Urbanization and Resilience

Ronak B. Patel and Thomas F. Burke. 8/2009. “Urbanization - An Emerging Humanitarian Disaster.” The New England Journal of Medicine, 361, 8, Pp. 741-743.Abstract

This paper describes the current rates of urbanization and the developing health consequences framed as a humanitarian crisis. The authors go on to analyze the current state of knowledge and policy on urban health. They lay out the priorities for future research and work and the role for academics, governments and international agencies to prevent the impending deterioration in global health due to rapid urbanization.

Neel Butala, Ronak B. Patel, and Michael VanRooyen. 9/2010. “Improved health outcomes in urban slums through infrastructure upgrading.” Social Science & Medicine, 71, 5, Pp. 935-940. Read PublicationAbstract

This study evaluated the health impact of a public private partnership using microfinance to upgrade slum infrastructure in Ahmedabad, India. The authors show a statistically significant reduction in waterborne illness as a result of the intervention and point to further unmeasured benefits from the upgrade. This is an example of the data driven projects HHI is conducting to lend evidence with operational research on interventions.

Reference: Soc Sci Med. 2010 Sep;71(5):935-40.

Ronak B. Patel, Frederick M. Burkle Jr., Laura Janneck, Amit Prasad, Jostacio Lapitan, and Shada A. Rouhani. 12/2011. “A Blueprint for the Development of Prevention and Preparedness Indicators for Urban Humanitarian Crises.” Prehospital and Disaster Medicine. Read PublicationAbstract

As rapid urbanization creates complex environments that concentrate the risks and hazards of man-made and natural disasters, it also presents a vital advantage that must be exploited. Urban humanitarian emergencies by their very nature occur within the geo-political sphere of a governing body, the municipal government, and as such they are the responsibility of that body. It is the duty of the municipal governments to prevent and prepare for and respoond to humanitarian emergencies that may affect their citizens. Preparedness at the city level, therefore, remains a valuable area for development to mitigate the effects of humanitarian crises. Rapid urbanization now allows a greater proportion of the population to fall under a responsible municipal government and an opportunity to promote and advance urban planning around preparedness.

Ronak B. Patel and Frederick M. Burkle Jr. 7/2011. Urban Health: a 21st Century Crisis .Abstract

This brief report reviews the health concerns that arise with rapid urbanization and confront humanitarian organizations during acute emergencies.  The authors argue that one way forward is for humanitarian organizations to learn from existing grass-roots efforts.

Laura M. Janneck, Ronak B. Patel, Shada A. Rouhani, and Frederick M. Burkle Jr. 3/2012. “Toward Guidelines for Humanitarian Standards and Operations in Urban Settings .” Prehospital and Disaster Medicine. Read PublicationAbstract

Rapid urbanization represents the most significant demographic change of the twenty-first century. 2008 marked the first time in human history that over half of the world population lived in urban settings. The process of urbanization, fueled by economic and social foreces, has particularly accelerated in countries in the Global South. By the year 2050, it is predicted that 70% of the world's population will live in urban settings. 

Ronak B. Patel, David Alejandro Schoeller-Diaz, Victoria-Alicia Lopez, and John Joseph “Ian” Kelly IV. 6/2012. Hope in the Face of Displacement and Rapid Urbanization.Abstract
This study seeks to offer a practical examination of resilience in complex urban landscapes for the academic community and humanitarian actors at the local and international levels. Distrito de Aguablanca (Cali, Colombia), a complex settlement area with some 600,000 residents, functions as a case study in human security and resilience that can inform public policy and community level decision making in especially difficult humanitarian environments, with sociopolitical volatility, large populations of internally displaced persons, and high crime and violence rates.
Ronak B. Patel, John de Boer, and Robert Muggah. 10/2016. Conceptualizing City Fragility and Resilience. United Nations University Centre for Policy Research. Read PublicationAbstract
This paper introduces a preliminary analytical framework that re-conceptualizes fragility and resilience at the city level. It aligns the two concepts across a range of political, social, economic and environmental factors enabling comparison across thousands of cities globally based on existing data. The framework was then partially applied to map out fragility in over 2,100 cities. It finds that roughly 14 percent of the sample score in the highly fragile range. Another 66 percent report average levels of fragility while 16 percent report low fragility.4 Of course, fragility and resilience are both dynamic and change over time. The paper finds that all cities are fragile to some degree, though intensity varies in relation to the aggregation of risk.
Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 1/2017. What Practices Are Used to Identify and Prioritize Vulnerable Populations Affected by Urban Humanitarian Emergencies?. Humanitarian Evidence Programme. Read PublicationAbstract

Individuals and organizations responding to humanitarian crises recognize the need to improve urban emergency response and preparedness – including the need to devise better methods for assessing vulnerability within urban populations. 

This systematic review represents the first ever attempt to systematically search, sort and synthesize the existing evidence in order to consolidate findings on the tools, methods and metrics used to identify and prioritize vulnerable people, households and communities, including those displaced within and to urban areas. It is accompanied by a stand-alone executive summary and evidence brief. It forms part of a series of humanitarian evidence syntheses and systematic reviews commissioned by the Humanitarian Evidence Programme

Ronak B. Patel, Jami King, Laura Phelps, and David Sanderson. 10/2017. “Discussion Informed by Recurrent Lessons from a Systematic Review on Targeting Practices in Urban Humanitarian Crises.” PLOS Currents: Disasters. Read PublicationAbstract

Introduction: Urbanization has challenged many humanitarian practices given the complexity of cities. Urban humanitarian crises have similarly made identifying vulnerable populations difficult. As humanitarians respond to cities with chronic deficiencies in basic needs stressed by a crisis, identifying and prioritizing the most in need populations with finite resources is critical.

