Public health experts insist again and again that the zip code is more determinant than the genetic code. The Social Determinants of Health and well-being mark more the evolution of a person than what he inherited from his parents. The neighborhood where you live indicates access to sports areas or exposure to pollution, but also the purchasing power, if you can pay for an exam by a private specialist and if you have a high educational level, you are more likely to enjoy good nutrition and practice sports. Because, in Madrid there are up to ten years of difference in life expectancy between neighborhoods: in some they do not exceed 78 years while in some they reach 88.
We strive to educate each individual and forget that when it comes to public health, thinking in terms of population is essential, "says Bilal
And since it is estimated that in 2050 70% of the world population will live in cities, we are interested in knowing how they determine the health of their inhabitants. This is what the urban epidemiologist Usama Bilal, born in Gijón 32 years ago, wants through a project that has just received two million dollars of funding from the National Institutes of Health (NIH). Bilal's plan, which will last five years, is one of 11 scientists that have received funding throughout the country through a research program aimed at providing independence to young "exceptional" scientists to develop especially innovative projects: "high risk and high reward" jobs, as defined by NIH.
In your case, the plan is to discover what the urban ingredients that affect health in the big cities are and how they interact and that at the moment have not revealed their secrets. "There is a real need to understand the health consequences of this urbanization process and how it can be managed to promote health," Bilal explains by videoconference from Baltimore, a city of which he knows well his social conditioners. The Spanish researcher will form a team of four people who will study numerous factors and health statistics in a gigantic sample of the more than 700 cities with more than 100,000 inhabitants of the United States and ten Latin American countries (Mexico, Guatemala, El Salvador, Nicaragua, Costa Rica, Colombia, Peru, Chile, Brazil and Argentina). A sample of millions of people and their evolution over the past 30 years, to study how the health of citizens changes as cities grow. It is the first time that something like this is going to be done on that scale.
"We will look at factors such as wealth, pollution, wages, housing, kilometers of road per person, but also in others such as criminality or the number of social contacts that take place, which favors the transmission of infections" says Bilal, associate professor at Drexel University (Philadelphia). All these determinants will be crossed with health statistics, such as mortality from different causes, metabolic diseases and other conditions such as depression, substance abuse, smoking, etc., to form a complex mosaic of causes and effects that interrelate in the lives of urbanites .
Bilal believes that there are universal patterns although in each city living in very different cultural, legal and social contexts, such as those that can be found in New York or San Jose in Costa Rica: "Despite these great differences between countries, we believe that they share characteristics, such as the correlation with the salaries of the city or the association between population, pollution and transport ". This young epidemiologist has several working hypotheses, such as that big cities will get worse grades in infectious and cardiovascular diseases, while small cities will get worse stops in accidents. But there are still many patterns that do not know how they will behave and, some, like the influence of food, which is still thinking how to measure it.
"Outside the field of health, we know a lot about how certain decisions made in the cities affect other aspects, such as urban planning in criminality, but we still need to establish this connection with health," says Bilal, trained at the University of Oviedo and later in the US thanks to a grant from the Obra Social of La Caixa. For this, his project aims to provide tools that help identify these phenomena that only emerge in large cities or growing, to mitigate the negative aspects and promote healthy. "Sometimes, we insist on the need to educate each individual to make healthy decisions and forget that when it comes to public health, thinking in terms of population is fundamental and even more fundamental in cities."