The threads that connect us: Epidemiological logistics ecologies of extended urbanization

Abstract

A crusader for the margins, Roger Keil went as far as calling planet Earth ‘suburban’ in his book Suburban planet: Making the world urban from the outside in. This iconoclastic and heretical take on the ‘urban’ is not just an attempt to be intellectually provocative; it is a call to look at the world from a different angle, from the ‘outside in’, starting from those places that have been dismissed as secondary, peripheral, and parochial. It is also a call to see suburban and extended urbanization as an ongoing planetary process that we cannot ignore. In this article, we examine how the ideas developed through the frameworks of extended urbanization and urban political ecology help develop new insights for understanding global health (antimicrobial resistance) and critical logistics (the port–city interface).

Introduction

A crusader for the margins, Roger Keil (2018b) went as far as calling planet Earth ‘suburban’ in his book Suburban planet: Making the world urban from the outside in. This iconoclastic and heretical take on the ‘urban’ is not just an attempt to be intellectually provocative; it is a call to look at the world from a different angle, from the ‘outside in’, starting from those places that had been dismissed as secondary, peripheral, and parochial. It is also a call to see sub/extended urbanization as an ongoing planetary process that we cannot ignore. In this article, we examine how the ideas developed through the frameworks of extended urbanization and urban political ecology (UPE) help develop new insights for understanding global health (antimicrobial resistance (AMR)) and critical logistics (the port–city interface).

Starting from Keil's contention that the ‘urban centre’ need not be (or should not be) the centre of attention, we aim to refine the idea of ‘extended UPE’ by bringing together Keil's focus on the periphery and UPE's ongoing contributions. In fact, although Keil called for moving beyond the ‘urbanization of nature’ thesis and paying more attention to infrastructures, logistics, and ‘extended UPE’ (Tzaninis, Mandler, Kaika and Keil, 2020), the concrete analytical value of logistics for extended UPE remains under-specified; this paper addresses that gap. By situating Keil's arguments within the field of critical logistics, we propose that logistics offers an analytical and material entry point into how extended urbanization is organized and lived. Critical logistics can make visible the infrastructural and metabolic circulations through which urban life extends beyond the city and into the planetary.

We specifically draw inspiration from two recent papers. First, Matthiessen's (2025) paper in the UPE journal in which, drawing insights from critical logistics, she moves beyond the dichotomy of planetary versus situated UPE. Second, Aguiar et al. (2024b) mobilize Keil's concept of extended urbanization to examine AMR as a process shaped by extended and planetary urbanization and socioecological inequities, illustrating how UPE can inform the urban dimension of global health governance. Building on this work, we consider supply chain infrastructures not as peripheral appendages but as constitutive sites that reconfigure urban metabolisms by governing port logistics and hydrosocial cycles, or by shaping pathogen ecologies and concentrations of microbial diversity. We ask: how can the notion of extended UPE help theorize the entanglement of global health and the port–city interface? We exemplify this question by focusing on two contemporary phenomena related to extended UPE: the changes in the port–city interface in the region of Antwerp in Belgium, and the spread of AMR, in tandem with the One Health (OH) approach. Thus, in this article, we extend Keil's contributions conceptually by proposing a framework of ‘epidemiological logistics ecologies’, a way to theorize how critical infrastructures mediate socioecological risks and global health vulnerabilities in extended urbanization.

In the following sections, we first lay out UPE thinking on extended urbanization, with a particular focus on Keil's work and its implications for scholarship in the field. We then bring an extended UPE approach to an analysis of the port–city interface and global health by focusing on the port of Antwerp and OH. We conclude with insights that can potentially advance the study of extended urbanization, UPE, global health, and critical logistics. We should note that while Connolly and colleagues explore urbanization and infectious disease in this special issue, we focus specifically on linking the port–city interface and OH through critical logistics, while extending Keil's work on global health towards infrastructures of circulation and exposure.

