The Urban Crucible How Can We Ignore the Urban Imperative

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The Urban CrucibleHow Can We Ignore the Urban
Imperative?

• Victor K. Barbiero
• October 14, 2005

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The World is Urbanizing
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The Urban Imperative
The Train Left the Station
Elvis Has Left the Building
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Population Growth rates in Urban and Rural Areas
1950 to 2000, and 2000 to 2030
Annual Rate of Growth
2x 18.9 yrs
2x 30.3 yrs
Developed Countries
Less Developed Countries
United Nations, 1999. www.org/esa/populations/wup1
999/wup99ch1
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Urban Trends
Percent Urban Population
United Nations, 1999. www.org/esa/populations/wup1
999/wup99ch1
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Urban Growth by Region
Percent Urban Population
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Ten Largest Agglomeration Cities in the World by
2015

• Tokyo 26.4 million 0.0
• Bombay 26.1 million 2.4
• Lagos 23.2 million 3.6
• Dhaka 21.1 million 3.6
• Sao Paolo 20.4 million 0.9
• Karachi 19.2 million 3.2
• Mexico City 19.2 million 0.4
• New York 17.4 million 0.3
• Jakarta 17.3 million 3.0 Calcutta 17.3
  million 1.9

United Nations, 1999. www.org/esa/populations/wup1
999/wup99ch1 Bloem, MW., 2003. Health and
Nutritional Surveillance for Development
(presentation)
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Top 12 Urban Populations City Limits
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Major African Cities
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Doubling Time of Urban Areas 2000-2030
United Nations, 1999. www.org/esa/populations/wup1
999/wup99ch1
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Mumbai - Slums
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Urban Challenges in India

• 20 of the urban population age 6-17 are out of
  schools
• 10 of urban households do not have electricity
• 25 of urban households do not have access to
  piped water
• 50 of urban households do not purify water
  before drinking
• 20 of urban households do not have toilets
• gt25 of urban households use wood or cow dung or
  charcoal for cooking
• gt3 people share one room in 30 of urban
  households.

Source National Family Health Survey 1998-99
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Growth of Cities Urban Population in India
Population in million

• Number of Cities
• In 1961 2700
• In 2001 5161
• During last four decades
• The Urban population has grown by more than three
  and half times
• The number of cities has almost doubled

Source 1930 Projected figure from PRB
publication Other figures Census of India,
1961, 71, 81,91, 01
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Infant Mortality Rates in Rural/Urban Economic
Quintiles, India 92-93
Source Socio-Economic Differences in Health,
Nutrition, and Population, The World Bank, 2000
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Child Morbidity in Urban and Rural Areas in India
Percent Ill During Two Weeks Before the Survey
Source NFHS 1998-99
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Poverty and Urbanization

• Poverty is growing in urban areas.
• By 2020 two-thirds of the poor in Central Asia
  and almost half of the poor in Africa and Asia
  will reside in cities and towns

Percent of Poor Population In Cities and Towns
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World Bank Urban Strategy

• The ultimate aim of this strategy is
• to promote sustainable cities and towns that
  fulfill the promise of development for their
  inhabitants
• in particular, by improving the lives of the poor
  and promoting equity
• while contributing to the progress of the country
  as a whole
• Wheres USAIDs strategy? - USAID needs to build
  one

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The Urban Crucible

• Urban agglomerates will grow in the future
• Slums will be a crucible for infectious diseases
  including TB, HIV, AI, diarrhea and immunizable
  diseases
• Polio stubbornly retreats to urban slums
• WS/S challenges loom
• Chronic diseases are on the rise
• Social, behavioral norms may facilitate or impede
  action
• Infrastructure may facilitate or impede action
• Local municipality engagement is essential

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What Must Be Done?

• USAID should expand it attention to and
  investment in urban health build a rational
  strategy
• BGH should be the vanguard supported by EGAD and
  Regional Bureaus
• Linkages to PEPFAR, MCH, Malaria and Infectious
  Disease (including AI) programs should be
  maximized i.e. wrap around efforts with other
  programs
• A task force on urban health should be
  established and chaired by one of the DAAs BGH
• 3 demonstration urban programs should be
  initiated in FY 2007 with a budget of up to
  10M/yr/program, thus, 30M should be made
  available
• Which countries?...India?, Zambia?, Nigeria?,
  Brazil?...

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Outcomes

• Urban health mainstreamed on USAIDs agenda
• Mitigation of disease spread in urban areas
• Improve long-term urban planning
• Face head-on the interface between infectious and
  chronic disease epidemiology control
• Increase local municipality engagement in health
• Manifest active and sustained private-public
  partnerships
• Pursue new models of HIV, ID and CS/MCH
  prevention, treatment and care

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Conclusions

• Recognize the urban imperative, mainstream it
• The epidemiologic transition is upon us
• deal with in the urban setting
• Balance/address infectious and chronic
  interventions in the crucible
• Maximize sensible and viable linkages to existing
  initiatives (PEPFAR, CS, ID, Malaria, AI, etc.)
• Promote new PPP models to address new problems
• Commit resources for 3 demonstration efforts
• Embrace the vision

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Thank You