Urban Crisis: Public Health at the Intersection of Economic and Social Change

Cities are experiencing increasing negative health effects stemming from austerity including rising rates of illicit drug use, disease transmission, and lowered life expectancy. Multi-sector decision making processes come into play during crises such as the opioid overdose crisis or the Covid-19 pandemic. But how do these processes, policies and practices shape urban public health and care? Urban Crisis: Public Health at the Intersection of Economic and Social Change investigates how intersecting crises, including economic, social, and public health crises, shape local governance of health and social care in cities. The research focuses on Athens, Manchester, and Santiago, examining how state-led restructuring has transformed urban public health and social service systems, both within formal institutions and across broader governance networks. It focuses on identifying the ways that local government innovates around access to health and social care for marginalised communities. The project has developed a robust comparative framework identifying key moments of policy change, institutional reform, and community response, highlighting how municipal governments navigate crises linked to austerity, inequality, and in turn produce governance innovation. The renewal phase aims to build on this foundation through three complementary objectives: Enhancing the Dataset, Cross-City Comparative Analysis, and Stakeholder Engagement and Knowledge Translation. First, the project will refine and expand its existing data from the three case cities, incorporating new policy documents, local government reports, community feedback, and observational studies. This enriched dataset will allow for a more nuanced understanding of how urban populations, particularly those in low-income communities, experience intersecting crises, and how state-led restructuring shapes the availability and accessibility of health and social services. Second, the research will extend to three additional cities, Glasgow, Rome, and Bogotá, enabling a richer, multi-sited comparison. This cross-city approach will explore how diverse political, economic, and cultural contexts influence the governance of urban crises, the sustainability of care services, and the innovation of local responses. By linking these new sites with the original three, the project will generate a trans-urban analysis that traces how ideas, practices, and policy frameworks circulate, adapt, and are contested across different urban systems. This comparative lens will identify both shared patterns and context-specific divergences in crisis governance. Third, building on strong partnerships established in the first phase, the project will continue to collaborate with municipal authorities, NGOs, and community organisations. Recent activities include workshops, public panels, and a tri-city knowledge exchange in Athens involving over 100 participants. These collaborations ensure that research findings are translated into actionable policy insights, while supporting community-led capacity to navigate health and social care challenges. To date, the project has completed fieldwork, conducting 240 interviews across the three cities, and has developed a novel methodological approach to Policy Mapping for tracing how policy is formed, debated, and implemented at multiple scales. Findings to date highlight long-term urban transformations under crisis conditions, including displacement, spatial reorganization of services, and changes to community infrastructure. The fellowship renewal will advance understanding of urban crisis governance by integrating robust comparative data, extending cross-city analysis, and deepening stakeholder partnerships. It will generate evidence to guide policy and practice, strengthen local capacity for innovation in public health and social care, and contribute to a global understanding of how cities respond to intersecting crises.