban public health will continue to play in addressing these challenges.

Read on to learn more about the responsibilities and challenges of working in urban public health, and what you can do to prepare to succeed in the field.

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What is Urban Health?

The study of public health involves understanding how the conditions in which we are born, live, work, play, and age (also called the social determinants of health ) can impact individual and community health outcomes. 

Urban health refers to this study as it applies specifically to urban populations and focuses on the unique challenges and conditions associated with urban life. Some important topics in urban health include: the ease at which disease spreads in an urban setting, physical and mental stress associated with urban living, and the existence of “food deserts” where entire neighborhoods lack equitable access to affordable nutrition. 

According to Neil Maniar, director of Northeastern’s Master of Public Health in Urban Health program, the urban health discipline takes the community public health discipline and frames the concept within the context of urbanization. It’s an underserved field, he says, and one that promises great opportunity for professionals to make a major impact.

Careers in Urban Health

“When we talk about urban environments,” Maniar says, “we’re often talking about communities with high population density; places where environmental factors that influence public health, such as educational, environmental, economic, and biological conditions, can impact millions of people all at once.”

These are different from suburban or rural environments where these factors have a more limited impact. Working in urban health requires its practitioners to tease apart highly complex processes to better understand how environmental factors work together to affect these health outcomes among large populations. One might focus on, for example, trying to understand why certain major cities are seeing higher rates of cancer, violence, or cardiovascular disease, and uncover all the different factors underlying these health outcomes.

But this work only represents a fraction of the work opportunities available to urban health professionals. In a city like Boston, Maniar argues there are at least 100 different career trajectories in the public health field, many of which connect directly to the field of urban health.

“Many choose to pursue work at state or local health agencies, such as the Boston Public Health Commission or the Massachusetts Department of Health . Others choose the route of an epidemiologist, developing public health programs. And others choose to work within a healthcare system to address health disparities.”

But that’s not all, according to Maniar. By pursuing a career in urban health, you can also work directly with individuals in the community, or within a school system, housing authority, or even at the intersection of criminal justice and public health.

The Challenges of Working in Urban Health

Maniar identifies three persistent challenges he says are present in most areas of urban health work:

1. Long-term Projects

Many of the outcomes the field is trying to address are impossible to change “overnight.” Maniar says professionals in the field need to take a long-term perspective when thinking of their work. Some of the health outcomes they’re trying to affect might not yield results for five to 10 years, so they must remain determined, persistent, and patient.

“It can be frustrating to work on a long-term project and not feel like you’re impacting change. In reality, you are doing impactful, important work—it’s just that the results won’t reveal themselves until potentially years down the line. It’s important to keep this in mind.”

2. Collaboration

The need and shared desire for collaboration in the industry is both an opportunity and a challenge, Maniar says.

“Along the course of a project, you may have people who need to drop out of an effort, causing a resourcing or funding problem. Public health organizations must juggle many priorities that may impact their ability to participate at the level you would like them to.”

And because urban health contexts are fluid, he says, organizations can have emergent issues come up that affect your work:

“Say you’re focused on reducing the rate of hypertension in an area and you’re a part of a large collaborative effort when all of a sudden there’s an epidemic. Many of your community partners might have to shift their focus to those priorities, leaving you stranded.”

3. Lack of Resources

In conjunction with the above challenge, in an environment with fixed resources, including people, space, and time, it’s likely you’ll constantly be looking for new people to develop or sustain the work you’re doing. This can become challenging and force you to prioritize more effectively, Maniar adds.

Looking Forward: Trends in Urban Health

Maniar shares upcoming trends in urban health that professionals should continue to observe.

Digital Health Technology

As digital health, including telemedicine and connected health, innovations continue, the urban health industry is gaining access to innovative approaches to improve health outcomes. These will become increasingly important tools in the urban health discipline, particularly in the industry’s ability to improve healthcare access for all individuals in a community.

Health Informatics and Big Data

The urban health discipline is becoming much better at leveraging data to better understand drivers and root causes of health outcomes, Maniar asserts. By harnessing these technologies, industry professionals can develop more impactful and successful approaches to improving public health.