Urban political ecologies of a suburban planet – the importance of critical infrastructures

For over three decades, UPE has developed theoretical and methodological insights to examine the power relations involved in sustaining or disrupting the metabolic processes involved in the urbanization of nature. Within this rich empirical and theoretical engagement with processes that transcended the nature/culture, human/nonhuman, and urban/rural binaries, Keil was an early and influential voice insisting and demonstrating that peripheral spaces, voices, and practices demand at least as much analytical attention as those of the centre (Keil, 2018b). Contributing to, building on, and relating to foundational UPE scholarship (Gandy, 2003; Heynen et al., 2006; Kaika, 2005; Swyngedouw, 2004), Keil emphasized the need to address the political ecologies of planetary suburbanization and peripherality, suggesting a UPE of extended urbanization. This idea pushes back against the understanding of suburbs as passive backdrops to urban life or appendages to cities, and reconceptualizes the suburbs as vibrant, contested spaces where social and environmental struggles play out in ways that not only demand expanded and critical scrutiny, but can also be politically transformative.

As critical infrastructures – ports, roads, pipelines, energy grids, etc. – become an increasingly crucial aspect of the practice and governance of planetary extended urbanization, Keil's (2018c: 1954) provocation that ‘[t]he emancipatory potential of the urban planet lies in fact in the periphery’ becomes more relevant than ever. Infrastructure building and function are deeply political and always shaped by power struggles over location and access, especially in the context of the ‘in-between city’ or the ‘not quite traditional city and not quite traditional suburb’ (Young & Keil, 2010). Infrastructures are not just conduits of urban life, they are sites of struggle, contestation, and uneven development (Kipfer and Keil, 2002).

Connecting UPE with infrastructure scholarship, Keil urges colleagues to look at suburban environments not as settled, fixed landscapes but as dynamic, contested realms where environmental injustices and political conflicts are constantly unfolding. These interventions help us situate the paper's empirical sections on the port–city interface and the OH approach. The discussion that follows is based on the authors’ research on how port operations affect local communities and ecologies, and on global health governance and the OH initiative.

Urban political ecologies of the port–city interface

The UPE framework on extended urbanization offers new tools for analysing extended and peripheral infrastructures (Connolly et al., 2021, Menon, 2025). This framework can be readily applied to a reconceptualization of ports as peripheries within a broader system of global trade, and as infrastructures which are at the same time both central and unseen, as they are physically positioned at city edges. Ports can be paradoxical spaces: fixed yet defined by constant movement, invisibilized in their daily operations yet profoundly shaping processes of urbanization (Cowen, 2014). The port interfaces with the city as a spatio-temporally fixed ‘terminal’ in the circulation of goods, people, and information, but also of disease, waste, and all sorts of ‘undesired’ others of human and other-than-human form. The port is a ‘terminal landscape’ (Diamanti, 2023) where accumulation unfolds not in dramatic ruptures but through relentless flows and environmental transformation. These processes enact a form of quiet, ‘slow’ violence through pollution, displacement, and ecological degradation, a violence that remains largely unnoticed (Nixon, 2011), often precisely because it lies outside the cognitive map of urban dwellers. Yet, slow violence is not always ‘out of sight’, since, as Davies (2022) argues, invisibility is relational, highly visible to frontline communities, yet made invisible by logistical and regulatory practices. In any case, slow violence is absorbed into the rhythms of global commerce, the massive influx of commodities, and the creation of wealth, at least for some (Davies, 2018; Marks and Miller, 2022).

