UC Berkeley

Perhaps one of the greatest public health challenges of the 21st century is managing the health of populations in the context of rapid urbanization and the growth of slums in the cities of the global south. Slums are characterized by insecure residential status, poor structural quality of housing, overcrowding, and inadequate access to safe water, sanitation, and other infrastructure. Currently, 828 million people live in slums--growing, living and working in conditions that threaten their health. Demographers predict that in the next 30 years, the urban population in the cities of the global south will double, further compounding the problem. Slum dwellers experience poor health as a result of a complex and intertwined set of social, economic, physical and political factors, a fact underscored by a growing body of research demonstrating health disparities between slum dwellers and their urban counterparts. In order to address the challenge of poor health in slums, global public health practitioners must be prepared to grapple with these complexities, both in terms of analyzing how health is shaped and in terms of responding to the factors that shape health in such places.

In this dissertation, I contribute to a growing body of knowledge focused on analyzing and responding to health in informal settlements. In the following papers, I describe health in informal settlements, drawing from the literature to describe slum specific social determinants of health. I probe deeper into understanding health in slums by using empirical data and employing the relational framework to analyze health in a specific place, the Mathare informal settlement in Kenya. Here, I examine which living conditions matter for health and how, integrating the voices of slum dwellers to better understand how health is shaped. I find that health in slums is a function of complex and interrelated social, economic, physical and political factors. I take a similar approach in exploring microsavings, a potential response to the complex determinants of health in slums. First, I draw from the literature to develop a theory for how microsavings may play a role in addressing health in slums, and delve deeper into how this may occur by conducting a case study examining four microsavings groups in Mathare. I find that microsavings has the potential to build health in informal settlements through five specific pathways: facilitating empowerment, building community, creating information and action networks, amplifying the voice of the poor, and building financial strength.