This move to the cities has a particularly dramatic impact on health. The combination of overcrowding and the lack of potable water and sanitation render the population susceptible to epidemics of contagious disease. The Aedes mosquitos that carry Dengue Fever and Hemorrhagic Fever thrive in stagnant pools throughout the slums. Diarrhea and respiratory illnesses are more common. Despite closer theoretical proximity to health care, mortality in infants and children under five is actually higher among the urban poor than it is in the countryside. There is also disintegration of the extended family and kinship support system usually available in rural areas. Long standing cultural traditions are often lost. This lethal combination causes severe psychological stress and family breakup. Because there is no money to buy food and no place to grow crops, malnutrition, particularly in children is rampant. Ironically, lifestyle changes, including decrease in exercise and increased consumption of junk food contribute to a major increase in obesity, diabetes and cardiovascular problems.
Some government health systems have attempted to respond to this complex crisis, but are overwhelmed by the scope of the problem and the costs involved. Other governments remain indifferent. In 1992 the UN Conference on Environment and Development, more commonly known as the Earth Summit, formed a committee that addressed the global issue of urbanization, and formed a plan for human settlement development. This committee continues to meet every four years, but has had little impact on the problem. As health volunteers, we need to be aware of global urbanization and the marked effect it has on the health of the countries we serve. We also need to consider an increasing emphasis on supporting local health systems and serving the health needs of these urban poor.
Roger Boe MD
Patel, R. B. et al. Urbanization—An Emerging humanitarian Disaster. NEJM 2009; 361:741-43.
Moore, M. et al. Global Urbanization and Impact on Health. Int J. Hyg. Envirn. Health 2003; 206:269-278.