Health promotion in the city: A review of current practice and future prospects in the United States

To achieve its health goals, the United States must reduce the disproportio nate burden of illness and pour health borne by urban populations. In the 2 0th century, patterns of immigration and migration, changes in the global e conomy, increases in income inequality, and more federal support for suburb anization have made it increasingly difficult for cities to protect the hea lth of all residents. In the last 25 years, epidemics of human immunodefici ency virus infections and substance abuse and increases in homelessness, la ck of health insurance, rates of violence, and concentrations of certain po llutants have also damaged the health of urban residents. Several common st rategies for health promotion are described, and their relevance to the uni que characteristics of urban populations is assessed. To identify ways to s trengthen health promotion practices in U.S. cities, lessons have been take n from five related fields of endeavor: human rights, church- and faith-bas ed social action, community economic development, youth development, and th e new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic m ission of public health, contribute to creating healthier cities, and bette r achieve national health objectives.