THE HEALTH CONSEQUENCES OF URBAN AGGLOMERATION IN THE DEVELOPING COUNTRIES
Abstract The current rapid rate of global urbanization is of an important demographic
concern
in
all
ramifications
especially,
economically,
politically, socially, environmentally, security-wise and health-wise. Coping with the ills brought about by this urban sprawl presents daunting challenges for the developing countries while the more developed countries have been better able to manage the problems effectively. The laissez-faire migration policy of many developing countries, poverty, illiteracy, lack of political-will coupled with sustained high fertility regime in these countries worsen the problems associated with rapid urbanization. Of all the problems emanating from rapid urban agglomeration, negative health outcome is the most salient that calls for urgent remedy so as to avoid high mortality tendency which this can degenerate into. It is, therefore, imperative that this subject-matter should be given utmost consideration to open up a discourse by which rapid rate of global urbanization can be addressed.
Introduction Urban growth, one of the attendant problems of high fertility and uncontrolled population movement especially in the developing countries, has been gaining attention widely in the recent time from both local and international policymakers. The rapidity of growth of large cities is increasingly becoming the focal point of concern in various planning efforts and way of life of individuals, society at large, governments and nongovernmental bodies. Urbanization can be described as the transformation of a lowly populated rural community into a densely populated and expansive large city. Various descriptions have been given about urban area to show its salient features. The Nigeria Population Commission and UNs classified a geographical location with a population above 20,000 people as urban area while an urban centre with a population of 10 million and above is a megacity. However, in this paper, urban area is referred to, in general sense, as an area of concentrated population associated with natural increase of high fertility but low mortality and great influx of people into such a particular location.
The evolution of modern urbanization can be traced to the European experience of industrial revolution in the Eighteenth Century. The European Industrial Revolution led to the growth of large cities as more erstwhile rural agrarian communities became industrialized. There were high demands of labour in the newly emerged industrial sector and the situation resulted in freeing up of labour from rural agricultural sector to urban industrial sector. The advancement of technology which makes mechanized agricultural practice possible further added to the impetus of growth of cities as increasing rural population were released from the agricultural sector which now required less labour. Equally significant in the development of urban cities was the invention of steam engine which led to the manufacturing of automobile for easy mobility of people. This trend of population movement which was also propelled by high population growth due to demographic gap (produced by high fertility and low mortality) recorded at the time. The emergence of the growth of cities and its accompanying odds affected the way of life of the Europeans in many ways.
Unlike the developed world, urbanization in the third world countries was not prompted by industrialization. The developing countries especially, the African continent are faced with unprecedented rapid urbanization in the recent time. Urbanization in the African countries first came with the influence of the colonialism which carved the continent into many different colonies. Each colony had a city as an administrative headquarters and the seat of colonial government. This led to the skewness of developmental effort towards these selected cities while other geographical areas were devoid of meaningful development. Typical examples are Lagos Nigeria, Kumasi Ghana, Younde Cameroun, Freetown Sierra Leone and Addis Ababa Ethiopia. Consequently, migration into these cities took a very high momentum partly because of the better living conditions offered by the cities and also due to the wide economic options available in these urban centres. After the independence of African countries from colonial rule, there was devolution of governmental power through creation of more states in many African countries. The creation of more states diverted developmental attention to the capital cities of the created states which function as the administrative headquarters and seats of power for the government. In their plans for infrastructural development, African
governments give priorities to these capital cities while other geographical areas suffer neglect. This soon led to rural impoverishment and precipitated uncontrollable population movement from the rural areas to urban centres. This scenario is further worsened by the fact that most African countries are characterized by high fertility especially, among the rural population. As a result, the rural areas became the origins of great magnitude of migrants who move to the urban cities almost on daily basis to take permanent abode.
