For the first time in history, more people are now living in cities than in rural areas. Worldwide, virtually all population growth over the next 30 years will be in urban areas, with the most explosive growth taking place in Asia and Africa. By mid-century, seven out of every ten people will live in a city.
This scenario presents both opportunities and challenges. In general, urban populations are better off than their rural counterparts. They tend to have greater access to social and health services, literacy rates are higher, and life expectancy is longer. When cities are planned, managed, and governed well, life flourishes for most residents and health outcomes surpass those seen in rural areas.
However, there are many challenges to city life, especially for the poor. Poor living and working conditions expose them to a range of health hazards. In the cities, poor often live in large numbers in highly congested areas. Access to basic services like water and sanitation is impaired and the quality of service is poor leading to a range of problems from contamination of the food or water, high levels of indoor air pollution, etc. As such cities concentrate opportunities, jobs, and services, and, at the same time, also concentrate risks and hazards for health. In countries like India, urban growth has outpaced the ability of governments to build essential infrastructure and services. Today, around one third of urban dwellers, amounting to nearly one billion people, live in urban slums, informal settings, or pavement tents. More than 90% of slums are located in cities of the developing world. In many of these cities, slums have become the dominant type of human settlement. Such diseases are likewise numerous. Slums are productive breeding grounds for tuberculosis, hepatitis, dengue, pneumonia, cholera, and diarrhoeal diseases that spread easily in highly concentrated populations.
Cities also tend to promote unhealthy lifestyles, like cheap and convenient diets that depend on processed foods rich in fats and sugar, yet low in essential nutrients. Like sedentary behaviour, smoking, alcoholism and substance abuse. These lifestyle changes are directly linked to obesity and the rise of chronic conditions like heart disease, stroke, some cancers, and diabetes. These conditions are costly to treat, for households and societies, and they are increasingly concentrated in the urban poor.
The growth of urban centres in the 21st century is being accompanied by a shift in the burden of poverty. In previous centuries, poverty was greatest in scattered rural areas. Today, poverty has become heavily concentrated in cities.
It is therefore important to engage in removing health inequities in the cities. Cities with high degrees of inequity are also homes to violent crimes and history has demonstrated that economic class is no insulation during such emergencies such as a disease outbreak. It is therefore everybody’s business to ensure that when it comes to equity in health, it can not be ‘business as usual’.
What can be done to promote health equity in the cities?