PRB – Urban poverty & health in developing countries

August 4, 2009 · 0 comments

Urban poverty & health in developing countries, 2009. by Mark R. Montgomery, Population Reference Bureau.

Full-text: http://www.prb.org/pdf09/64.2urbanization.pdf (pdf, 1MB)

The era in which developing countries could be depicted mainly in terms of rural villages is now in the past. A panoramic view of today’s demographic landscape reveals a myriad of cities and towns.

By 2030, according to the projections of the United Nations Population Division, more people in the developing world will live in urban than rural areas; by 2050, two-thirds of its population is likely to be urban.1 The world’s population as a whole is expected to grow by 2.5 billion from 2007 to 2050, with the cities and towns of developing countries absorbing almost all of these additional people.

This demographic transformation will have profound implications for health. To understand these consequences, it is important to set aside the misconceptions that have prevented the health needs of urban populations from being fully appreciated. The most urgent need is to acknowledge the social and economic diversity of urban populations, which include large groups of the poor whose health environments differ little from those of rural villagers. On average, urbanites enjoy an advantage in health relative to rural villagers, but health policies for an urbanizing world cannot be based on averages alone. Disaggregation is essential if policies are to be properly formed and health programs targeted to those most in need.

The supply side of the urban health system is just as diverse as the urban population. The private sector is a far more important presence in cities than in rural areas, and urban health care is consequently more monetized. Even in medium-sized cities, one can find a full array of providers who serve various niches of the health care market, ranging from traditional healers and sellers of drugs in street markets to well-trained surgeons. In addition to the socioeconomic and supply-side differences within any given city, there are important differences across cities that warrant attention. Much of the demographic and health literature has concentrated on the largest cities of developing countries, leaving the impression that most urban residents are found in these huge agglomerations. In fact, small cities and towns house the vast majority of developing-country urban dwellers.2 A number of studies suggest that rates of poverty in these smaller settlements often exceed the rates in large cities, and in many countries small-city residents go without adequate supplies of drinking water and minimally acceptable sanitation.3 Rural shortages of health personnel and services are receiving attention in the recent literature, but similar shortages also plague smaller cities and towns.4 As developing countries engage in health-sector reforms and continue to decentralize their political and health systems, allowances will need to be made for the thinner resources and weaker capabilities of these urban areas.

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Mark R. Montgomery is a professor in the economics department at Stony Brook University and a senior associate with the Population Council’s Poverty, Gender, and Youth Program.

India – Health of the Urban Poor in Jharkhand

August 4, 2009 · 0 comments

Health of the Urban Poor in Jharkhand Key Results from the National Family Health Survey,2005-06. Urban Health Resource Centre, May 2009. (pdf, full-text)

Although Jharkhand is among the less urbanized states of India, the state has been witnessing rapid growth of urban population in recent decades. As per the 2001 Census, 60 lakh persons comprising 22.25 per cent of the state’s population were residing in towns and cities. It is estimated that the urban population of Jharkhand will grow rapidly to reach 93 lakh by 2026. Along with rapid urbanization, there is a rapid growth of the urban poor population in Jharkhand. As per estimates of the National Sample Survey Organization, 13.2 lakh persons comprising 20.2 per cent of the state’s urban population is living below poverty line. However, estimates of the Jharkhand government put the slum population at around 40 per cent of the total urban population. The urban poor rarely benefit from the facilities in urban areas and are as deprived as those in rural areas. The health of the urban poor is considerably worse off than the non poor and is comparable to the rural figures.

This wall chart presents health of the urban poor in Jharkhand compared with other population groups based on an analysis of the Third National Family Health Survey conducted in 2005-06. A wealth index has been developed based on 33 assets and household characteristics. The bottom quartile in urban areas is taken as the representative of the urban poor.

Novel Dengue Fever Control Strategy: Adult Mosquitos Deliver Poison To Offspring

August 4, 2009 · 0 comments

Novel Dengue Fever Control Strategy: Adult Mosquitos Deliver Poison To Offspring

Poisoned bait is a very old pest control strategy. Because of high chance of serious collateral damage, controversy inevitably follows. For disease carrying, flying insects, the most common control strategy has been to directly poison breeding areas (standing water). It’s difficult to hit all the breeding areas in dense, urban areas And, spraying typically causes collateral damage. Here’s a new variation on that strategy, innovative, less costly, and with a far sharper focus.