In comparison, the rate of urbanization in the developed countries is on the decline while the less developed countries especially, in the African continent, are experiencing rapid rates. This is largely due to the population growth decline and effective policy formulation on redistribution of population in the more developed regions of the world. Presently, urbanization in these advanced countries is only borne out of immigration from other poor countries. Therefore, migration rather than natural increase is the only force propelling urbanization in the developed countries in the recent time. However, the urbanization process in the developing
countries is fueled by both forces of natural increase and internal migration.
In a nutshell, the mind-boggling problems of urbanization are more felt now than what was experienced some decades back due to addition to total global population, especially by the poor developing countries. The World Health Organization (WHO) in 1998 reported that the number of cities with a population of 1 million has increased tremendously over the half of the last century. The report stated that there were only 90 such urban agglomeration with 26% of urban residents in cities of at least this size in 1955. Whereas, in 1995, over a space of barely forty years, the number of such urban agglomeration has grown to 336 with 36% of world’s urban population residing in them. Globally, there are currently almost 25 cities with a population of more than 10 million people each. The growth trend of these megacities is highly on the increase as more cities are expected to join the group by the middle of this century according to UN projections.
Although, some level of urbanization is needed for economic development and socio-political civilization, its rapidity presents various problems ranging from social, economic and political problems to health problems. In this discussion, emphasis is not laid on the social, economic, political and other relevant issues aside health. However, attempts are made to discuss these other issues in connection with the health consequences of urban development which is the main focus of this paper.
The Consequences Urban development can present both positive and negative consequences to any population. However, coping with the negative consequences and harnessing the positive ones depend on the socioeconomic framework and political advancement of a particular country. The politically advanced and economically healthy countries around the world have been able to effectively harness the opportunities presented by urbanization while manageably coping with the demerits. In contrast, the demerits have relatively masked the advantages the growth of cities brought about in the poor developing countries.
Positive Consequences Urban growth in the developed countries sprang from industrialization. The great commercial activities in the urban cities resulted in large accumulation of income and wealth with which the provision of many social amenities were made possible. Consequently, there are more health facilities and other health related institutions in the urban centres than the rural areas. Hospitals, clinics and pharmacy and chemist stores are more present in the urban than the rural areas. Also, schools and health institutions where health and hygiene issues are being taught and health information is disseminated to the public are mainly situated in the urban centres.
Negative Consequences As earlier described, urbanization involves population increase of a particular location in a concentrated form. When population concentration emerges, from global evidences, there will be loss of biodiversity as more people demand for more housing, more office buildings, more schools, more parking lots, more extension of markets, more recreation facilities, more hospitals, ,more police stations and more roads. As long as land
supply is fixed in nature, there will be encroachment of the marginal land resulting to various nature adversaries of environmental degradation, congestion and pollution. The implications of this on health are discussed as follows:
Malnutrition Encroachment of marginal land due to urban sprawling results into shortage of farmland for growing staple foods for human consumption. Consequently, there arise problems of famine. This effect of shortage of food is not pronounced in the advanced countries where modern technology and scientifically improved methods are applied to agricultural practice. More and better crop yields are obtainable with this improved agriculture. However, due to technological backwardness and poverty which are responsible for low agricultural yields in the less developed countries, urban growth poses a formidable threat on food production. As urban development results into rapid expansion of cities towards the suburbs and nearby agrarian communities, the resulting food shortage due to loss of farmland to urban use is highly palpable among the infants,
under-5 children and pregnant women who are the weakest group in a population.
Farmlands are further pushed into the interior rural areas farther away from the urban cities. The cost of transportation of food to the urban areas rises astronomically with the inefficient transportation system in most developing countries. This adds further to the inflationary market price of staple foods. It, therefore, places an economic strain on the affordability of intake of proper dietary requirement for healthy living in the urban areas. The essential nutrients like Vitamin C, Vitamin A and Iodine supplied by food items like fruits and vegetables are insufficient. This is because these food items are perishable in nature so, they become costlier due to long distances over which they are to be transported to the big cities. The resultant effect is the urban high prevalence of nutritional health problems like obesity, diabetes, diarrhea, eye defects and cretinism among children.
