Slum Health: From the Cell to the Street

Slum Health: From the Cell to the Street. Jason Corburn and Lee Riley, eds., Oakland: University of California Press, 2016, 315 pp.

Slum Health: From the Cell to the Street, edited by Jason Corburn and Lee Riley, is a passionate appeal for providing better health care to residents of the world’s poorest urban communities. Using a bold mix of quantitative public health methodologies, as well as social theory, the editors and contributors describe why the health of poor urban residents is often worse than that of their wealthier neighbors; how their health is shaped by the material details of their living conditions as well as by socio–political structures of sentiment and practice; and why residents themselves must be involved in improving what the authors refer to as “slum health.”

Early on in the book’s Introduction, the editors remind their readers of the growing relevance of urban health and, in particular, of urban poor populations to all practitioners and scholars of health. As of 2015, the majority of the world’s population lives in cities, and the majority of urban populations are slum dwellers. The slums are, in a strictly empirical sense at least, becoming us. But rather than reify 19th-century Dickensian narratives that draw an unrelentingly bleak portrait of urban poverty, Slum Health aims to publicize the innovative solutions that the urban poor have already fashioned to promote the health of their families and communities and to amplify these solutions using state-of-the-art epidemiological and public health techniques and methodologies. Ultimately the editors’ use of the word slum is defiant and works in the tradition of repurposing pejorative monikers as a form of empowerment.

The volume’s geographic reach is limited. It draws from specific case studies conducted in the cities of Salvador (Brazil) and Nairobi (Kenya). A final set of chapters on urban India combines quantitative data sets to describe the health inequities experienced by the urban poor as well as the results of water supply and sanitation improvements in the city of Ahmedabad. The editors’ insistence on discussing urban health in the context of these particular cases is extremely rewarding; rather than a fuzzy outline of urban health problems, readers come away with multiple and detailed illustrations of one of the book’s core themes: how social, economic, and political forces (what the editors call the Street) can transform the biology of disease (referred to as the Cell). For medical anthropologists and their intellectual kin, such a claim may be preaching to the choir, but it is refreshing to see it backed up by reams of statistically significant data.

An example of the importance of Street/Cell interaction is found in Chapter Eight, by Sara Y. Tartoff and several coauthors, who describe a cross-sectional study of group a streptococcus (GAS), otherwise known as strep throat. The authors track strains of GAS at three pediatric clinics in Salvador, ultimately taking data, including throat swabs, from 2,194 children. Prior research has demonstrated that developing countries have a higher diversity of GAS strains than developed countries, but it was generally assumed that at the city level, the number of GAS strains would be relatively homogeneous. The authors demonstrate that even within one city, there is considerable variation with regard to the number of GAS strains, and that poorer neighborhoods, just like poorer countries overall, have a much higher level of strain diversity. The contributing factors to GAS strain diversity have long puzzled researchers, but Tartof et al.’s research on the contributing factors to GAS strain diversity highlights the crucial role that local epidemiological data can play in identifying meaningful patterns and categories. By shifting attention away from broad categories such as “developing country” and toward environmental–economic factors, including housing density and porous building material, public health resources might ultimately be allocated more effectively.

Chapter 9, “Co-producing Slum Health in Nairobi, Kenya,” by Jason Coburn and Jack Makau, takes on the topic of “co-producing knowledge.” Widely used by medical anthropologists and science studies scholars, here co-production is used to illustrate how, over the history of Nairobi’s development from the colonial period through independence, authorities used health justifications to segregate Nairobi’s population. Current partnerships among slum residents, nongovernmental organizations and academic entities have continued this process of co-producing knowledge, but are now working together to redress historic health inequities. The historical portrait of co-produced knowledge is crucial because it demonstrates the danger of assuming a priori the inherent morality of co-produced knowledge. Rather, with whom and to what ends knowledge is being coproduced is paramount.

In this long and detailed chapter, the authors demonstrate a remarkable list of efforts undertaken by a wide range of actors, including international NGOs, governmental officials, university professors, and community leaders, to improve the infrastructure of a Nairobi slum. These include proposals for upgrading roads, drainage, water, sanitation, and electricity. The authors are careful to detail the shifting strategies the NGOs used as the projects got underway. Chapters such as this could be used as a rough blueprint for community organizers around the world as well as a demonstration of the intricate work being done on behalf of and by residents of urban poor communities in their struggle to achieve health, and to reassert agency in their lives.

The only downside of the volume’s case study approach is that nearly every chapter is prefaced by repetitive summaries of ubiquitous concepts such as global urbanization, urban poverty, and the health challenges faced by low-income residents. Readers of Medical Anthropology Quarterly are unlikely to turn to the book for new theoretical insights, but they should find novel the explicit linking of concepts such as “structural racism” or “embodiment” to data-driven public health frameworks. Advanced undergraduates and graduate students in a wide variety of disciplines (anthropology, sociology, epidemiology, and public health) will find multiple chapters based around case studies of particular communities that could be used as stand-alone discussion points. Ultimately, the editors’ conviction in convening Slum Health: From the Cell to the Street is resoundingly clear: Scholars of all stripes have a responsibility “to recognize the human right of the urban poor to lead a healthy life and to offer some strategies toward this goal” (p. 3). This volume moves us forward on both counts.