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An expository paper that points to the negative health implications of the rapid growth of urban cities in the developing nations citing an example of Nigeria.
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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 non-
governmental 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, Sub-
Saharan 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 Sub-
Saharan 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-à-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 ill-
managed 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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Awake! December 2011 Publication, The 2011 Japan Tsunami
www.watchtower.org
Cesar Chelala, The Impact of Rapid Urbanization on Health
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Tinbergen Institute Discussion Paper(2009)
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Countries
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Population Reference Bureau (PRB)
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Wikipedia, The Free Encyclopedia, Urban Sprawl