Unsafe Drinking Water The costs of water treatment for safe drinking increases as cities become congested. Provision of potable and safe drinking water has become a
knotty issue in the urban centres as urban population continues to rise. The problem is that of high fund channeled to water purification projects on the part of the governments. This becomes burdensome in terms of budgetary allocation required to clean up river dams from impurities coming from urban wastes and other contaminants due to urban congestion. In the developed world, this is being somewhat managed. The high level of literacy and availability of high income make it possible to come up with effective legal framework and policies on prohibition of wanton disposal of wastes. This has been fruitful in safeguarding the water bodies while advanced technology has helped in the effective water purification. On the contrary, the developing nations are seriously bearing the brunt of unsafe drinking water. Poor socioeconomic situation and irresponsible political leadership have given no room for improvement in both safeguarding and purification water projects. The situation is worsened by urban congestion. The developing countries are characterized by rapid and unplanned urban growth, thereby making habitation and life generally difficult and unhygienic in the urban cities. For example, SubSaharan Africa has grown to be the world’s most rapidly urbanizing region with almost all of these growths occurring in slums, shacks, and shanty-
towns where new city residents are confronted with overcrowding, inadequate housing and housing facilities, lack of safe drinking water and poor sanitary system. It was reported in the UN 2006 MDG’s Report that a meagre proportion of 32% and 37% of the total population in the SubSaharan Africa were using improved sanitation in 1990 and 2004 respectively. This figure indicated that a high proportion of 63% on the average were living under unhygienic condition in 2004 with the larger number of them residing in the slums and shacks of urban cities. This scenario makes the urban population in the developing continent of Africa susceptible to preventable water-borne diseases. The recent Cholera outbreak in the cities of the northern part of Nigeria in 2009 and early months of 2011 is a point of reference. The high rate of infant and under-5 mortality has been said to be traceable to poor sanitary system and unsafe drinking water among other factors in developing countries.
Communicable diseases and other infections With the current situation of global urbanization, 74 per cent of Latin American and Caribbean populations live in urban areas, 73 per cent in Europe and more than 75 per cent in Australia, Canada, New Zealand and
the United States. Urban residents are about a third of the total population in Africa and Asia. Specifically, in Africa, over 50% of the populations of Tunisia, Algeria and South Africa are urban dwellers. The observed trend of urbanization indicates continuing growth of urban agglomerations in the less developed countries (LDCs). This congested urban condition, especially in the Sub-Saharan Africa, denotes continuous shrinking per capita space. The resultant compact living arrangement paves way for easy and fast spread of contagious diseases. Communicable diseases like: Tuberculosis and Pertusis(whooping cough), Acute Respiratory Tract Infections(ARTI), measles and others are easily spread in compact dwelling condition brought about by urban congestion. A relevant example was the easy and fast spread of Severe Anti-Respiratory Syndrome (SARS) which was aided by the highly congested nature of the urban cities in China in the beginning of this millennium. More so, the urban emergency public utilities like the public toilets in banks, schools, offices and on the highbrow streets, motor parks and in the marketplaces are rendered as media of contracting infections if not properly managed health-wise. Also, users of public mass transit system in the big cities are prone to contagious infections like
respiratory diseases. All these are due to congestions brought about by uncontrolled urbanization.
More importantly, the access to healthcare among urban dwellers becomes highly competitive with ever increasing urban population patronizing limited health facilities. As cities tend to grow larger, the situation becomes worse. The effects of this are more felt among the urban poor. Increasing number of urban people will no longer be able to afford healthcare which is highly monetized in the urban setting. However, the fact that urban life, due to congestion, provides many but insufficient and imbalance economic options for livelihood between the rich and the poor renders the urban poor to wallow in abject poverty. Therefore, the teeming populations of the urban poor are more prone to adverse health outcomes than the rich. Consequently, mortality level among the poor is relatively higher than that of the rich class, especially in the low income countries, as cities grow bigger.
