Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T14:52:25.947Z Has data issue: false hasContentIssue false
  • English
  • Français

Urbanization and human health

Published online by Cambridge University Press:  23 August 2011

D.R. Phillips
D.R. Phillips
Affiliation:
Institute of Population Studies, University of Exeter, Hoopern House, 101 Pennsylvania Road, Exeter, UK
Get access Rights & Permissions [Opens in a new window]

Summary

Urbanization involves a physical change in which increasing proportions of populations live in urban settings, however defined. It also implies considerable changes in the ways in which these people live, how they earn their livelihoods, the food which they eat, and the wide range of environmental factors to which they are exposed. There is another underlying assumption that, increasingly, urban populations will be more healthy than their rural counterparts and that higher levels of urbanization will equate with better health status. This paper discusses some of the assumptions underlying this contention. It takes issue with certain of them, particularly the assumption that urbanization affects the health of all residents equally. It is manifestly evident that in many cities, particularly in the developing world, the poor are exposed to greater risks and have much lower health status than their richer neighbours. In addition, whilst urban residents may theoretically have a better access to health care and services than do residents in many rural areas, and whilst many indicators of health do appear better in more highly urbanized societies than ones less so, there are caveats. The paper introduces the concept of epidemiological transition, which suggests that, whilst life expectancy might be higher in many urbanized countries and in certain cities, the inhabitants are often merely suffering from different forms of ill-health, often chronic or degenerative, rather than infective. In certain cities in middle-income countries, residents, particularly the poor, are exposed to a double risk of both infection and chronic degenerative ailments. The paper concludes with a consideration of more general recent statements from the World Health Organization among others, on the impact of urbanization on health. The ‘Healthy Cities’ project is also discussed. WHO identifies a range of general determinants of urban health: physical, social, cultural and environmental. Many represent the by-products of modernization and especially industrialization. It is emphasized that urbanization, and the concentration of human beings into new areas in particular, can bring exposure to new risk factors for large numbers of people. The growth of infectious and parasitic disease in some urban settings must therefore be recognized, as must the emergence of chronic diseases, with the concomitant need for investment in new types of health and social care. However, a number of constraints militate against the achievement of improved urban health, especially in developing countries. The paper concludes by considering some important constraints: the very scale of urban health problems; the impacts of structural adjustment programmes which cut public expenditure on environmental health, health services and nutrition, thereby increasing the vulnerability of the poor; urban management problems; lack of political will; and the difficulties of measuring change in health and effects of policies.

