The Urban health crisis : strategies for health for all in the face of rapid urbanization, report of the Technical Discussions at the Forty-fourth World Health Assembly

Abstract

Responds to concern over the impending health crisis in urban areas, where explosive population growth has outstripped the capacity of local authorities to provide basic services, and where conditions favouring poor health are increasingly the norm. Adopting a public health approach, the book aims to guide decision-makers in setting priorities and selecting the most realistic policy options, particularly in situations characterized by escalating problems and dwindling resources. Throughout, recommended lines of action are presented within the context of a "new public health", which recognizes the need for a balanced mix of environmental change, personal prevention measures, and appropriate therapeutic interventions. The book has seven chapters. The first explains the many factors that have converged to make the urban health crisis so pressing. In situations where cities have outgrown the capacity of the surrounding land to provide sufficient resources, problems cited include a vicious circle of environmental deterioration, reduced agricultural productivity, natural disasters, increased poverty and landlessness, and the creation of ideal conditions for epidemics of both chronic and communicable diseases. Since rapid migration to the cities is often accompanied by the breakdown of families and social supports, the book also draws attention to the additional problems posed by AIDS, drug abuse, and a high prevalence of mental disorders. Demographic factors are considered in the second chapter, which describes recent trends and identifies some of the causes of rapid urban growth. The chapter also explains several conditions that help account for the continuing migration to cities and the maintenance of relatively high fertility rates, even when family planning programmes are in place. Against this background, the third and most extensive chapter considers the importance of urban environmental health services and explains why their responsibilities need to be expanded to include the ecological problems that now threaten health in most urban areas. Since so many different components of urban life can affect health, the chapter also argues for an intersectoral approach that regards environmental health as an integral part of overall urban development. The chapter concludes with a discussion of the main threats to health, characteristic of urban life, that can be reduced through effective environmental health services. These range from the provision of safe water and food, through waste disposal and pollution control, to occupational safety and the prevention of accidents and disasters. Chapter four outlines the changes in health services needed to meet the challenges of rapid urbanization. Concentrating on the needs of the urban poor, the chapter identifies four main characteristics of services capable of meeting a population's health needs, and then explains why a district health system based on primary health care provides a key approach to meeting these needs. Suggested lines of action are supported by examples of several innovative programmes that have had a significant impact on health. The remaining chapters describe city network projects, including the WHO Healthy Cities project, and discuss the importance of comprehensive urban health policies, since many of the conditions having a major impact on health are subject to rules, regulations, and laws