In addition, the unprepared and irresponsible postures of the governments as regards urban development place unbearable burden of infrastructural,
policy and program developmental efforts on government in terms of improving the health conditions of urban dwellers. As a result of this, available health facilities are becoming over-stretched, dilapidated and obsolete. Efforts of governments in stemming down the incidence rates of dreadful scourges like HIV/AIDS are becoming increasingly insufficient in the urban centres. The resulting situation and palpable sharp economic class disparity in the urban cities lead many people (mainly the poor) to live indecent lives prone to negative health consequences especially, in the developing countries.
Environment and Health Due to urban sprawling, there arise high demand for more housing facilities, public institutions like schools and police stations, social amenities like roads, parking lots and recreation centres. All these require considerable expanse of land which an already urbanized environment cannot afford to provide due to its congested state. It then becomes imperative that encroachment into the marginal land of the surrounding environment is taken as the only option. The increasing pressure on the marginal land results in massive deforestation which causes imbalance in
the ecosystem because of intense human interference in the natural biodiversity. Consequently, more human habitations are prone to cyclone, hurricane, typhoon and other environmental hazards which damage lives and properties. Even, in the more developed countries, the effects of this urban sprawl induced environmental hazards on health cannot be taken as unserious. The situation is responsible for the little increase in the mortality levels of some developed countries prone to natural disasters like Chinese Earthquakes, Japanese Tsunami and others. A clear example is the recent tsunami that wreaked untold havoc across the cities of Japan in 2011(Awake: December 2011 Publication). Many lives were lost and many more survivors are left maimed for life.
Also, among the important components of environmental degradation are air and water pollutions. The growth of cities all over the world has contributed immensely to these types of pollutions. The industrial activities in the industrialized countries involve a lot of liquid and solid wastes some of which are toxic to the atmosphere and the water-bodies. The localization of these industries and the attendant problems of conurbation which sprang up due to the pull factor of migration, that attracted too many
people to settle around these industrial cities are now posing serious threats to the environment. A lot of liquid wastes, which are frequently released into the water-bodies either deliberately or unintentionally, pollute the source of water for human consumption. As a result of this, purification of water for healthy consumption becomes burdensome in terms of cost outlay. In the middle and low income countries, industrial wastes are less accumulated since these countries are characterized by little or no industrial investment due to high poverty level which makes savings level for investment almost unattainable. However, due to prevalence of high poverty level especially, in the Sub-Saharan African, Latin American and Asian countries, most of the additional urban populations settle in the slums, shacks and shanty-towns where required necessary facilities for healthy housing suitable for urban life are non-existent. Consequently, most houses in the slums and shanty-towns lack toilet and waste disposal facilities. This makes many people to defecate and dispose of their wastes indiscriminately. The result is the frequent outbreak of water-borne diseases and other diseases related to filthy environmental conditions.
Equally important is the sound pollution and introduction of poisonous gaseous substances into the atmosphere. Ultra-audio pollutants like sounds from factories and other industrial noises, hooting of automobiles and noises of numerous religious activities and other noisy activities like very loud marketing campaigns are more common in the urban areas than rural villages. These and many others are factors which cannot be dissociated from some illnesses which are of higher prevalence in the urban than rural areas. Relevant examples are various mental and psychological illnesses, hypertension and high blood pressure.
Introduction of harmful gaseous substances into the atmosphere tends to increase with urban growth. This is because activities in the urban areas rely so much on the burning of inorganic fuel which produces these poisonous gases. As cities grow larger, increasing demand for urban transportation results in increasing numbers of automobiles. The product of exhaust produced by the internal combustion system of great number of automobiles plying the urban roads is responsible for the larger proportion of poisonous gases which are frequently released into the atmosphere. These gases consist of the greenhouse gases that cause depletion of the
ozone layer which protects human population on the earth from the harmful ultra-violet rays. With the depletion of the ozone layer, these harmful rays escaped to the planet earth causing a lot of strange diseases like cancer which are inimical to human health. Many of these diseases are deadly and largely incurable.
