Making cities healthier for all

With the increase of people living in cities, the impact of urban living on human health is now a growing concern. It is the utmost importance to ensure health services for these growing numbers of city dwellers, especially the poor.

As more people are living in cities, the World Health Organisation (WHO) has planned to mark this year’s World Health Day accentuating the importance of urban health. The day will be observed on April 7 with the theme 1000 cities, 1000 lives that will encourage efforts to make cities healthier places for people to live.

According to WHO Knowledge Network on Urban Settings (KNUS) Report 2008, around one billion people in present world live in deplorable conditions in slums or informal settlements. This number may double in coming decades unless appropriate policies for economic, social and health equity are made.

As for Bangladesh, gross health inequity exists in cities, especially in Dhaka city which is overburdened with over 11 million people including 4 million slum dwellers. These people are struggling to access basic health services like safe water and sanitation.

Global climate change has further highlighted the importance of health equity because the poor dwellers from both rural and urban areas have been projected to be the most vulnerable to the health hazards of global warming. Climate change will exacerbate the already prevailing poverty and inequity.

The State of World Population 2007 report that 27 per cent of the total population of Bangladesh lives in the urban area. The urban population growth rate is projected to be 3.5 per cent per year up to 2010. Hence it is very much predictable that in coming years, the cities especially Dhaka will be burdened with poverty and ill health many times greater than that of now.

Consequently the question arises if we are prepared to endure the upshots and ready to deal with the encumbrance that lies ahead?

In 2010, the population of the Dhaka city has been projected at 17.6 million, with up to 60 per cent in the slums. This hardcore poor community living in slums is among the largest migrant groups who move to Dhaka from the rural areas in search of employment; sometimes being climate change refugees. This migrant group remains the most vulnerable and excluded from all basic services in city.

The Ministry of Health and Family Welfare itself admits that the health indicators for the urban poor are worse than those of the rural poor due to the unavailability of urban primary health care (PHC) and poor living conditions (Asian Development Bank 2008).

This is because the healthcare services in the city are generally meant for those who can avail it with cash. Moreover, the sanitary system, hygiene practice and awareness of communicable or non-communicable diseases are very low among the slum dwellers.

When availed, the poor population more often fails to use health services effectively for lack of knowledge and education. Their earnings are so low that the expenditures for healthcare consume a negligible amount.

Infant and child mortality rates in urban slums are higher than that of national average figures. In urban slums, the infant mortality rate is 63 per 1,000 live births, while it is 29.8 in non-slum urban areas and the national rate is 52.

Similarly, the prevalence of contraceptive use and the total fertility rate are higher in slums than that of in the non-slum urban areas.

To cater to the health needs of urban poor, currently two major projects are running funded by the ADB and USAID. Although they are working for the vast urban population, a number of working urban poor fails to seek for health assistance when needed due to the clash of working hours. Their operational time during the day does not fit with the lowest income groups. This clinic hours need to ascertain that their services reach to these people rightly and thus set hours acceptable to working poor urban.

Nevertheless, in order to effectively address health concerns of urban population inline with the World Health Day campaign civil society needs to take active part to promote, support and protect health justice to the poor–non-poor and slum–non-slum dwellers of the city.

Dr Md Shamim Hayder Talukder and Sohana Samrin Chowdhury
Source: The Daily Star, April 03, 2010