Urban Health in Developing Countries

: Agarwal S, Srivastava A, Kumar S. Urban health in developing countries. In: Gibbons MC, Bali R, Wickramasinghe N, Eds. Perspectives of Knowledge Management in Urban Health. Springer, 2010:6194.

Posted: 25 May 2016

See all articles by Siddharth Agarwal

Siddharth Agarwal

Urban Health Resource Centre; Dept. of International Health, JHBSPH

Aradhana Srivastava


Sanjeev Kumar


Date Written: 2010


An urbanizing World: The world is becoming more urbanized. This trend is now particularly pronounced in the developing world, where the urban population is expected to double in the next 30 years.

Challenges accompanying rapid urbanization in developing countries: The impact of urbanization on the health of citizens in developing countries has received increasing attention recently. Urban residents in developing countries, especially the poor, are exposed to the health hazards of low access to healthcare, food insecurity and under-nutrition, polluted living environment, poor water quality, violence and accident injuries.

Poor people in urban centers also suffer from health problems associated with poor access to social services and safety nets. In such a scenario, ensuring access to basic yet life-saving healthcare among the urban poor is a key development priority. Efforts towards this end can be vastly improved through shared learning of experiences in enhancing access of the urban poor to basic services, healthcare and social security. A robust knowledge management system for urban health in developing countries is essential for achieving this.

What can be done: lessons from developing countries:

Energetic Policy Implementation: It is critical for development agencies including donors, technical agencies, public health movers and shakers, think tanks, other global development players to unequivocally acknowledge the unprecedented demographic transition that the world is witnessing and the associated public health challenges that are emerging.

Develop Lead Programs in Asia and Africa: To provide a strong dose of catalytic stimulus, donors, national, sub-national and city governments should join hands to develop need responsive programs in select cities. In light of the fact that the proportion of urban poor and the pace of increase of urban and urban poor population is fastest in Asia and Africa, these should be focus destinations for such early learning programs. These lead programs can provide working examples to stimulate other cities in the same country and also encourage other countries to address urban health challenges systematically.

Make the Invisible Visible: A large proportion of slum dwellers are unrecognized and therefore uncounted. A large part of making the invisible visible and highlighting the need for action requires that data on slums be collected locally, through the process of community mapping. Making the invisible visible will not only help give slum dwellers a voice in the political process, but will also allow governments to better prepare and respond to the complexities, as well as to build on the opportunities, that urbanization brings

Ensure that Underlying Determinants of Health are Included in the Scope of Programs Even if limited by a specific technical funding stream, it is important for such programs to have a broader ‘urban under-served habitation development/improvement approach’ while maintaining the focus on “health”. There is a need to focus on environment issues such as water contamination, sanitation, drainage, growing threat of water and vector borne diseases.

Demonstrate the Economic Benefits of a Well-Functioning Urban Health System With cities being recognized as the drivers of economic growth in most developing countries, one important dimension that is vital to emphasize upon national and city leadership is the far-reaching impacts of an urban health system that ensures good health in an inclusive manner, not leaving out the poor. Urban health is integral to the ability of educational programs to increase individual opportunities and labor productivity.

Engage the Urban Poor Communities as Active Agents of Change It has been noted in several initiatives that some of the most effective approaches to reduction of urban health problems had the poor themselves meaningfully involved in the program processes. It is worthwhile to recognize that like the rich, urban poor also have an inherent desire for good health. They have proved to be potential partners in health and development programs. Organized community groups have generated awareness, promoted health behavior and mobilized communities to take action towards improving their health status. Initiatives from community groups such as Mahila Milan, National Slum Dwellers Federation, Shack/Slum Dwellers International in Cambodia, India, Nepal, the Philippines, Sri Lanka; Africa: Kenya, Namibia, South Africa, Uganda and Zimbabwe can provide valuable lessons which can be adapted (d’Cruz and Mitlin in press). Similar experiences of slum based CBOs in Indore and Agra also have valuable lessons that can be utilized in different cities (Agarwal et al. 2007).

Capacity Building at All Levels: While working at the national level is important and financing in most developing countries flows from the that level, it is crucial to acknowledge that problems manifest themselves at the city level and strategies to address them are implemented and managed at the city level. The centrality of city governments to the effort of addressing the vulnerabilities of the urban poor implies a need to develop local capacity to act in terms of technical ability as well as through fiscal resources. Local governments cannot act alone. In capacity building efforts, it is important to include managerial capacity including financial management so that when resources are allocated, the authorities at sub-national and city levels are able to expeditiously and effectively utilize the same for improving health of the underserved urban population. Slum- CBOs (community-based organizations) play a vital role in improving the lives of the urban poor. The urban poor are also potential advocates themselves. Their direct voice when facilitated at appropriate levels is potent and can contribute valuably to policy advocacy efforts. Hence capacity building efforts aimed at enhancing their ability to take better care of their health and also advocate for the cause of the urban poor (Agarwal et al. 2007).

Foster Learning from Experiences Through ExchangePrograms and Dissemination of Lessons It is important to utilize lead programs to share knowledge in terms of data, reports of slum mapping exercises, program planning consultations and program lessons through appropriate media to reach out to the global public health fraternity.

Financing and Creative Utilization of Resources: Financing issues are typically related to national priorities, which are reflected in national budget allocations. International funding, such as development aid, flows directly to national governments and often does not adequately filter down to the local levels of administration, where it is needed to tackle the multifaceted challenges that accompany (unplanned) rapid urban growth. Collective savings of the federations of slum based women’s groups of Shack/Slum Dwellers for an Urban Poor Fund in Tanzania, Phnom Penh, Dar-es-Salaam and Mumbai. Creation of incentives to foster cooperation between local governments/health authorities and NGOs and CBOs in capacity building and service delivery (Agarwal et al. 2008) serve the interest of the urban poor.

The Real/Most Crucial Action Point: Translate words into action: The suggestion about lead programs can provide the catalytic stimulus for converting words/ideas into real action which reaches health benefits to the urban poor. Slum .

Keywords: urbanization, urban poor, slums, health and environmental challenges, developing countries, Asia, Africa

JEL Classification: D10, D19, D33, D39, D60, D63, D69, D70, D71, H40, H41, H43, I1, I10, I12, I18, I30, I31, I38, I39, L

Suggested Citation

Agarwal, Siddharth and Srivastava, Aradhana and Kumar, Sanjeev, Urban Health in Developing Countries (2010). : Agarwal S, Srivastava A, Kumar S. Urban health in developing countries. In: Gibbons MC, Bali R, Wickramasinghe N, Eds. Perspectives of Knowledge Management in Urban Health. Springer, 2010:6194. , Available at SSRN: https://ssrn.com/abstract=2781296

Siddharth Agarwal (Contact Author)

Urban Health Resource Centre ( email )

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Aradhana Srivastava

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Sanjeev Kumar

Independent ( email )

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