Besides, many deaths are traceable to inhalation of carbon-mono-oxide fumes resulting from the burning of inorganic fuel from both indoor and outdoor sources in the poor countries. In the Sub-Saharan Africa especially, in Nigeria, the urban challenge of providing stable electric power for the teeming urban population has made the use of alternative power supply an indispensable option. As cities grow bigger, the need for alternative power supply increases as more people put higher pressure on the available electrical facilities. With the congested nature of the urban cities, coping with the fumes coming from numerous power generating sets becomes nauseating. Many families have lost their lives to the inhalation of fumes in this manner in Nigeria.
Urbanization and Accidents
The development of cities into urban agglomeration results into high demand of many basic needs by the urban population. For example, demand for housing facilities and urban mass transit facilities increase as urban population grows. This, couple with the fact that governments’ provisions and developmental plans for urban population needs are neither well thought-out nor followed by decisive implementation actions, subjects high proportion of urban population to high risks exposure to preventable accidents. Due to soaring demand for housing facilities, the private investors are left with the responsibilities of providing the excess demand as governments become irresponsible in this direction especially, in the developing countries. Meeting the expected targets in terms of numbers, standards and project delivery time in the absence of any serious regulation gives room for the use of substandard materials and delivery of shoddy housing projects. Many of these houses, more than often, collapse and kill the inhabitants who may number in hundreds as most of the houses are high-rise. The lives lost to frequent preventable collapse of buildings in the Nigerian cities of Lagos and Port-Harcourt is a typical example.
In addition, urban congestion has worsened the inability of various governments to deliver on their responsibilities of road construction mainly in the poor developing countries. However, the traffic congestion keeps increasing as more automobiles are procured to cater for the transportation need of urban agglomeration. Due to poor road network and poor road maintenance, road accidents are commonplace especially, in the less developed countries.
Even the developed countries also have their own share of the bitter pills of urbanization related cases of accidents. The rapid urban growth of Hong Kong City culminated in the exhaustion of the marginal land leaving 90 per cent of the landscape of the city dotted with high-rise buildings. This caused difficulty for aircraft taking off as the Cathay Airport runways became shorter due to the availability of high-rise buildings very close to the airport. Consequent upon this, two deadly air crashes which inflicted severe injuries on many people were recorded in Hong Kong in 1993.
Conclusion
Generally, urban development is not without its peculiar consequences both positive and negative. This paper has exhumed issues on urban development vis-Ă -vis its positive and negative impacts on health outcomes of urban population. Strictly speaking, both the high income developed countries and the low income less developed countries are negatively affected health-wise by urban growth. However, while the developed countries have been able to cope with and manage the outcomes of urban agglomeration, the poor developing countries are seriously grappling with the menace more painfully. With the UN projections that almost 90% of the urban growth in the next half of this millennium will come from the developing African continent, it means the burden will grow bigger than the presently unbearable level in 2050. This could be worsened by the currently high fertility regime and young age structure of the continent. A huge addition to total population in Africa would spell doom for the African countries as more cities grow to sprawl considering the high general poverty
level
and
ubiquitous
poor
African
government
budgetary
commitment on health sector. With the following unsavoury statistics on the government budgetary commitment as a percentage of total public expenditure of six African countries in 2004, the growth of more cities
would transform Africa cities into ghost towns, if a brake is not quickly and firmly applied to the current ugly growth trend of largely unplanned and illmanaged urban arrangement which make health outcomes tend towards mortality increase.
Government Budgetary Allocation on Health as a Percentage of Total Public Spending in Six African Countries in 2004:
Nigeria
: 3.5%
Egypt
: 7.9%
Burundi
: 2.3%
Ghana
: 8.4%
Angola
: 4.4%
Morocco
: 5.5%
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