Keywords

urbanizationepidemiological transitionhealth impactsThird World cities
Type
Research Article
Information
Parasitology , Volume 106 , supplement S1: Symposia of the British Society for Parasitology Volume 30 The impact of global change on disease , January 1993 , pp. S93 - S107
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ashton, J. (1992). Healthy Cities. Milton Keynes: Open University Press.Google Scholar
Caldwell, J. C. (1982). Theory of Fertility Decline. London: Academic Press.Google Scholar
Copplestone, J. F. (1991). What is health? World Health Forum 12, 440–2.Google ScholarPubMed
Frenk, J., Bobadilla, J. L., Sepulveda, J. & Cervantes, M. L. (1989). Health transition for middle-income countries: new challenges for health care. Health Policy and Planning, 4, 29–39.CrossRefGoogle Scholar
Gans, H. J. (1968). Urbanism and suburbanism as ways of life. In Readings in Urban Sociology (ed. Pahl, R. E.), pp. 95–118. Oxford: Pergamon.CrossRefGoogle Scholar
Hansluwka, H. (1986). Mortality in South and East Asia: an assessment of achievement and failure. In New Developments in the Analysis of Mortality and Causes of Death (ed. Hansluwka, H.et al.), pp. 325–408. Institute for Population and Social Research, Mahidol University, Bangkok, Thailand, and WHO.Google Scholar
Hardoy, J. E. & Satterthwaite, D. (1989). Squatter Citizen: Life in the Urban Third World. London: Earthscan Publications.Google Scholar
Hardoy, J. E., Cairncross, S. & Satterthwaite, D. (1990). The Poor Die Young. London: Earthscan Publications.Google Scholar
Harpham, T. (1992). Urbanization and mental disorder. In Principles of Social Psychiatry, (ed. Leff, J. & Bhugra, D.). Oxford: Blackwell.Google Scholar
Harpham, T., Lusty, T. & Vaughan, P. (1988). In The Shadow of the City: Community Health and the Urban Poor. Oxford: Oxford University Press.Google Scholar
Hellen, J. A. (1983). Primary health care and the epidemiological transition in Nepal. In Geographical Aspects of Health (ed. McGlashan, N. D. & Blunden, J. R.), pp. 285–318. London: Academic Press.Google Scholar
Hewitt, T. (1992). Developing Countries – 1945 to 1990. In Poverty and Development in the 1990s (ed. Allen, T. & Thomas, A.), pp. 221–37. Oxford: Oxford University Press.Google Scholar
Hewitt, T., Johnson, H. & Wield, D. (1992). Industrialization and Development. Oxford: Oxford University Press.Google Scholar
HONG KONG GOVERNMENT (1991). Hong Kong 1991. Hong Kong: Government Printer.Google Scholar
Hyma, B., Ramesh, A. & Gunasekaran, K. (1989). Lymphatic filariasis in Madras, India. Social Science and Medicine, 29, 983–90.CrossRefGoogle ScholarPubMed
Kitching, G. (1982). Development and Underdevelopment in Historical Perspective. London: Methuen.Google Scholar
Leete, R. (1985). Increased survival in East and South-east Asia: towards new outer limits of life. In Proceedings of the International Union for the Scientific Study of Population. International Population Conference, Florence, 429–42.Google Scholar
Lopez, A. (1989). La santé en transition à la Réunion de 1946 à 1986. Annales de Géographic 546, 152–78.CrossRefGoogle Scholar
Mcglashan, N. D. (1982). A West Indies Geographic Pathology Study. Occasional Paper No. 12, Department of Geography, University of Tasmania.Google Scholar
Mckeown, T. (1965). Medicine in Modern Society. London: Allen and Unwin.Google Scholar
Mckeown, T. (1988). The Origins of Human Disease. Oxford: Blackwell.Google Scholar
Mamdani, M. (1991). Reproductive Behaviour in Poor Urban Areas: A Review. Urban Health Programme, London School of Hygiene and Tropical Medicine.Google Scholar
Messkoub, M. (1992). Deprivation and structural adjustment. In Development Policy and Public Action (ed. Wuyts, M., Mackintosh, M. & Hewitt, T.), pp. 175–98. Oxford: Oxford University Press.Google Scholar
Mott, K. E., Desjeux, P., Moncayo, A., Ranque, P. & De Raadt, p. (1990). Parasitic diseases and urban development. Bulletin of the World Health Organization, 68, 691–8.Google ScholarPubMed
Olshansky, S. J. & Ault, A. B. (1986). The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Memorial Fund Quarterly, 64, 355–91.CrossRefGoogle ScholarPubMed
Omran, A. R. (1971). The epidemiologic transition: a theory of the epidemiology of population change. Milbank Memorial Fund Quarterly, 49, 509–38.CrossRefGoogle ScholarPubMed
Omran, A. R. (1977). Epidemiologic transition in the United States: the health factor in population change. Population Bulletin 32, 2.Google ScholarPubMed