To control the Aedes mosquitos that spreads Dengue aka “breakbone” fever, SCiDevNet reports that “Researchers working in the Peruvian Amazon used adult Aedes aegypti mosquitoes to carry an insecticide to their own breeding sites, thus killing most larvae found there.”

During their life cycle adult mosquitoes must travel between breeding grounds and resting places. Researchers exploited this trait by disseminating a safe and persistent insecticide called pyriproxyfen in the areas where adult mosquitoes rest. The insecticide is neither lethal nor repellent to adults.
The adults then take the insecticide to breeding grounds. This strategy ensures a strong, wide coverage of aquatic breeding sites by treating only a small portion of the adult resting areas because adult mosquitoes move around so much.

Pyriproxyfen (a.k.a. methoprene), the active ingredient used to treat ‘mosquito rest stations’ in this research, is a common ingredient in flea control medicines used on cats and dogs. USEPA has a methoprene fact sheet (PDF) available which describes the risks and benefits in fairly scientific terms. Here’s an important excerpt.

The available information indicates that Methoprene will not result in unreasonable adverse effects on the environment since Methoprene degrades rapidly in sunlight27, both in water28 and on inert surfaces.

Methoprene is also metabolized rapidly in soil and does not leach29. Thus, Methoprene is not expected to persist in soil or contaminate ground water.

Ecological effects Methoprene has been shown to be practically non-toxic to terrestrial species…

Use of this relatively benign larvacide to control such a widespread, misery-causing, and potentially deadly disease as Dengue is a reversal of the historic “exterminator” mindset, which typically matched the most dangerous of pesticides with the most dangerous of disease-causing pests – with wildlife and possibly humans to subsequently take the damaging side effects.

Source, July 30, 2009 – Treehugger

Latin America – Chagas disease spreading to urban areas

August 4, 2009 · 0 comments

Chagas disease, Latin American killer, pushed aside by swine flu

Geneva, Switzerland (GenevaLunch) – Chagas disease is one of the largest debilitating and killer diseases in Latin America, but it is not winning the battle it needs for public attention in order to reduce the number of its victims. It is considered a neglected tropical disease by the WHO (World Health Organization), which put it on the agenda for the May 2009 World Health Assembly, in part because it appears to be traveling, thanks to eco-tourism. It was bumped when the agenda was reduced to allow the meeting to focus on the new pandemic, A/H1N1.

Chagas disease appears to be spreading from isolated rural areas to urban areas as people move to cities, but there is little prevention for the insect-borne disease, no standardized diagnostic test and huge knowledge gaps remain about effective treatment.

Some 50,000 people are diagnosed every year, but it has until now remained mainly a disease of very poor and isolated populations, “making it a commercially unviable candidate for drug development,” according to SciDevNet in Reuters AlertNet. “Chagas is the disease with the highest impact in Latin America. It is probably causing over two-and-a-half times more lost years of healthy life than malaria, leprosy, bilharzia and leishmaniasis combined.”

A new National Institutes of Health initiative in the US, the Therapeutics for Rare and Neglected Diseases programme, is putting $24 million into research, but doctors, scientists and public health authorities are concerned that the insect-borne disease is getting ahead of them, with new clinical presentations and the disease showing up in Europe, North America and Japan. “Growing human migration and mobility have increased the geographic distribution of Chagas in recent decades and the disease now has the potential to become an international threat,” reports SciDevNet. Chagas disease can take up to 15 years to show its more serious symptoms, including heart and eye problems, which makes it difficult to detect. In the early stages it causes mild swelling at the site of the insect bite, often on the face, and mild headaches, slight fever.

The WHO in 2007 set up its Global Network for Chagas Elimination to coordinate global efforts to eliminate the disease by 2010 but the scale of the programme remains relatively small.

Source, July 30, 2009 – GenevaLunch

South Africa – Rats running wild in major cities

August 3, 2009 · 0 comments

Rats running wild in SA’s major cities

If South Africa’s city dwellers think they smell a rat, they probably do: the rodents are thriving in Johannesburg, Cape Town, Durban and East London.

Migration to cities, a growing number of informal settlements, street vendors and poor waste management by municipalities, business and homeowners are among factors responsible for the population explosion of these dirty pest.

Now city authorities, who are responsible for maintaining hygiene, are having to fork out millions to kill the vermin. But officials say they cannot keep urban centres clean by themselves and residents need to play their part.

Pamela Mudley, the marketing manager of a leading pest control firm, said Johannesburg, Durban and Cape Town were “in an advanced state of infestation”.

