The Built Environment and Health Comorbidities in Urban Informal Settlements: Mechanisms, Evidence, and Interventions

Abstract

The built environment, encompassing housing quality, sanitation infrastructure, neighbourhood characteristics, and urban design, is a fundamental determinant of health and plays a critical role in shaping the burden of chronic diseases and multimorbidity in urban populations, particularly in informal settlements of low- and middle-income countries. This paper examines the complex relationships between built environment characteristics and the development of comorbidities (multiple coexisting chronic conditions) in residents of informal settlements. Drawing on extensive empirical evidence from diverse geographic contexts, we explore how poor housing conditions, inadequate water and sanitation infrastructure, environmental hazards, and neighbourhood disadvantages create pathways to chronic disease development and multimorbidity. The paper identifies key mechanisms linking built environment factors to comorbidity burden, including biological pathways (disease exposure, stress physiology), behavioural pathways (reduced physical activity, unhealthy food consumption), and psychosocial pathways (chronic stress, depression, social isolation). We examine evidence on housing conditions, neighbourhood safety, green space access, and environmental quality as determinants of comorbidity patterns. Finally, we propose integrated interventions addressing built environment improvements as a strategy for reducing comorbidity burden and health disparities. The paper concludes that addressing built environment deficits is essential for reducing the disproportionate burden of multimorbidity in informal settlement populations globally.