Increased Interdisciplinary Collaboration

Increasingly in the past decade, there has been a push toward interdisciplinary collaboration in the community. There’s now a shared understanding among community partners that health occurs in all places—virtually any community partner can play a role in improving the health of their surrounding community, and not only physically, but economically and environmentally as well.

Important Skills for Working in Urban Health

1. broad public health knowledge.

In order to be effective in their roles, Maniar says that urban health professionals must have a deep understanding of and appreciation for the concepts of social justice and the social determinants of health. Urban health workers must have a concrete grasp on how all social determinants can affect health, including access to healthcare, nutrition, housing, safety, economic factors, and education, in order to be effective. With a deep knowledge of these determinants and their effects on health outcomes, the more likely those working in the field can put their skills into practice and effectively impact change to improve health outcomes.

2. Flexibility

Maniar stresses that working in urban health is challenging, and therefore it’s important for industry professionals to remain flexible. You must be able to apply your board range of knowledge to solve problems, and pivot between looking at the big and small pictures as situations require. Sometimes, he explains, it’s important to focus on data analytically, while other times it’s critical to consider the long-term or far-reaching implications of health policies and their influence on outcomes.

3. Collaboration skills

Due to the collaborative nature of most urban health initiatives, Maniar says, it’s important to hone your collaboration and interpersonal communication skills. Doing this will allow you to work more effectively with various members of the community, including practitioners, organizational leaders, community leaders, and community members.

4. Curiosity

It’s important to be a curious learner focused on constantly expanding your knowledge says Maniar. The discipline is evolving rapidly with advances in digital health technology, and connected health, and even the healthcare system itself.

“To stay relevant and to be able to propose innovative solutions,” he says, “it’s critical that you’re up-to-date on the latest industry trends.”

How to Advance Your Urban Health Career

Maniar says that there are generally high concentrations of public health professionals in small areas, giving you ample opportunity to collaborate, network, and learn from one another. Take advantage of these opportunities to help advance your career. He suggests:

• Participate in collaborations with other community partners. Many advances in public health are a product of one person reaching out to one another and saying “I’m working on this, can you help me?” Don’t be shy about sharing your industry knowledge.
• Never underestimate the importance of building your network . Make networking a priority to increase your opportunities for collaboration.
• Never stop learning. Don’t rest once you earn your degree, he says, but keep upskilling and staying abreast of industry trends to be proactive instead of reactive in your ideas. He suggests joining professional organizations, such as the Massachusetts Public Health Association or the American Public Health Association , which he says will not only provide you with knowledge but additional access to industry experts.
• Don’t be afraid to take on some of the big challenges in urban health. Although the thought of addressing issues such as violence and health disparity can be quite daunting, Maniar says, these challenges also present exciting opportunities to “apply innovative methods, think outside of the box, and tackle the same issues that folks have been trying to tackle for the last 50 years.”

How an MPH Can Help You Address Critical Issues in Urban Health

Maniar says that the value of a Master’s in Public Health is in the fundamental knowledge that it provides. An MPH (or a similar advanced degree) will give you the broad base of knowledge you need for a successful career in the field. In a degree program, you’ll gain expertise in the fundamental areas of urban health, including epidemiology, health policy, social determinants and their role in public health, and successful models you can use to improve public health.

And while Maniar maintains that you can have a successful career without a degree, what he’s seen, more often than not, is that those who don’t have an MPH do have another closely related advanced graduate degree. Generally speaking, the specialized knowledge gained in an advanced degree program is invaluable when tackling the types of complex issues that arise in the industry. Graduate public health education equips professionals to be much more impactful in work that they do.

Additionally, some top programs, like Northeastern’s Master of Public Health in Urban Health , allow students to participate in capstone projects where they elect to work with community partners, giving them the opportunity to try their hand at the collaboration he mentioned is such a critical part of success in this industry.

Interested in advancing your career in urban health? Explore Northeastern’s Master of Public Health program to find out how an advanced degree can help you get there. 

Editor’s note: This article was originally published in August of 2018. It has since been updated for accuracy and comprehension. 

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On urban health, and the state of the science ..