“The lack of proper hygiene standards in the major cities has been a contributory factor to the increased numbers of rodents,” she said. Rats transmit a wide range of diseases including salmonellosis, typhus, rat bite fever and trichinosis.

Dr Ivan Bromfield, executive director, Cape Town City Health, confirmed there was “a significant rodent population in the city”, made worse by the fact that refuse was collected only once a eeek in residential areas. “In the last decade, the number of informal settlements has increased significantly with accompanying waste management challenges ,” said Bromfield.

The CBD, restaurants, informal settlements, harbour and transport hubs were worst infested. The city is spending R500000 on poison alone to exterminate rats this year.

Johannesburg city health department spokesman Nkosinathi Nkabinde said abandoned buildings in the inner city, extensive illegal dumping and dirty back yards had increased the rodent problem.

“The city of Johannesburg spends approximately R15-million annually … on pesticides, health education, and paying the salaries of about 70 personnel,” said Nkabinde.

The money was also used for the extermination of cockroaches, bees and mosquitoes.

Source: Aug 2, 2009 – http://www.thetimes.co.za/PrintEdition/Article.aspx?id=1043334

CITIES AND WOMEN’S HEALTH: GLOBAL PERSPECTIVES

July 31, 2009 · 0 comments

The aim of the Penn-ICOWHI 18th Congress, Cities and Women’s Health: Global Perspectives, is to deconstruct urban planning in terms of its potential to better support women’s health. When structuring an urban environment conducive to promoting and preserving women’s health, we must give up the assumption that the needs of women are the same as for men in order to understand the health needs of women in cities. In fact, there are remarkable opportunities to have profound impact on meeting the unique needs of urban women by bringing together professionals from all facets of health care, health policy and urban design, among others, to open interdisciplinary discussions about their work.

Penn-ICOWHI 18th International Congress on Women’s Health
Wednesday, April 7- Saturday, April 10, 2010
UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA, USA

Program information, abstract specifics and submission guidelines are available via the ICOWHI website – http://www.icowhi.org.

Health and the urban environment: revolutions revisited

July 31, 2009 · 0 comments

Health and the urban environment: revolutions revisited. (pdf, 158KB)

Gordon McGranahan, May 2009 – IIED

From cholera pandemics to smog episodes, urban development driven by narrow economic interests has shown itself to be a serious threat to human health and wellbeing. Past revolutions in sanitation and pollution control demonstrate that social movements and governance reforms can transform an urban health penalty into a health advantage. But many environmental problems have been displaced over time and space, and never truly resolved. Health concerns need once again to drive an environmental agenda – but this time it must be sustainable over the long haul, and globally equitable. With the global economic crisis raising the ante, what’s needed is no less than a revolution in environmental justice that puts health, not economics, at the core of its values.

Social captial and health in Botswana

July 30, 2009 · 1 comment

Does Level of Social Capital Predict Perceived Health in a Community?—A Study of Adult Residents of Low income Areas of Francistown, Botswana, in forthcoming issue of the Journal of Health, Population and Nutrition. (pdf, 184KB)

Tirelo Modie-Moroka

This study explores and describes the relationships among neighbourhood characteristics, social capital, and health outcomes among low-income urban residents in Francistown, Botswana. Using an explanatory correlational research design to explore the relationships among the study variables, data were collected from 388 low-income urban residents in Francistown, Botswana. The study further examined the role of social capital on the environmental quality for the overall health and quality of life and the psychological, physical and level of independence domains of health. Several studies have explored these relationships but currently no study has explored this relationship in Africa and Botswana in particular. Selected concepts from social capital theory and stress theory were used as a conceptual framework. Using linear and multiple regression models, results of the study showed that social capital did not correlate with the overall health and quality of life and the level of independence domain of health but positively correlated with psychological well-being. Social capital negatively predicted physical health. Hierarchical moderated multiple-regression analyses were conducted to examine the moderating role of social capital. To the contrary, social capital did not moderate the effects of chronic community stressors on all health outcomes. Social capital, however, moderated the effects of the poor environmental quality on level of independence and physical health outcomes but not on the psychological and overall health and quality of life. These results underscore the importance of considering the role of social capital, especially in low-income communities.

