Urban Inequalities: Measuring, Forecasting, and Understanding Human Health Implications

Date of Award

Spring 2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Forestry and Environmental Studies

First Advisor

Seto, Karen


Urbanization, inequality, and human health are three of the biggest challenges facing society. Demographic projections from the United Nations suggest that the number of people living in urban areas will increase by ~200,000 every day, on average, between now and the middle of this century. A recent report suggests that inequality is rising in countries where 70% of the global population lives. The COVID-19 pandemic has amplified the significance of these challenges and points to an intricate interlacing between urban areas, inequality, and human health. This research is motivated by a pursuit to understanding how. It examines a central proposition that inequalities can be intertwined with urbanization and are not necessarily an outcome of urbanization. Further, it studies the human health implications of the intertwining. This dissertation presents three papers that cumulatively examine the structure, dynamics, and human health implications of urban inequalities through an infrastructure lens. The first paper develops and applies an inequality measure to infrastructure distributions in India (a rapidly urbanizing country) and South Africa (a more urbanized and more unequal country), using a comparative methodological framework. It uses spatially-detailed census and satellite remote sensing data to measure inequalities across spatial scales, i.e., national to city level. The second paper studies the nature and dynamics of infrastructure inequalities and forecasts inequality levels under five shared socioeconomic pathways (SSP). It leverages a twenty-year historical record of satellite remote sensing data to measure sub-national within and between regions inequalities across countries and over time. Finally, it uses a machine learning-based forecasting model to predict future inequality levels. The third paper focuses on India and asks how multi-dimensional urban inequalities associate with health inequalities based on infant mortality, child mortality, under-five mortality, diabetes, hypertension, and COVID-19 case counts. Specifically, it analyzes how spatial variations in multiple urban dimensions (infrastructure, economic, human mobility, and demographic) associate with multidimensional health outcomes. Four key findings emerge from this dissertation. First, I find that infrastructure inequality is inherent to urbanization. The comparative analysis results characterize urbanization in India and South Africa with fewer winners and more losers in terms of accumulating infrastructure—including basic infrastructure provisioning. Still, urban inequalities are greater in South Africa than in India. Second, a positive long-run association exists between infrastructure inequalities—measured from satellite remote sensing—and urbanization (urban share of the total population). Third, inequality forecasts across SSPs suggest more significant increases in infrastructure inequalities in the Global South, where inequalities will rise more than in countries in the Global North. Between countries in the Global South, inequalities will rise more in countries with significant urban primacy than otherwise. Fourth, compared to spatial differences in urbanization levels, multiple urban dimensions better predict health outcomes—multi-dimensional urban inequalities underpin human health. Understanding urban inequalities are necessary if we are to understand the human health implications of urbanization. The strong urbanization-inequalities intertwining evidenced in this dissertation suggest that even when urbanization contributes to advancing overall development outcomes, it does so by promoting unequal conditions—such as the unequal distribution of infrastructure. We will have more significant inequalities with fewer winners and more losers in a more urban world. Keeping this emergent inequality in check requires inequality-suppressing mechanisms and emphasizes the role of equity-promoting institutions. As countries in the Global South rapidly urbanize, the importance of inequality-suppressing mechanisms will increase.

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