In the United States the cost of health care is increasing faster than the cost-of-living, and huge disparities exist in health outcomes. For example an estimated 28% of the black; 17% of the Hispanic; and 10% of the white population suffers from asthma in the University of Illinois Health Primary Service Area in Chicago. Health outcomes are also affected by homelessness. High population concentrations can make cities more vulnerable to health impacts due to climate change. The physical characteristics of the built environment (such as water delivery systems, building conditions, and materials) affect health outcomes. In many urban areas, some people lack access to green space, safe areas to walk and play in and experience heat island effect. When community cohesion is impacted through population migration to safer areas, jobs, and better housing, the elderly, sick, and poorest people remain without a support system. Strategies need to address the underlying source of health risks.
Public health is becoming an increasing concern both in terms of access to quality care as well educational programs for healthy life-style behaviors. Inner city mortality is higher with lower life expectancy than suburban communities. Improved communication processes, community preventative health programs, and access to quality and affordable health care, are needed.