A synthesis of slow violence and Keil's notions of fragmented urbanization and the ‘in-between city’ (Young and Keil, 2010) helps us interpret ports as what we might call peripheral cores, spaces that are simultaneously marginal in their geography yet central in shaping metabolic and political life. Following Keil's emphasis on fragmentation and infrastructural politics, the port can be read as one of those disjunct fragments (2018a) that link global capital flows to local ecologies, generating environmental vulnerabilities. Through this lens, Antwerp's port is not simply a logistics hub but an urban fragment where global urbanization's contradictions, like control and vulnerability, circulation and stasis, materialize. As Keil (2018a: 505) points out:

The shifting of capitals from the overproduction of global city centres such as Dubai, London, Singapore, and Toronto to the expanses of the everywhere – must not necessarily lead to spiky urbanity in the core. It might just as well lead to the flattening of the peripheral city where those capitals are being deployed. Morphology is less important here than directing investment and development away from the classical over accumulated centres, even though the expansion into the region might entail new verticality everywhere.

The port of Antwerp in Belgium is amongst the largest and busiest in Europe. It spreads across an area of the city's northern periphery. A significant expanse of over 140 km2 compared to Antwerp's 205 km2 spread. The port's landscape, shaped like colossal fingers of water stretching into land, is morphologically expanding the city proper into the periphery while at the same time encroaching from the river into the urban, the polders, and the agricultural land. The Antwerp port is an exemplary case of a logistical node that is ‘of the city without being in the city… a site multiple that resists the dichotomy of the planetary and the everyday’ (Matthiessen, 2025: 19). Its operations involve dredging, sediment/water movement, and industrial activities. But they also intersect with ecological and health exposures (pollutants, potential microbial and virus reservoirs). At the heart of this system is the river Scheldt, which begins in Gouy, a small French village in Normandy, and flows through France, Belgium, and the Netherlands before reaching the North Sea. But the Scheldt is more than a natural body of water; it has become an entirely urbanized construct, its flow disciplined and engineered to serve trade and capital. The river is both crucial and adversarial, a conduit for inland transport and an unruly force requiring perpetual management and ‘taming’. Drawing on Keil's insights into the politics of urban metabolism, we can read the pollution and hydrosocial manipulation in Antwerp as symptoms of extended urbanization, forms of slow violence that redistribute ecological costs to peripheral spaces. Acts like dredging, redirection, and controlled flooding expose the governance of the river's hydrosocial cycles, where water is not merely a natural resource but a political material, shaped by capitalist imperatives (Swyngedouw, 2009). The river's banks, its soil, and the sediment it carries are not passive elements but active components in a broader assemblage of ecological process, urbanization, and capital accumulation. Following Keil (2018a: 506):

more attention needs to be paid to the articulation of what Lefebvre has called the “disjunct fragments” of the urban explosion. This interest in these fragments leads, at a minimum, to a qualification of the view from the centre. The multiple processes of extended urbanization come into relief this way, and the “fragments” are jointed into new constellations of understanding that are geographic, economic, social, and ecological. These constellations are now global in reach and interconnectivity.

In Antwerp, the ‘geographic, economic, social and ecological constellations’ are part and parcel of the disjunct fragments that the port generates. The port produces tensions between its own invisibilized infrastructure and how its operations affect urban life. As the port has expanded multiple times, the expansions exemplify the materialization of urbanization and capitalism through infrastructure. Locks, as engineered thresholds, do not merely regulate water levels but structure movement itself, imposing a logic of control, efficiency, and flow with minimum interruption. The locks, along with the docks and terminals, embody the abstract space of logistics, a domain governed by efficiency and global connectivity, and are disconnected from local everyday life (Cowen, 2014; Matthiessen, 2025). In fact, the relentless expansion of the port affects historically rooted communities, creating perpetual tension and struggle between the bureaucratic spatial logic of state and capital planning, and the social, cultural, and political dimensions of everyday life. As Keil (2020b: 1130) points out, ‘if we saw the extended city, the periphery, the peri-urban, the suburban as a historical landscape with layered geography, we would be closer to the truth as we begin the fixing. Much of what we see in today's urbanizing world imprints itself onto agricultural and otherwise traditional and used landscapes’. In the case of Antwerp, these struggles extend from the city itself to the surrounding communities on both river banks and the ecologies that surround and encompass the port. In other words, they extend through the port–city interface. As the port's influence extends beyond its physical footprint, and although it has no typical urban everyday life, it conditions urban life in countless ways: chemically, through pollution in water and air, materially, through traffic and noise, socially, through displacement and illicit economies, and politically through fragmented governance, as it falls into complex political configurations of diverse interests, i.e. shipping companies and industries, labour, and government. Meanwhile, as Keil (2020b: 1134) reminds us: ‘rather than pinning our current environmental predicament on all of humanity, there are reasons to single out the constant search in capitalism for cheap labor and nature as the main driver of the problems the planet faces today’.

