This research will address the interconnected challenges of rising urbanisation and vulnerability to infectious disease. From acute epidemics to slower onset issues such as antibiotic resistance, the world is facing a resurgence of infectious disease challenges. Far from being a thing of the past, these diseases have the potential to spread extensively in densely populated urban settings and to ‘go global’. A major implication emerging from crises like Ebola (2014-15) and Zika (2015- 16) is that dramatic inequities and pockets of severe neglect in public health standards leave us all vulnerable. Though their burdens fall most acutely on the poor, they also increase the potential for unmanageable crises with broader demographic impacts. Of particular concern are rapidly growing urban settlements which have played a role in exacerbating recent epidemics and where sanitary conditions pose an increasingly intractable challenge to health and development in many cities across the world.
The majority of the world’s population already live in urban environments and numbers are predicted to rise dramatically. A large and growing proportion of these urban residents live in informal slum-like settlements. We know very little about how health systems are organised in these rapidly changing contexts, except that they are highly informal and old rules and approaches do not apply. The Ebola epidemic in particular revealed glaring gaps in evidence and understanding of these environments and populations, with fatal consequences. Indeed, it revealed there were pervasive misunderstandings and misrepresentations in policy circles which make interventions for both epidemic control and for basic public health difficult. Yet Ebola has also created a window of opportunity, both to understand the health challenges in informal settlements better and as the impetus to do things differently.