Chapter 3 addresses the question of why health is so poor among low-income urban dwellers. We look at the very large health burdens associated with urban poverty, including very high infant and child mortality rates, large percentages of children malnourished, and large and easily prevented health burdens for children, adolescents, and adults. The causes, including very poor quality and overcrowded living conditions and the lack of provision for safe water, good quality sanitation, health care, schools, and emergency services, are in turn linked to local governments who may refuse to work with those living in informal settlements, even when they house a third or more of a city's population.
There are inadequacies in available data on illness, injury and premature death, provision for water and sanitation, and the impact on urban poverty of disasters. Again the inadequacy in official data on development is evident, as this relies so much on national sample surveys with sample sizes too small to reveal the inequalities within national urban populations or within individual cities. Urban averages for health-related statistics get pulled up by the concentration of middle and upper income groups in urban areas. This hides how low-income urban dwellers living in informal settlements can be facing comparable health problems to those faced by low-income rural dwellers — or, in some instances, worse health problems.
The concentration of people and housing in cities provides many potential agglomeration economies for health, as the costs per person or household served with piped, safe water, good quality sanitation and drainage, health care, schools, and the rule of law are lowered. But in the absence of a government capable of addressing these, this same concentration brings profound health disadvantages. In addition, the data collected in most nations on provision of water and sanitation provision do not show who has provision to a standard adequate for good health.
Next: Understanding the Informal Economy
Summarized from Urban Poverty in the Global South: Scale and Nature, by Diana Mitlin and David Satterthwaite, Routledge, January 25, 2013.