Inga Björk-Klevby
Officer in Charge, United Nations Human Settlement Programme (UN-HABITAT), Assistant Secretary-General United Nations, and Deputy Executive Director, UN-HABITAT
By far the greatest share of health problems in rapidly urbanizing contexts is attributable to living and working conditions. These conditions include social determinants such as poor and overcrowded housing; unhealthy and unsafe working conditions; lack of access to clean water and decent sanitation; and social exclusion. Currently, an estimated one billion people live in informal settlements and slums. Yet health policies in most rapidly urbanizing countries remain dominated by diseasefocused solutions that ignore the social and physical environment. As a result, health problems persist, health inequities have increased, and health interventions have produced less than optimal results.
Yet urbanization presents many advantages for more effective health policies and practices. There is little evidence, however, that public policies are being informed and shaped by these opportunities, as evidenced by the prevailing modes of chaotic and poorly planned urbanization. This urbanization of poverty and social exclusion increases health inequities and vulnerabilities.
Of the many risks to health that are linked to rapid urbanization, none is more compelling than urban poverty, manifested most clearly by the growth of informal settlements. While rising urban poverty is also evident in the developed world, this trend is more pronounced in developing countries and results almost invariably in housing deprivations.
Throughout the world, slum dwellers have less access to health resources, have more illness and die earlier than people in any other segment of the population. These unfair health gaps are growing in spite of unprecedented global wealth, knowledge and health awareness. Despite the relatively good health services in urban areas, the urban poor seem to have lower health status than their rural counterparts. This calls for a better understanding of intra-urban inequities and their implications for health.
Beyond epidemiology and improvements in health systems, the ultimate “cause of causes” of human well-being, at this particular stage of human development, can mainly be addressed through interventions directed at the urban setting.
This calls for paying more attention to the manner in which measures are taken to transform urban living and working conditions as well as the social processes and knowledge that can lead to a sustainable improvement of urban health. This joint report by UN-HABITAT and WHO makes a clarion call for taking concrete action in addressing health inequity in our urban settings. It is my sincere hope that the recommendations made in this report will advance this urgent cause