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Unequal &
UnhealthyFor
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 the way they
die. For much of the world, the increase in population of urban areas is synonymous with
rising poverty and growing environmental degradation. There exists a synergy of threats
facing the urban poor. Urban poverty and its effects exist within a context: the extensive
and harmful 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, 40 per cent of the world's population was living in urban areas. Most of them
live in developing countries, and projections for 2025 indicate that four out of every
five urban residents in the world will be in developing countries. In theory, living in
urban centres offers great potential gains, such as health benefits. 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 per cent of the urban population in developing
countries live 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 squatter areas are two to 10 times higher than in non-squatter areas.
A poor household in an urban area 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. Studies have shown that children under the age of five are the worst
sufferers of the poverty and environment nexus, particulary the absence of adequate water
and sanitation facilities.
Among 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 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 adult and
child health in the cities, the linkage from the urban environment, poverty and health
becomes apparent - both to children and adults. In this nexus the role of equity cannot be
ignored.
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 a piped water supply. Even their groundwater is
saline. They are also likely to share toilets which are already in a state of
deterioration. They are mostly likely to use smoke-emitting fuel, cooking in a poorly
ventilated environment, have 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
flies in their food-handling areas.
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