Extended urbanisation and the spatialities of infectious disease: Demographic change, infrastructure and governance

Emerging infectious disease has much to do with how and where we live. The recent COVID-19 coronavirus outbreak is an example of the close relationships between urban development and new or re-emerging infectious diseases. Like the SARS pandemic of 2003, the connections between accelerated urbanisation, more expansive and faster means of transportation, and increasing proximity between urban life and non-human nature — and subsequent trans-species infections — became immediately apparent.

Our Urban Studies paper contributes to this emerging conversation. Infectious disease outbreaks are now global events. Increasingly, health and disease tend to be urban as they coincide with the proliferation of planetary urbanisation and urban ways of life. The increased emergence of infectious diseases is to be expected in an era of extended urbanisation.

We posit that we need to understand the landscapes of emerging extended urbanisation better if we want to predict, avoid and react to emerging disease outbreaks more efficiently. First, we need to grasp where disease outbreaks occur and how they relate to the physical, spatial, economic, social and ecological changes brought on by urbanisation. Second, we need to learn more about how the newly emerging urban landscapes can themselves play a role in stemming potential outbreaks. Rapid urbanisation enables the spread of infectious disease, with peripheral sites being particularly susceptible to disease vectors like mosquitoes or ticks and diseases that jump the animal-to-human species boundary.

Our research identifies three dimensions of the relationships between extended urbanisation and infectious disease that need better understanding: population change and mobility, infrastructure and governance. Population change and mobility are immediately connected. Population growth in cities - driven primarily by rural-urban migration - is a major factor influencing the spread of disease. This is seen most clearly in rapidly urbanising regions such as Africa and Asia, which have experienced recent outbreaks of Ebola and SARS, respectively.

Infrastructure is also central: diseases can spread rapidly between cities through infrastructures of globalisation such as global air travel networks. Airports are often located at the edges of urban areas, raising complex governance and jurisdictional issues with regards to who has responsibility to control disease outbreaks in large urban regions. We can also assume that disease outbreaks reinforce existing inequalities in access to and benefits from mobility infrastructures. We therefore need to consider the disconnections that become apparent as rapid demographic and peri-urban growth is not accompanied by appropriate infrastructure development.

Lastly, the COVID-19 outbreak has exposed both the shortcomings and potential opportunities of governance at different levels. While it is awe-inspiring to see entire megacities quarantined, it is unlikely that such drastic measures would be accepted in countries not governed by centralised authoritarian leadership. But even in China, multilevel governance proved to be breaking down as local, regional and central government (and party) units were not sufficiently co-ordinated at the beginning of the crisis. This mirrored the intergovernmental confusion in Canada during SARS.

As we enter another wave of megaurbanisation, urban regions will need to develop efficient and innovative methods of confronting emerging infectious disease without relying on drastic top-down state measures that can be globally disruptive and often ineffective. This urges upon urban researchers to seek new and better explanations for the relationships of extended urbanisation and the spatialities of infectious disease - an effort that will require an interdisciplinary approach including geographers, health scientists, sociologists.

Read the full debates paper on Urban Studies - OnlineFirst.