chapter 4 - DRK

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