Urban Health in Cities of Low- and Middle- Income Countries

Unprecedented urbanization challenges population health in complex ways. In cities of low- and middle- income countries (LMICs), the rise in population rates and mass motorization are increasing health risks in urban populations. Therefore, cities drive innovation, economic growth, and social advancement but also cause health risks, environmental degradation and fosters inequities.

Today, more than half of the world’s population are threatened by conditions endemic to city-life, especially in LMICs where people are moving rapidly from rural areas to fast developing cities. By 2050, African and Asian cities only will host 90% of 2.5 billion new urbanites. By 2030, the number of African cities with more than half a million people will have increased by 80%.  Africa will remain the continent with the highest annual urban population growth rates in the world.

Today, more than half of the world’s population are threatened by conditions endemic to city-life, especially in LMICs where people are moving rapidly from rural areas to fast developing cities. By 2050, African and Asian cities only will host 90% of 2.5 billion new urbanites

Health on the Urban Agenda

Currently, fast-urbanizing cities of LMICs have limited tools and practices that enables policy makers to take health into account when designing urban policies. By not bringing health into the agenda of urban planning, the toll of disease and deaths in LMICs is increasing.

Douala, Cameroon. Edouard Tamba / Unsplash

Currently, LMICs have 80% of global non-communicable diseases (NCD) deaths, 92% of pollution-related deaths and 90% of traffic-related deaths in the world. The concentration and multiplication of urban settlements in LMICs are happening in restricted corridors causing overcrowded housing, slums, unsafe working conditions, lack of access to clean water and decent sanitation, social exclusion, increased motorization, and cumulative poor transport planning.

Currently, LMICs have 80% of global non-communicable diseases (NCD) deaths, 92% of pollution-related deaths and 90% of traffic-related deaths in the world

Increasing Challenges

Countries face the risk of getting locked in unhealthy and unsustainable systems, if decision-makers fail to consider the dimension of health on urban agendas. Urban policies can play a crucial role in preserving or degrading human health and acting on them can decrease premature deaths caused by road crashes, sedentary lifestyles, and traffic related environmental exposure.

As a major by-product of urbanization and motorization, air pollution is the largest environmental cause of disease and deaths in the world. About 90% of urban air pollution in rapidly growing cities in LMICs is caused by transport emissions. Air pollution in African cities alone costs 2.7% of national GDP. East and south East Asian countries suffer 59% of all global deaths related to air pollution.

As a major by-product of urbanization and motorization, air pollution is the largest environmental cause of disease and deaths in the world. Air pollution in African cities alone costs 2.7% of national GDP

The lack of physical activity is causing more than two million premature deaths per year in the world. Studies in several African countries show that sedentary lifestyles induced by urbanization are causing diabetes, high blood pressure and obesity. With unprecedented urbanization, commuting populations in Africa are also exposed to unsafe roads with an increase in road injuries by 33% in the last 20 years. Heat in Africa is predicted to increase 20-fold by the end of the century, casting an important threat on human health and lives.

Nairobi, Kenia. Peter Usher / Unsplash

Health Impact Assessment as a Tool for Urban Health

Tools such as Health Impact Assessment (HIA) are known to support the integration of health into wider policy agendas focused on urban development. HIAs can contribute to advancing cities where many political and institutional decisions are taken without considering their related health impacts.

This assessment tool estimates potential health effects —both negative and positive— a proposed policy, program, or particular intervention might have on population health. Results from several studies support that HIAs can support stakeholders to make informed decisions before, during, and after interventions or policies are framed and implemented.

HIAs are increasingly common in rich countries, but are extremely underused in LMICs. In a review, peer-reviewed HIAs were found in only 26 out of 156 LMICs. Most HIAs focus on health impacts of exposure to air pollution, but other urban-related factors such as transport and housing were less covered. The lack of resources and data scarcity can challenge the scaling and improving of HIA implementation in LMICs. These challenges can be addressed if HIA experts and local stakeholders adapt existing HIA models and tools to set affordances and needs in local settings.

Health Impact Assessment (HIAs) are increasingly common in rich countries, but are extremely underused in LMICs

Way Forward

What would, for instance, happen if policy makers continue to implement measures without considering health impacts? Urban interventions would run the risk of being deployed in silos and with very little impact on health and quality of life of urban populations.

Kampala, Uganda. Drew Wilson / Unsplash

Currently, there are very few tools that connect health and urban planning to the realms of policy-making because such endeavor requires strong governance, intersectoral collaboration and equity-driven practices. For this reason, impact assessments provide unprecedented flexibility and scientific validity to estimate health risks that can inform policy-making in LMICs. In order to support such assessments, more environmental health studies are needed to identify and monitor risk factors, especially in countries facing rapid urbanization and having weaker epidemiological surveillance systems.

Impact assessments provide unprecedented flexibility and scientific validity to estimate health risks that can inform policy-making in LMICs

Ultimately, HIAs can improve the development of healthy and sustainable urban networks while encouraging stakeholders to actively contribute to the future of their cities. In this way, bringing health into urban agendas can play a crucial role in boosting governance and achieving equity in cities of LMICs for healthier and brighter futures.