Urbanization and Health

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					Urbanization and Health

Introduction to Global Health
January 22, 2008
Rebekah Lewis, MPH
   Key Definitions

   Major trends in urbanization

   Demographic impact

   Public health consequences and
    implications for care
What is urban?

Classifications differ by country
     Density
     Number of residents
     % of population not dependent on
     Provision of public utilities and services

   United Nations
       Urban: community or settlement with a
        population of 20,000 people or more
       City: population of 100,000 or more
   Urbanization
       Growth in the proportion of a
        population living in urban areas
Major Trends in Urbanization

   Modern urbanization
       1800 to present
   Industrial revolution
       Movement from rural to urban areas in
        Europe and North America
       Rise of urban disease
       Leveling off of urbanization in high-
        income countries
Major Trends in Urbanization

   Global urbanization
       Half of world’s population is urban
       Rural to urban migration
       Megacities
       Rise in proportion of urban poor
                       Figure 4 - Percentage of urban population, by size class of
                                      settlement, World, 1975-2015

percentage of urban





                      0                                                              years

                           1975 1980 1985 1990 1995 2000 2005 2010 2015

                                   10 million or more      5 - 10 million
                                   1 - 5 million           500 000 - 1 million
                                   fewer than 500 000
Factors Impacting Urbanization

   Natural increase (more births than
    deaths), 60%
   Internal migration, 40%
       Long term relocation of an individual,
        household or group to a new location
        outside of the community of origin.
   Push and Pull Factors
Rural to Urban Migration

   Push Factors:
       High-unemployment
       Natural disasters
       Political upheaval
   Pull Factors:
       Employment
       Educational opportunities
       Higher standards of living
Rural to Urban Migration

   Circular migration of men
       Temporarily leave village to seek
        employment in urban setting
   Long-term migration of men
   Circular family migration
   Permanent urban settlement
Impact of Rapid Urbanization
   Strains on infrastructure
       Clean water
       Sewage
       Electricity
       Waste removal
       Transportation
   Inadequate housing
   Food supply
   Development of squatter settlements and
    urban slums
UN Habitat Definition of a Slum
-“heavily populated urban area
  characterized by substandard housing and
  squalor...and lacking in tenure security”
-One or more of the following:
     Lack of durable housing
     Insuffient living area
     Lack of access to clean water
     Inadequate sanitation
     Insecure tenure
Urban Slums and Squatter Settlements

   1 billion slum dwellers in the world,
    making up 1/3 of the global urban
   Can be permanent or temporary
   Often on dangerous or unwanted land
       Flood plains, garbage dumps, close proximity
        to train tracks or industrial sites
   Lack accessible roads
   Unregulated and illegal
Rio de Janeiro, Brazil 2005. One-third of Rio’s population lives in Favelas.
Kibera slum, Nairobi
Population over 1 million
Slum outside of Mumbai, 2004; Approx 49% of Mumbai’s population live in slums
Conditions in Urban Slums

   Extreme poverty
   Overcrowding
   Substandard housing
   Outdoor and indoor air pollution
   Food insecurity
   Little or no public infrastructure
   High rates of violence
Consequences for Health

   Infectious diseases
       Tuberculosis
       Measles
       Cholera
       Dengue fever
   Environmental disease
       Respiratory health
       Diarrheal diseases
Consequences for Health

   Infant and child health
       High infant mortality
       Respiratory disease
       Stunting and wasting in children
Consequences for Health

   Maternal Health
       Higher rates of sexually transmitted
       Lower age of marriage and first birth
       Higher rates of maternal mortality
Rural-Urban Comparison
   Overall, those living in urban areas
    have lower mortality and morbidity
    rates, “urban advantage”
   Does not exist for urban poor
       Mortality and morbidity comparable to
        rural counterparts
       Similar rates of malnutrition and food
       Slightly worse for child health
Urbanization and Health

“Double-health burden”
       Affected by both communicable and
        lifestyle diseases
   Pollution
   Poor diet
   Urban violence
   Industrial accidents
   Lack of health care
Access to Health Care
   More services available in urban
   Problems with access:
       Cost
       Difficult geographical access
       Inconvenient hours
       Lack of required identification papers or
       Attitudes of health care providers
Urban Health Interventions-Challenges

   Poor data
   Social complexity
        Established political, economic and social
        Transplanted rural social networks and
         health belief systems
o   Extreme poverty
        Chronic malnutrition
        Child labor

        Use of hazardous biomass fuel
Benefits of Urbanization

   Proximity and concentration
       High density of population
       Geographical access to municipal and
        healthcare services
   Opportunity for concentrated
    political movements
   Willingness to adopt new
Role of NGOs and CBOs

   Often the only providers of health
   Understanding of unique social
    structures and networks
   Liaison between international and
    local health agencies and urban
   Small scale interventions
TB Treatment
   Community DOTS implementation
    in Mumbai slum
       Local residents who have been cured of
        TB appointed Community DOTS
       “My shop is now like a TB clinic. I know
        everyone in the neighbourhood. So if
        someone does not turn up for their
        dosage, I go and knock on their door at
        night.". -Food stall vendor, Mumbai
Microfinance and Clean Water

   Residents of urban slums spend
    25% of income on water access
       Often contaminated
       “water mafia”
   Subsidized loan to build connection
    to municipal water supply
       Found time gained by reliable water
        supply allowed enough paid work to
        repay loans

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