Methods: The full systematic review applied standard systematic review methodology that was described in detail, peer-reviewed, and published before the research was conducted.

Results: While the science of humanitarian practice is still developing, a systematic review of targeting vulnerable populations in urban humanitarian crises shed some light on the evidence base to guide policy and practice. This systematic review, referenced and available online, led to further findings that did not meet the pre-defined inclusion and exclusion criteria for evidence set out in the full review but that the authors, in their expert opinion, believe provide valuable insight nonetheless given their recurrence.

Ronak B. Patel and Leah Nosal. 1/2017. Defining the Resilient City. United Nations University Centre for Policy Research. Read PublicationAbstract
This background note is part of the United Nations University project on Resilience and the Fragile City and is meant to complement the paper ‘Conceptualizing City Fragility and Resilience’ (de Boer, Muggah, Patel 2016) which formally presents the fragile and resilient cities assessment framework. As resilience has become a more prominent and pervasive concept, this paper explores its application for urban environments in contexts of fragility (i.e. urban zones characterized by complex crises that often involve high levels of violence, extreme poverty, and disaster simultaneously) (see de Boer 2015). The paper reviews dozens of resilience frameworks and highlights a number of important findings: 1) the majority of existing resilience frameworks are useful for assessing resilience to natural disasters, yet few are effective in understanding resilience in contexts of fragility; and (2) many existing frameworks have yet to be empirically tested and largely rest on a Theory of Change. This means that very few indicators have been independently derived based on empirical data of what works. To fill these gaps, the paper concludes by proposing an approach to assessing resilience in contexts of urban fragility, which is then fully developed in the framework paper mentioned above.
Ronak B. Patel and Kelsey Gleason. 10/2017. “The association between social cohesion and community resilience in two urban slums of Port au Prince, Haiti.” International Journal of Disaster Risk Reduction. Read PublicationAbstract
Multiple recent global agendas have advanced the case for resilience to underpin humanitarian action and disaster risk reduction. These agendas have been incorporated into multiple efforts but evidence to guide action has lagged behind. This study examines a specific link, often cited through qualitative research, between social cohesion and community resilience in two urban slums of Port au Prince, Haiti. Scales to measure social cohesion and resilience are applied to these communities to develop a quantitative measure of these two characteristics. These two characteristics are then analyzed with various other demographic variables of community members to quantitatively explore associations among them. The results show that a higher social cohesion score is statistically associated with a higher resilience score and among the variables tested, social cohesion had the greatest impact on the community resilience as measured by these scales. and shows a statistical association between the two. The findings add to the growing but nascent literature on empirical evidence for resilience characteristics. Further examinations are drawn out of the findings and future investigations should tackle the inductively derived characteristics of resilience to further guide programs and policy.
Beth J. Maclin, Hannah Wild, Nirma D. Bustamante, and Ronak B. Patel. 12/2017. Investigating Gender Based Insecurity & Mobility: Addis Ababa Country Report.Abstract

This study of gender based insecurity in Addis Ababa found that women and girls are vulnerable in public and private spaces at any time to assault and harassment, though they are at greater risk for physical violence, including rape, at night. They sacrifice time, money, education, socializing, and their mental health to mitigate the risks they face moving around their community and the city.
Overall, men commit almost all of the violence described by participants. Much of the insecurity is blamed on unemployed young men that abuse drugs and alcohol. Some also linked unemployment with massive migration from other areas of the country to Addis Ababa. Two cultural factors seem to inform violence against women. First, society normalizes men and boys touching and saying inappropriate things to women and girls, which then leads to increasingly violent forms of abuse. Additionally, limited police response to gender-based violence creates a culture of impunity, which furthers a cultural acceptance of violence against women. Several strategies that draw from participant coping strategies and an analysis of the sources of insecurity can be explored and are detailed at the end of this report.

This formative research seeks to determine the experiences, sources and effects of GBV and GBI among the urban extreme poor of Dhaka, Bangladesh; Port-au-Prince, Haiti; and Addis Ababa, Ethiopia, with the goal of informing the development of a pilot survey instrument to measure the prevalence and impact of GBI in selected urban slums of the same three cities. 

Ronak B. Patel, Beth J. Maclin, Nirma D. Bustamante, and Hannah Wild. 12/2017. Investigating Gender Based Insecurity & Mobility: Multi-City Report.Abstract

Rapid urbanization is the most significant demographic shift taking place. By the year 2050, it is predicted that 70% of the world population will be urban. The urban poor live in a state of chronic crisis and reside in extremely dense informal settlements without basic infrastructure or services. High levels of insecurity are of particular concern. Due to their unofficial status, density, high concentrations of poverty and, often, high turnover, urban informal settlements are either extremely difficult to police or effectively remain un-policed and ungoverned. While all residents of urban informal settlements face significant insecurity and susceptibility to violent crimes, women are especially vulnerable. 

This formative research seeks to determine the experiences, sources and effects of GBV and GBI among the urban extreme poor of Dhaka, Bangladesh; Port-au-Prince, Haiti; and Addis Ababa, Ethiopia, with the goal of informing the development of a pilot survey instrument to measure the prevalence and impact of GBI in selected urban informal settlements of the same three cities. 

Ronak B. Patel. 12/2018. “Precision Health in Disaster Medicine and Global Public Health.” Prehospital and Disaster Medicine, 33, 6, Pp. 565 - 566. Read PublicationAbstract
Current debates about precision medicine take different perspectives on its relevance and value in global health. The term has not yet been applied to disaster medicine or humanitarian health, but it may hold significant value. An interpretation of the term for global public health and disaster medicine is presented here for application to vulnerable populations. Embracing the term may drive more efficient use and targeting of limited resources while encouraging innovation and adopting the new approaches advocated in current humanitarian discourse.

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