For most people in the world, every step of life, from infancy to old age, is taken under the twin shadows of poverty and inequity, and under the double burden of suffering and disease.

— WHO Report, Bridging the Gaps

Today, urbanisation is perhaps one of the most pressing global changes affecting humans, both in the way they live and way they die. For much of the world the increase in the popula- tion of urban areas is synonymous with the rising poverty and growing environmental degradation. There exist a synergy of threats facing the urban poor. Urban poverty and its effects exist within a context: the extensive and damaging polarisation of socio-economic and environmental conditions within cities. Evidence indicates that inequality in itself has ramifications on health of the poor and on the development of a sustainable urban society.

By the 1980s, 405 of the world population had become urban citizens. Most of these are now living in the developing countries, and projections for 2025 indicate that four out of five urban people will live in the towns and cities in the developing world. In theory, living in urban centres offers great potential gains, including health benefits for their inhabitants. However this theory is broken by the reality that the urban poor or poverty and its ramifications in the developing world.

An estimated 30 – 70 % of the urban population in the developing countries are living in extreme poverty. So its not a pretty picture after all. The distinction between the physical conditions under which they live and their socio-economic circumstances is blurred. There is ample evidence that the urban poor pay more than the urban rich for the minimal, inadequate services that they receive.

Growing concerns about the disparate living conditions facing diferent areas in third world cities can be divided into three groups: infant, children and adults. The mortality rates of infants in the squatter areas are two to ten times higher than the non-squatter areas. A poor household in the urban areas may usually struggle to get its own facilities. But getting them may not necessarily protect the health of the children if the surrounding environment is poor.

Children under the age of five are the worst sufferers of the poverty and environment nexus and the importance of water and sanitation. Among the adults cardiovascular diseases have emerged as one of the main killers. And contrary to the popular thinking, heart diseases have now been acknowledged as the disease of the poor/poverty in both the developing and the industrialised world.

This does not take away the focus from the disease of the socio-economic condition as cholera and other infectious diseases. When one opens the Pandora’s box of the adult and child health in the cities, the linkage from the urban environment, poverty and health becomes apparent – both to children and adult. In this nexus the role of equity cannot be ignored.

Most of the people who migrate from the rural areas are forced to live in appalling conditions of poor sanitation and hygiene in the slums where they are more prone to infections and disease. Economic constraints force both the husband and the wife to work.

This compulsion creates its own problems on the dietary and child rearing practices of these migrant families. The unorganised sector sometimes constitutes more than 50% of the city population.

Who's hoarding?

Recently a panel of the World Health Organisation (WHO) commission on health and environment, and examining urban health issues came up with the following:

• In Guatemala, Haiti, and Pakistan infant mortality rates are much higher in the poor urban areas than in the wealthier areas.
     
• In Panama. diarhhoeal diseases are much higher in the poor urban areas.
     
• In Philippines, malnutrition and tuberculosis rates are much higher in the poor urban areas.

The WHO studies show that the:

Environment Matters... conditions in the physical and social environment are the most important determinants of health status and the health sector alone cannot be responsible for the health status.

Poor pay more... for health and environmental services. They lack services as they cannot afford them, yet studies show that poor people do pay relatively more for water than the wealthy and may be paying considerable sums for the private medical services.

Look at Jakarata, the capital of Indonesia, the fourth most populous country in the world. The city today is straining its environmental limits. Poor households are less likely to have piped water supple, even their groundwater is salinated. They are also likely to share toilets of deteriorating conditions. They are also mostly likely to use smoky fuels cooking in poorly ventilated environment, multi-purpose rooms and use mosquito coils to control pests. They are less likely to have waste collected from the their homes and more likely to have the flies in their food-handling areas.

Poor use vendors or public water carriers/public hydrants (these are constructed by the government but are operated by the private vendors). As many other environmental problems, there is a tendency of the poor to rely more heavily on the natural systems because they have difficulty in accessing the manmade supplies. Traces of bacteria indicating that the contamination of the piped water with sewage through some leaking pipe. The three most prevalent sources of indoor air pollution in Jakarta are cooking stoves, indoor smoking and coils used for mosquitoes all of which are prevalent in the poor households.

Poor environmental quality is directly responsible for 25% of all preventable ill- health, with diarhhoeal and acute respiratory infectious diseases heading the list.

Definitely, the urban poor die more.

Flimsy, overcrowded housing amid filthy conditions – uncollected garbage,  unsafe water, over flowing sewers – and the inability of the poor to get health care.

Even in London, the poor bear the burden

In the UNITED KINGDOM factories emitting toxic pollutants are disproportionately located in poorer communities. Research that compares the government’s data on factories that pollute the environment with the income data for particular areas, shows:

• There are 662 polluting factories in the UK in areas with an average household income of less than £15,000, and only five in postcode areas where the average household income is £30,000 or more.
    
• The more factories in an area, the lower the average income. In Teesside, one area has 17 large factories. The average income in the area is £6,200, 64% less than the national average.
    
• The poorest families (defined as household incomes of less than £5,000) are twice as likely to have a polluting factory in their immediate area as families with an income of £60,000 or more.
     
• In London, more than 90% of polluting factories are in areas with below average income, and in the Northeast, the figure is over 80%.