Cities are unhealthy places but poverty makes it worse.

Next months, these posts deal with the challenges of urban life but also with the prospects of bringing humane cities closer. These posts represent the most important findings of my e-book Humane cities. Always humane. Smart if helpful, updates and supplementary reading included. The English version of this book can be downloaded for free here and the Dutch version here.  

Polluted air: Photo by Holger Link on Unsplash

During the last decades, health has improved significantly. Globally, between 1990 and 2015, the worldwide mortality rate of children below the age of 5 dropped from 90 deaths per 1,000 live births to 43. But this is an average and hiding large differences between countries and within countries as the graph below illustrates[1].

Under 5-year child mortality rate – Source: The Urban Disadvantage, 2015.

The global decrease in child mortality resulted from successfully combatting infectious diseases, better medical care, more breastfeeding, measles vaccination, vitamin A supplementation, and the use of impregnated mosquito nets. At the same time, the AIDS epidemic threatened to reverse the progress made, in particular in eastern and southern Africa[2]. Moreover, in developing countries in particular, improvements in health of the poorest groups were not accompanied by improvement of income, job opportunities and living conditions, which resulted in a huge and persistent increase in family size, making the poverty even worse. 

The poverty of the rural population in developing and emerging countries triggered an unprecedented urbanization. Unfortunately, cities appeared to be unhealthy places, in particular migrants and other poor inhabitants. Infectious diseases are still widespread. In developing countries, they are associated with the lack of sanitation and drinking water. The presence of mosquitos is a lasting danger. Polluted air is threatening health in each city. According to the Global Burden of Diseases Study of the World Health Organization, 4.2 million deaths worldwide every year are caused by particulate pollution[3].

India

Take India for example. Air pollution is the direct cause of 627.000 deaths annually. Moreover, an official study of 1,405 cities reveals that only 50% of urban areas have water supply connections and that water is supplied on an average for only three hours a day. Waste disposal and sewage treatment plants are missing in most Indian cities: 30% of the households have no toilets, the coverage of the sewage network is merely 12% while the treatment of sewage is even lower at 3%. Most of the untreated sewage is discharged into rivers, ponds or lakes, which are also the main source of potable water[4].

In the past, cities in emerging and now developed countries where extremely unhealthy places too, characterized by frequent outbreaks of epidemics that regularly killed large sections of the population. Yet, living conditions, including sanitation and availability of clean drinking water and medical care have improved. Growing prosperity and deliberate policies were accompanies by decreasing family size.  The air has become cleaner but air pollution continues to be a major problem. Still, large wealth related differences in health persist.

Asthma

Many chronic diseases in emerging and developed countries are associated with air quality. More than 26 million people in the U.S. have asthma, and therefore difficulties with breathing. African-American residents die three times more from asthma than whites. They often live in segregated communities with poor housing, near heavy industry, transportation centers and other sources of air pollution[5]. The concentration of particulate matter near main road arteries is irresponsibly high, especially on warm, windless days.


Amsterdam

In Amsterdam too, the level of pollution from particulate matter and nitrogen dioxide (NO2) exceeded the standards of the World Health Organization (WHO). As a consequence, the life of an average citizen is shortened with one year [6]. Moreover, 4.5% of the loss of healthy years is the result of exposure to polluted air too. To put this outcome in context: The percentage is less than the damage to public health caused by smoking (13.1%) and overweight (5.0%), but more than the damage caused by lack of movement (3.5%) and excess drinking (2.8%)[7].


Lifestyle-related health problems

At the same time, growing prosperity of city-dwellers comes with lifestyle related health problems, the abuse of alcohol and drugs included, like heart problems, cancer, obese and  stress.  Their solution requires major changes in the design of cities and the behaviour of citizens, and include the provision of parks and other green spaces, making cities more walkable, a general reduction of cars, the transition to electric vehicles, and changing food and moving habits.

As a consequence, improving health implies improving the availability and affordability of care and fighting poverty as well. Many diseases are directly related to living conditions, which in turn are related to wealth. A billion city dwellers worldwide live in slums, on sidewalks or below bridges. Nearly all of them lack drinking water and sanitation.

Therefore, a humane city will focus on providing adequate care and for all its citizens, accompanied by healthy living conditions, shelter, work and income. 


[1] https://www.savethechildren.org/content/dam/usa/reports/advocacy/sowm/sowm-2015.pdf

[2] https://data.unicef.org/resources/levels-trends-child-mortality-2017/

[3] http://ghdx.healthdata.org/gbd-2016

[4] http://www.thehindu.com/opinion/columns/smart-cities-dont-make-me-laugh/article19897715.ece

[5] https://nextcity.org/features/view/why-racial-disparities-in-asthma-are-an-urban-planning-issue

[6] https://www.infomil.nl/onderwerpen/lucht-water/luchtkwaliteit/regelgeving/wet-milieubeheer/beoordelen/grenswaarden/

[7] https://www.parool.nl/nieuws/verwachte-verbetering-blijft-uit-lucht-in-de-stad-nog-net-zo-vies~bea8f836/