Part of the power in port politics lies in the port functions’ ability to shape landscapes, governance, and urban life without being overtly perceived as an active force. Though it is perceived as an abstract space of logistical flows and as a periphery, it is nevertheless a periphery that strongly defines the centre. In the case of the UPE of the Port of Antwerp, its expansions, material flows, and governance structures transform landscapes and lives. It is by examining the invisible parts of the city – namely, resource flows, historical and contemporary land struggles, and the infrastructures of control that mediate water, soil, and space – that UPE and Keil suggest we can see the ongoing processes of dispossession, metabolic shifts, and spatial abstraction that define ports relationships with their respective cities (Ryckewaert, 2010; Ng et al., 2014). Ultimately, port–city interfaces appear as logistic infrastructures of exposure.

Such a conceptual direction demonstrates the value of reading ports through Keil's extended urbanization and UPE. Rather than treating Antwerp as simply an illustration, the port becomes the analytic lens through which we test and sharpen Keilist ideas about peripheral centrality, metabolism, and fragmentation. This reorientation delivers two theoretical payoffs. First, it extends Keil's decentring claim into a circulatory ontology that focuses on flows and nodes rather than solely territorial forms; second, linking extended urbanization and infrastructure reveals risks to OH, like microbial ecologies and AMR selection pressures, therefore expanding UPE's capacity to engage with political and metabolic dimensions of OH governance agendas. In other words, an Antwerp-grounded extended UPE treats the port as a laboratory of planetary urbanization, a place where capital's demands for throughput meet ecological thresholds and where social struggle over land, labour, and health are materially mediated through logistics. By sharpening the conceptual and methodological implications of Keil's work in this way, UPE can help understand how infrastructures reorder environments and social relations, and where certain politics might break the logics of dispossession and slow violence.

Bringing together the lenses of critical logistics and extended urbanization gives us conceptual and methodological tools to examine how port expansions or the development of industrial hinterlands are logistic operations that can bring pollution, sediment disturbance, or generally affect hydrosocial flows related to urbanization. And, as we explore further in the next section: how logistic decisions and interfaces increase exposure to risk of health and beyond; and how power relations involved in critical logistics shape risks, and how these risks are mitigated and at which scale.

Urban political ecologies of global health

Roger Keil's contributions to UPE have been instrumental in exposing the urban dimension of global health. By unsettling notions of urbanization, he set the stage and charted the path for more critical and productive engagements with the urban dimension in global health, long before the COVID-19 pandemic made such discussions necessary and even fashionable (Ali et al., 2023, Kaika et al., 2022; Keil and Ali, 2007; Tzaninis et al., 2020). Exploring urbanization as a ubiquitous political, economic, and socioecological process, occurring at various scales, in extended and concentrated forms, produced an epistemic and methodological shift that enables UPE to serve as an interpretive frame that reveals overlooked dimensions of nature–society relations characterizing systemic risks related to global health.

