chapter 4 - DRK

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Strictly under embargo until Wednesday 22 September at 00:01 GMT (02:01 Geneva time)96CHAPTER 5environmentscan generally expect to live longer as they will also be well informedabout the health benefits of not smoking, hygiene, good diet and exercise.The other end of the urban health spectrum can be found in low- and middleincomecountries where most of the world’s impoverished urban dwellers live. Inhouseholds lacking basic shelter services – water supply and sanitation in particular– the prevalence rate of diarrhoea among urban children soars, averaging 38per cent in Pakistan, 33.3 per cent in Cameroon, 23.9 per cent in the DemocraticRepublic of the Congo and 32.3 per cent in Jordan. Diarrhoeal diseases account fornearly 2 million deaths out of a total of almost 10 million among children underthe age of 5. There are parallels here with what we see unfolding in relation to theimpact of natural disasters on urban centres and the dramatic differences in fatalitiesbetween low- and high-income nations (as highlighted in Chapter 1). Over theperiod from 1990 to 2006, industrialized countries saw under-5 child mortalityrates drop from 10 to 6 per 1,000 live births, while in developing countries overallthe reduction was only 103 to 79, a staggering gap which captures the urban riskdivide in health.In 2008, the average urban centre in Australia would not have experienced an infantmortality rate (IMR) of more than 5 per 1,000 live births, whereas, in the same year,the Nairobi Urban Health and Demographic Surveillance System, which covers ademographic surveillance area that straddles the two slums of Korogocho and Viwandaniwith a combined population of 73,661, found an IMR of 87 per 1,000 live births,above the national average of 81. It is not the fact of urban life as such that poses theproblem for health; rather, it is the way in which these cities are governed and theapplication, or not, of appropriate public health and housing policies which determinethe health consequences for the inhabitants.Hunger and malnutrition in urban settings result not only from food insecurity (seeBox 5.1) but are also a consequence of environmental hazards and shelter deprivation.Unhealthy living conditions in urban slums create a vicious circle whereby thelikelihood of a child contracting diarrhoea, an acute respiratory tract infection and / ormalaria are greatly increased by poor waste management and non-existent water treatmentsystems. According to current research almost half of all nutritional problems arelinked to slum living conditions. Malnutrition is particularly lethal in combinationwith infectious diseases such as pneumonia, malaria, measles and diarrhoeal diseases– the major killer diseases affecting children. It is an underlying factor in over half ofall child deaths.Data cited by the United Nations Human Settlements Programme (UN-Habitat)show that the prevalence of child malnutrition can often be higher in urban areas thanin rural areas in countries such as Benin and the Democratic Republic of the Congo.In the case of the latter, “46 per cent of children living in non-durable urban housing
Strictly under embargo until Wednesday 22 September at 00:01 GMT (02:01 Geneva time)are malnourished, compared with 16 per cent in rural areas […] in India, 45 per centof children from households without adequate sanitation are malnourished accordingto recent Demographic and Health Survey data”.Today, over 25 per cent of the world’s urban population live in informal settlementsor slums. A slum household is defined by UN-Habitat as lacking one or more ofthe following: durable housing; sufficient living area; access to water and sanitation;and secure tenure. There are no reliable statistics available for this last indicator.Boosted by immigration from rural areas and continuing high birth rates, today’sUN-Habitat estimate of 827.6 million slum dwellers is expected to hit a total of 889million by 2020 assuming government efforts to tackle the issue are maintained andstepped up.In many cases and especially in the developing world, urbanization has taken placeso quickly that governments have struggled to keep up when it comes to providingneeded infrastructure. When people are crowded together in unsanitary conditions,disease thrives. A 2005 report in The Lancet estimated that nearly half the urban populationin Africa, Asia and Latin America has one or more of the main communicablediseases associated with inadequate water and sanitation – including diarrhoea andworm infections. Even in the developed world, cities can attract infectious disease.TB incidence, for example, is much higher in big cities, even in developed countries.New York has four times the national average TB infection rate. In some parts of London,TB is more common than in China.But infectious diseases are only a part – and an increasingly small part on a globalscale – of the health challenge facing urban dwellers. Non-communicable diseases andmedical conditions, such as heart disease and diabetes, kill 35 million people a year.According to a 2009 WHO survey, the leading global risks for mortality in the worldare high blood pressure (responsible for 13 per cent of deaths globally), tobacco use(9 per cent), high blood glu cose (6 per cent), physical inactivity (6 per cent) and overweightand obesity (5 per cent). These risks are responsible for exposure to chronicdiseases such as heart disease, diabetes and cancers.Countries in South-East Asia and sub-Saharan Africa are particularly affected by theburden of disease as measured by WHO in disability adjusted life years (DALYs).These are underweight (6 per cent of global DALYs) and unsafe sex (5 per cent), followedby alcohol use (5 per cent) and unsafe water (4 per cent). While the other threeparticularly affect South-East Asia and sub-Saharan Africa, alco hol use shows a uniquegeographic and sex pat tern, with its burden highest for men in Africa, in middleincomecountries in the Americas and in some high-income countries.On current trends, non-communicable diseases – those that are not infectious and donot spread from person to person – will be responsible for 75 per cent of all deathsWorld Disasters Report 2010 – Focus on urban risk97
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214INDEXStrictly under embargo unti
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The International Federationof Red
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