Understanding Health in Cities, the Boston Example

In an effort to rationalize the full set of determinants of health within urban environments, we suggested that three particular factors be considered as drivers of health in cities: the physical environment, the social environment, and access to health and social services. Examples of how these factors influence health abound in the literature. But, perhaps the abstraction of “urban health” is brought home more acutely when one considers our home, Boston.

In a series of analyses, we have previously shown the remarkable heterogeneity of health within Boston. Mapping conditions on T-stops, for the sake of illustration, we can see in Figure 1 the heterogeneity in adult non-communicable disease indicators such as diabetes in Boston.

As we well know, these health indicators are closely linked to a broad range of social indicators that are unevenly distributed across the city. Poverty is a frequently used summary indicator of socioeconomic position, well established as a marker of a broad range of other adversities. It is then not surprising, given the map above, that poverty rates in some parts of Boston are four to eight times higher than those surrounding the healthier stops on the T (Figure 2).

Other measures of socioeconomic position, such as education, track accordingly, with a graduate education being three or more times more common around the Arlington and Fenway stops than around Dudley Square, Mattapan, or Maverick stations (Figure 3).

And these differences are associated with commensurately poor health behaviors, such as physical activity, that are substantially lower on the Red Line at Mattapan than on the Green Line at Fenway, for example (Figure 4).

Inured as we are to inequalities in health, we might well shrug off these health differences as ones between far-apart worlds. But are they? In fact, the geographic space we are talking about here is remarkably small (Figure 5). We are dealing with geographic differences of roughly four miles, or about an hour’s walk. In many respects, it is remarkable that areas so close to one another should have such dramatically different health indicators, “health worlds apart” that are simply down the street from one another.

Importantly, as we think about health in cities, we recognize that many of these differences are not driven by differences in health services. Boston is characterized by an incredible density of physicians and hospitals throughout the city (Figure 6). It is therefore not surprising that none of the T stops we are discussing are particularly far from medical facilities. Clearly, medical centers differ in terms of populations served and variations in availability of care, but as the map below shows (and as can be verified through much more thorough analysis), there are negligible differences in the physical distance of these neighborhoods to quality medical care.

This, then, tells a story of a city with health characterized by heterogeneity across proximal geography, driven undoubtedly by the conditions of health in the city. And, this being Boston, we have a fair bit of literature that has considered the urban characteristics of the city that shape the health of the populations who live here. For example, a spatial study by Dustin Duncan and colleagues compared open recreational space to neighborhood characteristics and found that neighborhoods with a high proportion of non-Hispanic black residents had significantly less open space, increasing obesity risk due to lack of physical activity. Another study focused on physical activity used the 2008 Boston Youth Survey to show a relationship between high social fragmentation in a neighborhood and lower physical activity among adolescents. Consistent with research in other cities, study after study show that many of the indictors that are associated with poor health cluster together. The lowest-income neighborhoods in Boston coincide with those that have less open green space and worse health outcomes. In many studies, area-level poverty serves as a ready marker for the accumulation of factors that adversely affect health in urban areas. In the aforementioned Boston study, Chen and colleagues found that the incidence of premature mortality rates was 1.4 times higher in the most economically deprived census tracts compared to those in the least impoverished tracts. They also found an attributable fraction of 25 percent to 30 percent of excess deaths due to living in high-poverty census tracts. These census tracts with the highest poverty have also consistently been found to have the highest proportion of black residents and the lowest levels of education .

Opportunities in Urban Health

In many respects, the study of health in cities presents a tremendous opportunity, both for a multi-level understanding of population health and for our urban school of public health to find a focus for scholarship and action. Clearly, factors at the political, structural, social, and service delivery level are jointly responsible for the health of urban residents, and an understanding of the dynamics that knit together this causal web presents opportunities for both knowledge and, potentially, intervention. There is growing momentum towards building movements that aspire to healthier cities , with emerging municipal efforts that aim to capitalize on the growing political latitude that cities are enjoying towards the development of innovative approaches to promote urban health. This strikes me as presenting us, in the academy, with an opportunity to marry multiple strands of the core mission of academic public health . Scholarship that aims to understand how cities influence health, and how the urban environment gets under the skin , can be interesting, formative, and productive. Our students overwhelmingly come from, and will overwhelmingly work in, urban areas, presenting an opportunity for grounding our scholarship and educational experience in our students’ salient present. And urban environments present translational opportunities that can, through partnerships with colleagues in practice, contribute to opportunities to improve the health of populations, and allow us to do well by doing good.

