Health promotion in the city: a review of current practice and future prospects in the United States.

To achieve its health goals, the United States must reduce the disproportionate burden of illness and poor health borne by urban populations. In the 20th century, patterns of immigration and migration, changes in the global economy, increases in income inequality, and more federal support for suburbanization have made it increasingly difficult for cities to protect the health of all residents. In the last 25 years, epidemics of human immunodeficiency virus infections and substance abuse and increases in homelessness, lack of health insurance, rates of violence, and concentrations of certain pollutants have also damaged the health of urban residents. Several common strategies for health promotion are described, and their relevance to the unique characteristics of urban populations is assessed. To identify ways to strengthen health promotion practices in U.S. cities, lessons have been taken from five related fields of endeavor: human rights, church- and faith-based social action, community economic development, youth development, and the new social movements. By integrating lessons from these areas into their practice, public health professionals can help to revitalize the historic mission of public health, contribute to creating healthier cities, and better achieve national health objectives.