Strategies to reduce exclusion among urban poor in Bangladesh

July 30, 2009 · 0 comments

Strategies to Reduce Exclusion among Populations Living in Urban Slum Settlements in Bangladesh, forthcoming article in the Journal of Health, Population and Nutrition. (pdf, 158KB)

Authors: Sabina Faiz Rashid

The health and rights of populations living in informal or slum settlements are key development issues of the twenty-first century. As of 2007, the majority of the world’s population lives in urban areas. More than one billion of these people, or one in three city-dwellers, live in inadequate housing with no or a few basic resources. In Bangladesh, urban slum settlements tend to be located in low-lying, flood-prone, poorly drained areas, having limited formal garbage disposal and minimal access to safe water and sanitation. These areas are severely crowded, with 4-5 people living in houses of just over 100 sq feet. These conditions of high density of population and poor sanitation exacerbate the spread of diseases. People living in these areas experience social, economic and political exclusion, which bars them from society’s basic resources. This paper overviews policies and actions that impact the level of exclusion of people living in urban slum settlements in Bangladesh, with a focus on improving the health and rights of the urban poor. Despite some strategies adopted to ensure better access to water and health, overall, the country does not have a comprehensive policy for urban slum residents, and the situation remains bleak.

Siddarth Agarwal editorial on the urban poor of India

July 30, 2009 · 0 comments

Off the map

by Siddharth Agarwal, executive director of the Urban Health Resource Centre

July 20, 2009 – Indian Express

The urban poor, although one of the most disadvantaged sections of the country, is also among the hardest to target for government. While the new government, as visible in the recent Budget, has paid some attention to enhancing services and attempted to increase the provision of facilities for the urban poor, the success of all these social welfare schemes will hinge on what Finance Minister Pranab Mukherjee highlighted in his speech as a challenge: “re-energising government and improving delivery mechanisms.” This is doubly problematic when it comes to our cities.

India has been rapidly urbanising; the urban poor, who number 100 million, are the fastest growing segment of India’s population. Living mostly in temporary (and hence frequently undocumented) settlements, they lack access to water supply, sanitation and healthcare services. The poor living standards and suboptimal healthcare is reflected in high child mortality rates — one in 14 children do not live to see their fifth birthday, according to the 2005-06 National Family Health Survey.

Several of the newly-announced social welfare schemes have the potential to positively impact living conditions of the urban poor. The Jawaharlal Nehru National Urban Renewal Mission, for example, has set aside — under the heading “Basic Services for the Urban Poor” — an allocation for housing and amenities of Rs 3,973 crore, including the provision for Rajiv Awas Yojana announced recently. The problem this will take on is vast: there is currently a shortage of 2.6 crore housing units in cities, almost all of which is for low- income groups. It will be critical to ensure that these provisions reach the most disadvantaged city dwellers.

Initiatives towards food security and the increase in outlay — by 17 per cent — for the National Rural Health Mission may not be directly targeted at the urban poor. A specific allocation was not announced, for example, for the National Urban Health Mission. Our cities will continue to hope that the government’s commitment to launching the NUHM will be turned into action. (Almost the entire increase in health outlays has been focused on rural areas.)

But the question is: will increased spending alone be enough? While the government has certainly upped the spending on schemes for marginalised populations their implementation — as has been signalled by several within government — will need a sense of purpose, urgency, capacity and efficiency if optimal outcomes are to be obtained. And this will be particularly true when the needs of the urban poor are taken into account. Why? Because the temporary nature of many settlements of the urban poor means they fall into the cracks in any government programme.

Nearly 49 per cent of slums in India are unlisted, according to National Sample Survey Organisation data. It would be necessary, therefore, to extend all essential services to unidentified sections of urban poor by mapping unlisted and hidden slum clusters, and other temporary settlements. Any effective, speedy and honest implementation of policies will require efficient management, convergence and coordination among all departments at national, state and city levels, to reach vulnerable communities.

Then there is the question of manpower. Whether or not there are enough well-trained people to administer programmes for the vulnerable in urban areas is a matter of serious concern. When designing the propagation mechanism of welfare schemes, care should be taken to expeditiously recruit a reasonable number of people with expertise from outside; and training or re-training personnel in government departments on the provisions of the new schemes, with a special focus on how policy provisions can reach the most disadvantaged, should not be forgotten either.

Finally, government alone cannot do everything. State intervention can be made more effective by force-multipliers from outside. Several successfully implemented interventions have shown that the involvement of civil society in planning, delivery, progress review and addressing operational bottlenecks can enhance accountability of well-intentioned policy initiatives. Their efficiency and reach would also improve. Strengthening community level partnerships by building sustainable community-based organisations in slum clusters, to improve their institutional and financial capacity, should be a priority; that will enhance demand for and utilisation of the planned programmes.

The government has said it is concerned about the well-being of the least-privileged sections of society. The rest of us must ensure the translation of words into action.

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