To the end of understanding better the study of urban health, and the state of the science in the field, I am much looking forward to the symposium we are hosting this week called Urban Health: State of the Science . I look forward to seeing many members of our community there.

I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro Galea, MD, DrPH Dean and Robert A. Knox Professor Boston University School of Public Health Twitter:   @sandrogalea

Acknowledgement: I would like to acknowledge the help of Laura Sampson on this Dean’s Note.

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On Urban Health, and the State of the Science

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Global Action for Urban Health Lab

Faculty Facilitators: Dr. Jo Ivey Boufford , Dr. Alexis Merdjanoff and Dr. Tom Kirchner

Lab Coordinator: Gina Gonzales, MPH

Urban health is an evolving area of research, education, practice, and policy making. Students are in a strong position to be part of these developing activities to advance the evidence base on research, implementation and evaluation in urban health. The Global Action for Urban Health Lab, co-developed by Dr. Jo Boufford and Dr. Alexis Merdjanoff, provides a space for students both within and outside of GPH to collaborate on various projects around urban health worldwide. The primary goals of this lab are for students: (1) to learn about the role of cities in global health and the role of urban governance in health, including policy approaches both across agencies and in public-private partnerships in the context of the SDGs and UN-Habitat’s New Urban Agenda (2) to develop a network of academic programs, faculty, and students across NYU focusing on urban health; (3) to engage with UN agencies and national/ municipal governments, international and domestic NGOs, urban health researchers, practitioners and policy makers worldwide (4) to develop skills for data collection, analysis and project implementation of priority urban health programs from collaborating organizations; and (5) to build on the platform of the International Society for Urban Health as a global network of researchers, educators, practitioners and policy makers committed to improving health and health equity in cities.

The Global Action for Urban Health Lab provides a platform for both individual and team activities with students from different disciplines and areas of interest from GPH and graduate students from across other NYU schools and programs (e.g., Wagner Urban Planning, Rudin Institute, Real Estate Institute, CUSP, Engineering, Marron Institute, Stern, Journalism, Institute for Public Knowledge, Furman Center, Geography, Department of Population Health at Langone, Tisch School of the Arts, etc.).

Projects for the lab will be proposed by faculty advisors and other faculty in partnership with participating local and global organizations, though individual and small groups of students may develop their own proposals. Each project will have a student lead to serve as the point of contact for the faculty advisor and “client” organization. Opportunities to potentially tie lab activities to student thesis projects or Applied Practice Experiences can be discussed with the faculty advisors.

The lab meets every two weeks and regularly brings in speakers and experts within and outside of NYU.. For more information or if you’re interested in joining the lab, please email [email protected]

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Urban Health

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Urban health is the study of the health of urban populations. More than half the world’s population is now living in urban areas, and two-thirds of the world’s population will live in cities by 2030. This means that characteristics of cities—including, for example, features of the built environment—are shared by a large proportion of the global population. These characteristics ultimately shape how most of us think, feel, and behave; they shape what we eat and drink; and, inevitably, they shape our health. The ubiquity of urban exposures suggests that a full understanding of the features of urban environments that affect health—and how they do so—can unlock the potential for approaches to prevent disease, promote health, and make a substantial impact on the health of urban populations. Studying urban health therefore requires an appreciation both of the urban exposures themselves and the approaches that can inform scholarship in the field. This book combines these with case studies that illuminate the progression of health in cities, aiming to capture the current state of the field while also pushing the field, through holding a mirror to itself, to consider its next decade.

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Doctor of Public Health

Learn to translate knowledge into powerful results as the leader of a public health organization.

For more information on the DrPH Program , please visit our website ( here ). 

