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 Post subject: Health problems due to urbanisation
 Post Posted: Sat Jul 09, 2005 10:21 pm 
Health problems due to urbanisation

by Dr. D.P. Atukorale

"The effect on health due to urbanisation is two-edged. On the one hand there are the benefits of ready access to healthcare, sanitation and secure nutrition, whilst there are the evils of overcrowding, pollution, social deprivation, crime and stress related illness. In less developed countries, urbanization also opens the door to 'Western' diseases including hypertension, heart disease, obesity, diabetes and asthma" (Godfrey and Julien, Clinical Medicine, March/April 2005).

Urbanisation has been going on since the beginning of recorded history, but it was with industrial revolution that large scale migration from villages to the cities began leading to congested housing and rapid deterioration to slum conditions. In most of the cities especially in the developing countries like Bangladesh and India, there are frequent outbreaks of dysentery, typhoid, cholera and pneumonia. Tuberculosis is widespread and nutrition is often poor due to absence of drinking water and poor sanitation.

With the improvement in public health, cities started to become fashionable places for the growing middle classes as cities had the best hospitals, schools and best chances of profitable employment. At the same time, problems such as alcoholic addiction, drug addition, crime and homelessness are more concentrated in the cities.

Sexually transmitted diseases (STD) such as gonorrhoea are more common especially in the young in the cities. Tuberculosis is still common in the urban areas of developing countries and stress related illnesses such as high blood pressure are more common in the urban sector, Due to social breakdown, isolation, loneliness, depression and other psychiatric illnesses are more common in the urban areas. Alcohol and drug addition and homelessness are more common in the cities.

Diseases caused by pollution due to smoke, exhaust fumes, noise pollution, cigarette smoking and passive smoking and industrial diseases are more common in the cities. Accidents (road accidents and accidents at work) and criminal violence are also more common in the urban sector.

Diseases due to over-nutrition such as obesity, diabetes, hypertension and heart diseases are more common in the cities. Lifestyle hazard due to lack of exercise, anxiety and stress due to long working hours and hyper-competitiveness are also common in the urban sector.

In many poorer countries, child mortality is high in slum dwellers in the urban sector due to high incidence of water-borne infections such as dysentery in the slums. In Africa, HIV/AIDS prevalence is very high in the cities. as mentioned earlier diseases due to western lifestyle such as cardio-vascular disease (coronary heart disease, stroke and hypertension) respiratory infections, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, cirrhosis, obesity, diabetes and mental illnesses are typical health problems.

Improving urban health in poor countries
In poorer countries like Sri Lanka, urban problems due to poor planning of towns and cities, shortage of medical and para-medical personnel is quite common and these problems are made worse rapid with the increase in population.

Present drive by the Health Ministry against smoking and passive smoking by highlighting adverse effects of smoking and by developing smoke free workplaces such as hospitals, schools and other public areas should be highly commended. Health education should be disseminated by health education section of the Health Ministry.

Health education should be started in our schools and there should be public campaigns to prevent diseases such as diseases due to infections and noncommunicable diseases.

Exercises should be encouraged and this should be started in our schools. There is evidence that cities which encourage walking and cycling, over use of cars, buses and trains have better health statistics.

Brain drain from poorer countries such as Sri Lanka should be halted. Rural urban migration should be slowed but this can never be halted or reversed. Improvement in urban health requires major involvement in infrastructure and health personnel.


Richard Godfrey and Marlene Julien. Clin, Med. 2005,5,137-41

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