This bulletin provides a sketch of urban health in developing countries, documenting the intra-urban differences in health for a number of countries and showing how the risks facing the urban poor compare with those facing rural villagers. It notes that, to better understand urban health in developing countries, the situations of the urban poor and near-poor must be distinguished from those of other city residents. Even among the urban poor, some live in communities of concentrated disadvantage (slums) where they are subjected to a daily barrage of health threats. The author recommends geographic targeting as an effective health strategy for reaching slum dwellers, though other approaches should be devised to meet the needs of the poor who live outside slums. Public health agencies need to work in tandem with other government agencies, and public health programmes should draw on the social capital that is embodied in the associations of the urban poor.
Poverty and health
The number of poor and food-insecure people in developing countries is increasing more quickly in urban areas than in rural areas, and could be dropping off the policy radar, according to new research by the US Department of Agriculture (USDA). By 2030 the majority of people in all developing countries will live in urban areas, and UNFPA estimates that about 60 percent of the urban slum population will be under the age of 18. Sub-Saharan African countries have the world's highest rates of urban growth and highest levels of urban poverty – the slum population in these countries doubled from 1990 to 2005, when it reached 200 million. Health hazards emanating from food in urban areas are a critical concern: buying pre-cooked food from street vendors, close contact between humans and poultry and other domestic animals for slaughter, and generally unhygienic conditions in urban markets can have significant health consequences.
This first edition of the biennial Global Assessment Report on Disaster Risk Reduction (DRR) aims to review and analyse the natural hazards threatening humanity and seeks to provide new evidence on how, where and why disaster risk is increasing globally. It found that economic development increases a country’s exposure at the same time as it decreases its vulnerability, but this trend was more pronounced in low- and middle-income countries with rapidly growing economies. More than two thirds of the mortality and economic losses from internationally reported disasters were related to climate change and natural disasters. The translation of poverty into risk is conditioned by the capacity of urban and local governments to plan and regulate urban development, enable access to safe land and provide protection for poor households. Community- and local-level approaches can increase the relevance, effectiveness and sustainability of DRR across all practice areas, reduce costs and build social capital.
The International Baby Food Action Network, through its campaign called ‘One Million Campaign: Support Women to Breastfeed’, submitted a petition to the President of World Health Assembly, Mr. NS de Silva, which was signed by more than 45,000 people from 161 countries. The petition demanded concrete support systems for breastfeeding women and urged the Assembly to adopt a resolution in 2010 to deal with four key issues: to prepare a specific plan of action on infant feeding, which is budgeted and coordinated in the same way as action plans for immunisation; to ensure the end of promotion of baby milks and foods intended for children under two years old in a time-bound manner, that is, by 2015; to end partnerships in the area of infant and young child feeding and nutrition with commercial sector corporations that present conflicts of interests; and to create support and maternity entitlements for women both in the formal and informal sectors, so that mothers and babies can stay close to each other for six months at least.
On the occasion of the Day of the African Child, 16 June 2009, the Africa Public Health Alliance and 15%+ Campaign called on African governments to end the ‘5 by 5 Tragedy’ by stopping the estimated five million African children under the age of five from dying annually of preventable, manageable or treatable health causes. The campaign blames the existing situation on a failure of government policy on child health and protection in particular, and health development and financing in general. [To] meet the Millennium Development Goal 4 on reversing and ending child mortality, African governments are called on to meet their pledge to allocate 15% of national budgets to health, and significantly increase per capita investment in health. Strategic investment in vaccinations, health systems, human resources for health and social determinants of health, such as clean water, sanitation, food security and nutrition, must also be implemented.
As Africa marked the Day of the African Child on 16 June, the Kenyan government launched an eight-year strategy aimed at delivering efficient and effective health services to improve the lives of women and children. ‘It [the strategy] aims at contributing to the reduction in health inequalities and reversing the downward trend in health-related indicators with a focus on child survival and development,’ Beth Mugo, the Minister for Public Health and Sanitation, said in Nairobi when she launched the ‘Child Survival and Development Strategy 2008–2015’. The ministry developed the strategy with other line ministries as well as representatives of civil society, academia, the donor community and general population. Kenya has one of the highest numbers of newborn deaths in Africa, with a neo-natal mortality rate of 33 per 1,000 live births – approximately 43,600 deaths every year.
In this paper, child mortality and its relationship to specific variables relating to background and proximate factors were considered. Between 2006 and 2007, proportions of households with child deaths declined in all the districts and the proportions of health facility deliveries decreased in households that experienced under-five deaths. Measles vaccination coverage was lower among households with child deaths and so was use of insecticide-treated nets (ITNs). Households living in poor conditions experienced the highest proportions of child mortality. Education of mothers remains a significant determinant of child mortality along with health facility delivery. No difference in child mortality was realized between mothers having primary education and those that had none. Better health-seeking behaviour should be encouraged to help stem the high child mortality rates.
The aim of this study was to describe current infant growth patterns using World Health Organization Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants. A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003 with 723 mother-infant pairs. The prevalences of wasting and stunting were 4.2% and 16.7%, respectively. The adjusted analysis for stunting showed associations with age and gender – it was more prevalent among boys than girls (58.7% versus 41.3%). Sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size were associated with growth among Ugandan infants.
Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology.
The Moving Out of Poverty study, carried out in 15 countries, is one of the few large-scale comparative research attempts to analyse mobility out of poverty rather than poverty alone. This book is about local realities and the urgent need to develop poverty-reducing strategies informed by the lives and experiences of millions of poor people in communities around the world. The report notes the diversity of experience across households in their movement in and out of poverty within countries. It points to the need to examine the local realities of communities rather than countries and to move beyond assumptions and beliefs about poor people to identify the underlying causes of poverty and to inform development plans, policies and actions that address poverty.