Posted on 1-6-2003

Bracing for the Challenges of an Urban World
By J.R. Pegg

Photo shows Madagascar President Marc Ravalomanana

WASHINGTON, DC, May 29, 2003 (ENS) - Over the next three decades the world's population is expected to grow by some 2.2 billion people and the majority of this growth will take place in urban cities within developing countries. This rapid and far reaching urbanization represents a major transformation for humanity, said experts at the Global Health Council's annual conference, and will have profound impacts on global health and the environment.

The keys to preparing for this trend is better understanding of the cycles of poverty, disease and violence that affect the urban poor today, today's speakers explained, as these factors combine to put added stress on the environment and on efforts to improve global health. Madagascar President Marc Ravalomanana asked conference attendees - and the world - to address the continued growth of wealth inequality and urged for a cure to "the lethal disease of poverty." This needs to be made the "priority of all priorities," said Ravalomanana. The Madagascar President is under no illusion that this will not be easy, but he appealed to the global community to try and break the cycle of poverty that chains many of the world's individuals to lives of poor health and little hope. "Poverty not only causes poor health and education, but poor health and education makes in impossible to break out of poverty," Ravalomanana said.

The cycle of poverty reflects the "degradation of human potential of a colossal nature," added Samir Chaudhuri, director of the Children in Need Institute in Kolkata, India. Chaudhuri's organization, which he founded in 1974, targets its services to deprived women and children living in the slums and villages around Kolkata. The city - known until 2001 by many as Calcutta - has more than 10 million residents. Slum dwellings comprise some 40 percent of the city and many families live on the street. Chaudhuri described a vicious cycle of "poverty, malnutrition and illiteracy" that hangs over the poor in Kolkata - and over many in the developed world. Breaking this can be done, Chaudhuri said, but it requires training, steady funding and a longterm commitment.

The first 33 months of an individual's life - pregnancy and the first two years - is the key time period to break the cycle, Chaudhuri explained, an investment that costs about $290 per child for this time period. The cycle of poverty has caused a disturbing trend of violence and social unrest within urban areas in the developing world, in particular within South America, said Carolyn Stephens, a senior lecturer at the London School of Hygiene and Tropical Medicine.

In countries such as Brazil and Argentina, there has been a rise in "barrios privados" or gated communities, Stephens explained, as "income inequalities are increasing dramatically." The retreat of the wealthiest into gated communities increases the disconnect between the rich and poor and could lead to "a level of social injustice that is totally unacceptable," Stephens said. The consequences of this disparity and of a loss of hope among the world's poor are manifesting in increased violence, she explained. But is this increased violence, Stephens asked, best described as "crime, or terror or frustrated aspiration of young people?" This must be considered when discussing the trend of rapid and increased urbanization that the world faces, Stephens said.

In 2000, it was estimated that at least 500 million people earned less than $1 a day with another 160 million people unemployed. And by 2010, experts estimate there will be an additional 460 million new jobseekers and 70 percent of this total will be in Asia. The perception that all of this growth will be in the biggest cities is incorrect, said Mark Montgomery, a senior associate with the Population Council and cochair of the U.S. National Research Council's Panel on Urban Population Dynamics. "In thinking of the urban future, it is perhaps only natural to imagine growth in cities of the size of Sao Paulo, Cairo, Lagos and Shanghai," he said. "But the bulk of urban population growth will take place in smaller cities and towns of less than one million."

Smaller cities should be considered "much more carefully in the development of infrastructure and health policies," Montgomery said, but there is lack of data that impedes these considerations. The research record on smaller cities is "woefully inadequate," he said, but there is enough data to draw some conclusions. The panel Montgomery co-chaired found that from 15 percent to 33 percent of urban households in the cities and towns of under one million people lack piped water, flush toilets and electricity. "The urban advantage in health cannot be dismissed as a myth, but it is only a partial truth," Montgomery said. Where this advantage exists, he said, it is because of political will and massive investment in infrastructure and services.

Where this will and investment is lacking, Montgomery said, "we should not be surprised to see urban disadvantages emerge."