The Harvard Doctor of Public Health (DrPH) will prepare you for high-level leadership to make a difference in the fields of public health and health care. This first-of-its-kind, multidisciplinary degree provides advanced education in public health along with mastery of skills in management, leadership, communications, and innovation thinking. This is accomplished within a highly collaborative, small-group learning environment. The DrPH Program is a three-year program (with an option to extend to a fourth year) and during this time, students will learn how to address complex problems of public health policy and use advanced analytical and managerial tools to lead organizational and societal change. You will learn the scholarship of translation, assembling scientific evidence and using it to achieve real results in the field. Also, you will gain hands-on experience working to achieve a specific public health objective under the guidance of Harvard’s world-renowned faculty.

The Harvard DrPH is planned as a 3-year academic program (with an option to extend to a fourth year).  The first two years of the Harvard DrPH involve full-time, on-campus study as part of a collaborative cohort of approximately 9 – 15 students. The academic training will cover the biological, social, and economic foundations of public health, as well as essential statistical, quantitative, and methodological skills you will need to address today’s complex public health challenges, which rarely fall within neat disciplinary boundaries. You will also shape an individualized course of study in your second year by selecting courses to deepen specific areas of expertise and build skills that you will apply during your third year capstone project.

The DrPH Doctoral Project is the culminating experience of the Harvard DrPH degree program, and the primary locus of the knowledge translation elements of the degree. The pedagogical intent behind the Doctoral Project’s design is to provide an opportunity for the DrPH degree candidate to practice and develop personal leadership skills while engaging in a project that contributes substantively to advances in public health or healthcare.  

The optional fourth year are for students who need more time to complete their Doctoral Project.

Your Future

As a Harvard DrPH graduate, you will be ready to lead. You will be equipped with experience gained through real-world case work and field work conducted at a variety of organizations. You will have the skills to possibly start new organizations or work from within to change existing ones. You will know how to translate public health research into effective policies, programs, and initiatives that dramatically improve individual and population health. You will be comfortable in a leadership role and confident in your public health expertise. And whether you choose to pursue a career in a nongovernmental organization, health ministry, government agency, health care provider, start-up, or more established private sector business, you will be prepared to make a difference.

If you aspire to a leadership position in public health—whether at a health ministry, government agency, consulting firm, health-related start-up, established corporation, nongovernmental organization, or international organization—the Harvard DrPH will equip you to meet your goals.

Our Community

As a DrPH student, you will work closely with Harvard’s renowned faculty through rigorous case discussions, simulations, and field experiences in a variety of major public health organizations. You will also collaborate with passionate, highly skilled classmates who bring diverse talents, backgrounds, and creative problem-solving skills to the classroom. The rich relationships you establish during this experience will become lasting sources of collaboration and support, along with the global network you will gain as a member of the Harvard alumni community.

Who Should Apply?

All candidates for admission to the Harvard DrPH should have, at a minimum:

• A master’s OR doctoral degree in the health sciences or in another related field or non-US equivalent.
• At least six years of full-time public health and/or public service experience in a relevant discipline .  Advanced degrees will not be considered in lieu of work experience as coursework will build directly on professional skills and experiences.
• Prior coursework in public health-related methods and in specific technical areas of public health is also beneficial.

Beyond the formal qualifications, we seek top applicants who demonstrate an appetite and vision to effect change, displaying the energy and creativity to have already moved along that path early in their careers. We also explicitly seek to admit students with interest and experience across a broad cross-section of public and private areas of public health and health care locally, nationally, and internationally.

All students admitted to the DrPH program, including international students, should complete the financial aid application process . For admitted students with financial need, 50% tuition scholarships are offered for the first two years of the program.

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Urban Health, PhD

The PhD Program in Urban Health will provide innovative learning opportunities aimed at empowering graduates to work collaboratively across a range of disciplines to generate high quality evidence related to the concerns of individuals and communities, and to generate solutions to improve the health and well-being of diverse populations living in urban centres. This program will be housed in and administered by the Daphne Cockwell School of Nursing (DCSN). The three main domains associated with this program include: 1) health and wellbeing,  which is a “state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity”; 2) safety and security, that is “protecting individuals from critical (severe) and pervasive (widespread) threats and situations”; and 3) migration, immigration, and settlement, which examines the effect of relocation processes on the health and wellbeing of individuals. Graduates of this program will contribute to improving the quality and responsiveness of health and social services to address the needs of diverse populations in urban centres.

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