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  • Title: Urbanization and health in developing countries.
    Author: Harpham T, Stephens C.
    Journal: World Health Stat Q; 1991; 44(2):62-9. PubMed ID: 1926894.
    Abstract:
    In developing countries the level of urbanization is expected to increase to 39.5% by the end of this century and to 56.9% by 2025. The number of people living in slums and shanty towns represent about one-third of the people living in cities in developing countries. This article focuses upon these poor urban populations and comments upon their lifestyle and their exposure to hazardous environmental conditions which are associated with particular patterns of morbidity and mortality. The concept of marginality has been used to describe the lifestyle of the urban poor in developing countries. This concept is critically examined and it is argued that any concept of the urban poor in developing countries being socially, economically or politically marginal is a myth. However, it can certainly be claimed that in health terms the urban poor are marginal as demonstrated by some of the studies reviewed in this article. Most studies of the health of the urban poor in developing countries concentrate on the environmental conditions in which they live. The environmental conditions of the urban poor are one of the main hazards of the lifestyle of poor urban residents. However, other aspects of their way of life, or lifestyle, have implications for their health. Issues such as smoking, diet, alcohol and drug abuse, and exposure to occupational hazards, have received much less attention in the literature and there is an urgent need for more research in these areas. This article reviews some of the literature of the health of the urban poor in developing countries. Some studies focus on environmental conditions, others on personal lifestyles such as smoking, diet, alcohol and drug abuse, and most are descriptive. Poverty is the prevalent condition. The characterization of the urban poor, particularly those in squatter settlements, is one of the being socially and politically marginal with lack of skills and education. This stereotype belies the economic conditions that drive the poor to migrate to urban areas. This population also is integrated in the economic and political life in the informal sector. Their health however is marginal. Studies in Manila, Philippines and Buenos Aires, Quito, Colombo, and Pelotas, Brazil have demonstrated that mortality rates are associated with socioeconomic status or geographical areas as a proxy for status (slums, squatter areas). Intermediate variables are rarely incorporated in the models. There are also studies of intraurban differentials in mortality and morbidity, particularly due to infectious diseases, but not necessarily airborne diseases. Nutritional status studies also receive attention since measurement guidelines are available. Cause of death studies are problematic because of classification problems. The picture presented is one of the urban poor suffering the worst of both the developed and the developing world, chronic diseases such as cardiovascular disease and infectious diseases and neonatal deaths. Studies also investigate the at risk populations. The 5 population suffer similar mortality and morbidity as rural areas, but there is little available on 5-19 year olds. Also missing is data on women and workers in particular occupations. Presently, 33% of urban city dwellers live in slums or shantytowns. Urbanization is expected to increase from 33.9% in 1990 to 39.5% by 2000 and 56.9% by 2025. A summary table or urban poverty research is provided which indicated the author, the year, the location, the population investigated, and findings and comments.
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