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Urban Health & Environment |
Introduction
We have entered the urban millennium--half the world population now lives in cities. However, this new millennium does not belong to old urban giants like London and New York. In the next three decades, over 90 percent of the world's population growth will occur in developing country cities where over 2 billion new residents will need to be absorbed. If well managed, these cities will be engines for improved prosperity. If not, rapid urbanization can strangle economic growth by poisoning the environment and increasing the spread of disease.
While "on average" health indicators among city residents are typically better than among their rural counterparts, in the developing world there is a large and growing gap between urban upper-income and poor residents. Available data indicates that the urban poor face severe health challenges that inhibit their ability to be prosperous members of society. Child mortality rates for the urban poor are often as high - if not higher - than those found amongst similar groups in rural areas. Dependent on fragile earnings and without savings, food stocks, or access to land, children of the urban poor often have rates of malnutrition and stunting similar to or higher than the rural poor.
Poor air and water quality in developing cities adversely affects the health status of all residents. However, the poor are the most vulnerable, often living in marginalized areas beyond the reach of municipal water, sanitation and solid waste services. In addition, high population densities, limited access to health services, and proximity to pollution sources contribute to particularly high morbidity and mortality rates in urban slums. Of particular concern in slums are environmentally linked respiratory infections and diarrheal diseases, the two greatest child survival threats.
Urban slums also host a wide array of other infectious diseases (including tuberculosis, hepatitis, dengue fever and malaria) easily spread in highly concentrated populations especially where the population is unaware of simple, life-saving prevention measures. AIDS and HIV prevalence rates are also particularly high and growing in many urban areas - exceeding 50 per cent in some African cities.
While the challenges are severe, there is evidence that well-targeted, low-cost health service outreach and environmental improvements can dramatically improve the health and wellbeing of the urban poor. Supported by central government and donor partners, local governments must commit to inclusive service provision responding to the needs of all their constituents.
For more information, contact the USAID Urban Health Advisor, Anthony Kolb at akolb@usaid.gov.
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