Pahl, R. E. (1968). Readings in Urban Sociology. Oxford: Pergamon.Google Scholar
Pahl, R. E. (1970). Patterns of Urban Life. London: Longman.Google Scholar
Phillips, D. R. (1988). The Epidemiological Transition in Hong Kong: Changes and Health and Disease since the Nineteenth Century. Occasional Papers and Monographs No. 75, Centre of Asian Studies, University of Hong Kong.Google Scholar
Phillips, D. R. (1990). Health and Health Care in the Third World. London: Longman.Google Scholar
Phillips, D. R. (1991). Problems and potential of researching epidemiological transition: examples from Southeast Asia. Social Science and Medicine, 33, 395–404.CrossRefGoogle ScholarPubMed
Phillips, D. R. (1992). Ageing in East and Southeast Asia. London: Edward Arnold.Google Scholar
Picheral, H. (1989). Géographie de la transition épidémiologique. Annales de Géographie 546, 129–51.CrossRefGoogle Scholar
Riley, J. C. (1989). Sickness, Recovery and Death: A History and Forecast of III Health. Iowa City: University of Iowa Press.CrossRefGoogle Scholar
Riley, J. C. & Alter, G. (1989). The Epidemiological Transition and Morbidity. Working Paper No. 10, Population Institute for Research and Training. Bloomington: Indiana University.Google ScholarPubMed
Ruzicka, L. T. & Kane, P. S. (1986). Mortality and development in the ESCAP region: a review. Asia-Pacific Population Journal 1, 13–38.CrossRefGoogle ScholarPubMed
Simmonds, O. G. (1988). Perspectives on Development and Population Growth in the Third World. New York: Plenum Press.CrossRefGoogle Scholar
Smith, P. (1992). Industrialization and environment. In Industrialization and Development (ed. Hewitt, T., Johnson, H. & Wield, D.), pp. 277–302. Oxford: Oxford University Press.Google Scholar
Stephens, C. & Harpham, T. (1991). Slum Improvement: Health Improvement? PHP Departmental Publication No. 1, London School of Hygiene and Tropical Medicine.Google Scholar
Tabibzadeh, I., Rossi-ESPAGNET, A. & Maxwell, R. (1989). Spotlight on the Cities: Improving Urban Health in Developing Countries. Geneva: WHO.Google Scholar
Thomas, A. & Potter, D. (1992). Development, capitalism and the nation state. In Poverty and Development in the 1990s (ed Allen, T. & Thomas, A.), pp. 116–41. Oxford: Oxford University Press.Google Scholar
Todaro, M. P. & Stilkind, J. (1981). City Bias and Rural Neglect: The Dilemma of Urban Development. New York: Population Council.Google Scholar
UNITED NATIONS (1991). World Urbanization Prospects 1990: Estimates and Projections of Urban and Rural Populations and of Urban Agglomerations. New York: United Nations.Google Scholar
UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP) (1991). Human Development Report 1991. New York: Oxford University Press.Google Scholar
UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP) (1992). Human Development Report 1992. New York: Oxford University Press.Google Scholar
Verbrugge, L. (1984). Longer life but worsening health? Trends in health and mortality of middle-aged and older persons. Milbank Memorial Fund Quarterly, 62, 475–519.CrossRefGoogle ScholarPubMed
Wirth, L. (1938). Urbanism as a way of life. American Journal of Sociology 44, 1–24.CrossRefGoogle Scholar
WORLD BANK (1991). World Development Report 1991. New York: Oxford University Press.Google Scholar
WORLD HEALTH ORGANIZATION (1991a). Health and the Cities: a Global Overview. Technical discussions on strategies for health for all in the face of rapid urbanization. A44/Technical Discussions/2. Geneva: WHO.Google Scholar
WORLD HEALTH ORGANIZATION (1991b). Urban Policies and Health Status. Technical discussions on strategies for health for all in the face of rapid urbanization. A44/Technical Discussions/3. Geneva: WHO.Google Scholar
WORLD HEALTH ORGANIZATION (1991c). The Organization of Urban Health Systems. Technical discussions on strategies for health for all in the face of rapid urbanization. A44/Technical Discussions/4. Geneva: WHO.Google Scholar
WORLD HEALTH ORGANIZATION (1991d). City Networks for Health. Technical discussions on strategies for health for all in the face of rapid urbanization. A44/Technical Discussions/5. Geneva: WHO.Google Scholar
WORLD HEALTH ORGANIZATION (1991e). Development of Urban Environmental Health Services. Technical discussions on strategies for health for all in the face of rapid urbanization. A44/Technical Discussions/6. Geneva: WHO.Google Scholar
WORLD HEALTH ORGANIZATION (1992). Our Planet, Our Health: Report of the WHO Commission on Health and Environment. Geneva: WHO.Google Scholar