Third, the city is a contested place. Land tenure, shelter as well as economic development are critical issues and this explains the interest in urban regeneration processes, spatial justice and governance (Baviskar, 2003; Mitchell, 2003; du Plessis, 2005; Marcuse, 2009; Parnell and Pieterse, 2010). Many publications analyze the implications of urban relocations (see Annex Box 6). As already mentioned, formal as well as informal governance arrangements exist within the space of the city. Actors are changing and new actors are appearing, with an increasing role for civil society and the influence of big, powerful, corporate actors including transnational corporations (Williams, 2001; Appadurai, 2001; Bassett et al, 2002; Smith, 2004; Balbo and Marconi, 2006; Caldarovic, 2008; Chu, 2008; Das, 2009). Rationalities, structures, mechanisms, power resources, interests as well as agendas may differ (Pierre, 1999; Cowen & Bunce, 2006; Bevir, 2006). What becomes clear is that the different forms of governance and the way they are exercised are closely linked to (multi-level) political processes (Naerssen and Barten 2002).
The review found that the linkage between governance practices and health equity is under-researched and/or has been neglected. A search in Web of Science (1975-January 2010) PubMed (1975- November 2009) yielded very few peer-reviewed articles; few articles were related to the theme and even fewer based upon research findings18. Not surprisingly, most articles refer to large cities in advanced capitalist countries. Governance practices are dynamic, complex and comprehensive processes, embedded in a context; these develop and act at many levels, and therefore defy the capacity of traditional evaluation methods. In addition, health equity is a complex concept and the difference with health inequalities is often not well understood. In some languages there is only one word for both concepts. Also, information systems in many low and middle-income countries have often not yet incorporated identification of the living conditions and health status of populations living in large, unplanned and informal settlements.
Water and Sanitation: An analytical lens to examine governance and health equity
Unequal access to water and sanitation has historically been a leading cause of urban health inequalities. Still today, household piped water and sewerage connections are the privilege of a minority in the urban centres of most low and many middle-income cities (Heller, 2009; Nilsson & Kaijser, 2009; Torregrosa & Jimenez, 2009; Muradian et all, 2009). For water,
18 Also few publications were found in searches that combined the concepts “healthy cities” and “urban governance; or “healthy cities” and “health equity”.