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%

Reference:

Awake! December 2011 Publication, The 2011 Japan Tsunami

www.watchtower.org

Cesar Chelala, The Impact of Rapid Urbanization on Health

THEWIP(2009), www.thewip.net

E. Van de Poel, O. O’Donnell, E. Van Doorslaer, The Health Penalty of

China’s Rapid Urbanization

Tinbergen Institute Discussion Paper(2009)

Mark R. Montgomery, Urban Poverty and Health in Developing

Countries

Population Bulletin 64, no.2 (2009),

Population Reference Bureau (PRB)

Melinda Moore, Philip Gould, Barbara S. Keary, Global Urbanization

And Impact on Health

International Journal on Hygiene and Environmental Health

www.urbanfischer.de/journals

The African Child Policy Forum, How Child-friendly are African

Governments?

The African Report on Child Wellbeing 2008

The Health and Environment Linkages Initiative (HELI), The Urban

Environment

WHO and UNEP

UN Department of Economic and Social Affairs, World Urbanization

Prospects: The 2003 Revision

Population Division

Wikipedia, The Free Encyclopedia, Urban Sprawl