Keil's work helped us understand how AMR and infectious diseases emerge through urban metabolic flows and socioecological interdependencies shaping urbanization. Extended urbanization – informal settlements, infrastructures of livestock and agro-industrial production and circulation – is no longer the fringes of a completely urbanized world; they become important sites within a globalized network of political and socioecological processes constituting the planetary fabric that expands urban society, increasing vulnerabilities to emerging and resistant pathogens (Aguiar et al., 2025; Treffers et al., 2021; Brenner and Ghosh, 2022; Gandy, 2023). This insight emphasizes the capitalogenic limits of urban development entangled with biodiversity loss, climate change, global inequalities, and biosecurity discourses and practices that ignore local concerns and the wider context of global health risks (Aguiar et al., 2024b; Keil, 2020b). Aguiar et al. (2024a) expand further this framework empirically by engaging with issues of AMR and extended urbanization.

In The Urban Political Ecology of Antimicrobial Resistance (2024), Aguiar, Keil, & Wiktorowicz bridge UPE and OH approaches, offering a framework to explore how AMR is linked to environmental degradation, climate change, urban infrastructure provision, food production systems, and global health inequities. The authors explore OH approaches to address AMR and its interdependent systemic threats through a UPE lens that considers how planetary and extended urbanization processes shape these risks. Suggesting UPE as a framework for practical sustainability politics and human–nature relationships, these contributions suggest reframing AMR governance as a socioecological approach that must contend with planetary and extended urbanization forces increasing epidemiological risks and must be integrated within OH approaches emphasizing health and well-being of humans, animals, and the environment. These groundbreaking articles bring together major global concerns like public health (in light of the COVID-19 pandemic), and the urban (in light of massive sub/urbanization), and set the stage for future research on UPE, around the question of how we revisit OH through supply chains, terminals, and logistics?

As an integrated framework that connects the human, animal, and environmental health through intersectoral and transdisciplinary collaboration, OH through a UPE lens becomes a governance framework that foregrounds equity, sustainability, community, and local agency in the management of socioecological risks in extended urbanization forms and processes. OH approaches often conceptualize interfaces between humans/non-humans and the environment but sometimes fail to sufficiently locate logistic infrastructures as core nodes of exposure and transmission. For example, international supply chains may cross regulatory jurisdictions, while logistic delays may mask microbial risk, or surveillance might focus on hospitals or industrial farms but ignore transport hubs. By employing Keil's work on extended urbanization, we can frame logistic nodes as peripheral ‘risk centres’: peripheral spatially but central in terms of potential exposure and governance. What critical logistics suggests through these nodes is that waste flows and their unequal regulation are invisibilized, while distances are abstracted. Logistic hubs such as ports can indeed act as transmission vectors for pathogen spread, creating not just movement of goods but movement of microbes and waste. Critical logistics therefore urges us to locate the points where exposures emerge (loading zones, ballast water discharge, waste disposal) and focus on which parts of the system are of high risk and/or under-regulated. Ultimately, we can use critical logistics to see how governance and surveillance in OH might miss or underplay these crucial nodes. Bringing the port–city discussion into dialogue with global health allows us to see ports as epidemiological infrastructures, material assemblages that choreograph both circulation and contagion. Keil's framework helps us understand how these logistical peripheries mediate urban metabolisms of risk: the same infrastructures that enable connectivity and trade also redistribute pathogens, chemicals, and resistant microbes. A critical logistics perspective, aligned with Keil's extended UPE, thus foregrounds ports as sites where health, infrastructure, and capital intersect, producing uneven geographies of metabolism and exposure.

Conclusion; a call for epidemiological logistics ecologies of extended urbanization in global health

This article forms a first attempt to explore an integrated extended urbanization UPE framework for researching, understanding, and intervening at the interface of critical logistics and OH. We call here for the need to bring together OH and critical logistics research and policy agendas, and to explore how an extended urbanization UPE framework can give us the methodological and epistemological tools to do so. Such an agenda needs to move beyond the ‘urbanization of nature’ approach and address the fragmented and overlooked local dimensions of current OH and critical logistics approaches. Such an agenda foregrounds equity and environmental considerations within the human-other-than-human–environment interface, challenging modernist views that position nature and society as ontologically separate domains, and illuminate how imbalanced nature–society relationships engender global health threats (Aguiar et al., 2025; Kaika et al., 2022).

