A new United Nations report shows for the first time how poor health is linked to poverty in cities and calls on policymakers to identify those that need the most help and target measures to improve their well-being.
The report, entitled “Hidden Cities: unmasking and overcoming health inequities in urban settings,” was launched today in Kobe, Japan, where leaders from governments, academia, media and non-governmental organizations have been meeting for the past three days to examine how to improve the health of city dwellers.
Published by the World Health Organization (WHO) and the UN Human Settlements Programme (UN-HABITAT), the report is based on a new analysis that looks beyond city averages or beyond the usual information from cities and towns to identify hidden pockets of ill-health and social deprivation.
“Averages hide large pockets of disadvantage and poor health, concealing the reality of people's lives,” said WHO Director-General Margaret Chan. “This new analysis uncovers gaps in health and healthcare access across urban populations, and shows city leaders where their efforts should focus.”
The report reveals inequities by looking at subgroups of city dwellers according to their socioeconomic status, neighbourhood or other population characteristics.
“All too often policymakers and planners fail to understand that with the urbanization of poverty, many slum dwellers suffer from an additional urban penalty: they have a higher rate of child mortality, die younger and suffer from more diseases than their more affluent neighbours,” said Joan Clos, Executive Director of UN-HABITAT.
“To better understand the causes of poor health, the report focuses on several factors including population dynamics, urban governance, the natural and built environment, the social and economic environment, and access to services and health emergency management.”
Unless urgent action is taken to address urban health inequities, countries will not achieve the health-related Millennium Development Goals (MDGs), the set of anti-poverty targets world leaders have pledged to achieve by 2015, including slashing maternal and child mortality and improving access to clean water and sanitation.
With more than half of the world's population now living in urban areas, success in reaching MDG targets will depend very much on achievements among urban populations, the agencies pointed out.
Among the report's findings is that the poorest urban children are twice as likely as the richest to die before the age of five. Also, access to skilled birth attendance in urban areas of 44 low-and middle-income countries varies from a low of 40 per cent to a high of 100 per cent.
While access to piped water has has improved globally over the last two decades, substantial inequities persist between the richest and the poorest urban residents in Africa, the America and Asia, according to the report.
The report also shows that health inequity exists in both developing and developed countries. For example, tuberculosis is more common in Japan than in other developed countries, and the data revealed that bigger cities tend to have wider gaps. Within Osaka city, one area where many day labourers live has an incidence rate 9 times higher than the area with least TB.
Data from New York City reveal that certain neighbourhoods that are the poorest in economic terms are the ones in which people are least likely to have access to essential health care and suffer the worst health outcomes, as reflected in life expectancy and death rates from AIDS.