Urbanization and Health: challenges and promises Wilson Centre Seminar on Capitol Hill Improving Health Outcomes for the Slum Dwellers and the Urban Poor 20 July 2010 Dr Jacob Kumaresan
This year 1 billion people will wake up in an urban slum. 170 million urban residents will not have access to a latrine. nearly 1.2 million people will die from urban air pollution. 2
Urbanization trends Over half the world s population now lives in cities By 2030, six out of 10 people will live in cities, rising to 7 out of 10 by 2050 Today, a moral and political imperative: addressing urbanization and health is vital to ensure equity and reduce poverty 3
Urbanization trends and projections Urban population, millions 4000 3500 3000 2500 2000 1500 1000 500 0 More developed countries Less developed countries 1950 1970 1990 2010 2030 4
One billion people live in slums Urban Slum Incidence, 2001 5
Proliferation of Slums Western Pacific 233 South Asia 217 Eastern Mediterranean Latin America and Caribbean 113 127 Urban slum Urban non-slum Sub-Saharan Africa 156 0 200 400 600 800 Population in millions In Sub-Saharan Africa 67% of the urban population lives in slums while in the Eastern Mediterranean and South Asia nearly 50% do SOURCE: MERCADO S. ET AL. URBAN POVERTY: AN URGENT PUBLIC HEALTH ISSUE, JOURNAL OF URBAN HEALTH, VOL. 84, NO. 1 (MAY 2007 SUPPLEMENT) 6
Urban settings and health Cities confronted by a triple threat: infectious diseases exacerbated by poor living conditions; noncommunicable diseases and conditions fueled by tobacco use, unhealthy diets, physical inactivity, and harmful use of alcohol; and injuries, road accidents, violence and crime. 7
Higher Burden of TB in Urban India SOURCE: CHADHA VK ET AL. (2005). ANNUAL RISK OF TUBERCULOSIS INFECTION IN FOUR DEFINED ZONES OF INDIA: A COMPARATIVE PICTURE. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 9(5), 569 575. 8
Death from urban air pollution 9
Nutrition, urban settings, and health Changes in food supply and demand resulting in changes to dietary patterns and lifestyles: Energy-dense diets Less active lifestyle Access and availability of healthy foods: Forced reliance on local corner stores Overreliance on fast food restaurants 10
Transport Physical inactivity 1.9 million deaths per year and a loss of 19 million years of healthy life Traffic injuries 1.2 million deaths per year 11
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Unfair differences in people s health Intra-urban health differences exist in all cities: Male life expectancy in Calton is 82; in Lenzie it is 54. These are two wards in Glasgow, Scotland only 15 kilometres apart. In Nairobi, a child born in a slum is four times more likely to die before the age of 5 than his compatriot born kilometres away. 13
Urban inequities are significant Under five mortality per 1,000 live births 3.1 2.9 3.1 6.1 Urban Source: DHS 2003 2005 14
Health equity analysis 70% 60% 50% 40% 30% 20% 10% 0% SEN MAR EGY GAB BFA GHA NAM COG UGA CMR GIN ZWE KEN MLI LBR TZA MOZ NGA NER ETH RWA BEN TCD LSO ZMB MWI MDG DOM COL PER NIC HND HTI BOL TUR JOR ARM NPL KHM BGD IND MDA Prevalence of child stunting (height for age < 2 sd) AFRICA AMERICAS ASIA 15 E U R O P E Urban Poorest 20% Urban Richest 20% Urban average
Inter-city health differentials: concern in developed countries Mortality rate per 100,000 population Source: US Big Cities Health Inventory, NACCHO 2007 16
New York City Population living in poverty (quartiles) AIDS deaths per 100,000 population (quartiles) SOURCE: KARPATI A ET AL. HEALTH DISPARITIES IN NEW YORK CITY. NEW YORK, NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, 2004. 17
Urban TB, Japan 2006 18 Ward with lowest rate Ward with highest rate City average 284 100 80 60 40 20 Tuberculosis incidence rate Tuberculosis notification rate per 100,000 population, 2006 0 0 2 4 6 8 10 12 14 Osaka Kobe Nagoya Tokyo Kawasaki Kyoto Fukuoka Chiba Yokohama Kitakyushu Hiroshima Sendai Sapporo Source: Research Institute of Tuberculosis, Kiyose, Japan
2010 Year for urbanization and health World Health Day Awareness Global Report How-to-guide Global Forum Policy Commitment 19
World Health Day 2010 More than 1500 cities participating 20
25 cities in the US signed up 460 21
US support for urbanization and health 460 22
Conclusion Virtually all population growth will be in urban areas over the next 30 years. Global poverty is concentrating in cities. Urbanization can have positive and negative impacts on health. Action is needed now to ensure cities are safe and healthy. 23