The intimate intertwining of our everyday lives with processes of extended (sub)urbanization, with the lives of ports and the lives of viruses and microbes, came crashing into stark view in 2020 with the COVID-19 pandemic. Only 2 weeks before COVID-19 was declared a global pandemic in March 2020, Roger Keil, Creighton Connolly, and Harris Ali published an article (Connolly et al., 2020) on the ‘uncanny’ relationship between ‘the spread of global urbanity and the spread of disease’. It is always economists, who brag about being able to ‘predict’ the next big market move, and political scientists that brag about predicting the next global political constellation. But it was Connolly's, Keil's, and Ali's uncanny prescience that not only ‘predicted’ but also explained the global mess that the COVID-19 pandemic created. As we were made to watch day in-day out, the rapid socio-geographical spread of the virus, it became abundantly clear that the pandemic was constituted as much by the coronavirus SARS-CoV-2 as by the socio-economic ecologies that hosted, carried, and responded to it – the global supply chains and the ‘just-in-time’ economy that had come to characterize so much of the global extended (sub)urbanized life. And although it is urbanization itself that has opened pandora's box of infectious diseases (Keil et al., 2020), ports certainly play a role in exacerbating the spread through the global connectivities they produce and sustain. In any case, ports expose the geographical fragility of flows due to disruptive phenomena like the global COVID pandemic or the 2021 Suez canal obstruction by the Ever Given container ship.

What we have learnt from UPE's elucidation of suburbanization and extended urbanization, of new extensive forms and spaces of marginalization, offers not merely new descriptors to better name the world within which we find ourselves. It also offers conceptual lenses for thinking about the present conditions from which we will have to struggle to bring into being the future world we desire. As Keil (2011: 29) writes: ‘What and who my communities are during one day and how they need to be sustained changes continuously. In order to find my way through those mazes of relationships, I need to start where I am and not in an imaginary place that is either reviled (like sprawl) or celebrated (like the compact city)’.

This is a world where port entanglements, microbes and virus spread are not an imaginary ‘out there’ but something permanently with us, ‘in here’, in the tangled webs of extended sub/urbanization. When this critical understanding of logistics is paired with spatial and ecological sensibilities around health issues, we begin to see how circulation is also epidemiological. Therefore, we call for more attention to internal waste handling in ports, to the molecular or microbial flows enabled by ballast water or cargo, to the regulatory/institutional invisibility of supply chain flows. Ultimately, we propose the lens of critical logistics for taking UPE further towards considering possible extended and epidemiological logistics ecologies as a dimension of UPE. In this framing, logistics has the potential to not only move goods through the urban fabric but to reconfigure the very conditions of health and disease by concentrating risk, altering hydrosocial cycles, and mediating the boundaries between the human and nonhuman. Epidemiological logistics can highlight how these uneven processes produce uneven immunities, in other words, a stratified geography of exposure in which certain populations and ecologies bear disproportionate risk. Writing to planners in disP – The Planning Review (Keil, 2020a), Keil insists:

We need to keep pushing to make our cities and regions and especially their most vulnerable, racialized, economically exploited, and socially marginalized communities less susceptible to the damage done by emergencies, pandemics, financial crises, and the like. This does not mean to subscribe to a weak appeal to the mantra of resilience; it means committing to meaningful, structural change where we can help affect it through our thoughts and actions. In 2020 we learned that the new normal has been the always normal for many, and the old normal is something we cannot accept to go back to. The status quo ante is not an option. Planning must measure its mission by that fact.

Keil's work helps us ‘see’ so many of the ‘fine threads’ that always interconnect us, highlights the infirmness of the ground beneath our feet, and gives us tools that we can use to address this infirmness and to keep alive the conviction that a better world is still worth fighting for.