WHO – Megacities and urban health
WHO – Megacities and urban health. December 2009.
Full-text: http://www.who.or.jp/2009/reports/Megacities_Report_DEC09.pdf (pdf, 275KB)
Megacities are cities of 10 million or more inhabitants. There are more than 20 megacities in the world and they are highly diverse. They concentrate national and global economic and political power as well as scientific, political and media attention. When analysing health in megacities, it is difficult to separate the effect of size from other variables. However, cities of similar size do not necessarily suffer from the same problems, and at the same time common issues can be found among cities of very different dimensions. Nevertheless, starting with an analysis of their common characteristics, we identify nine challenges that megacities face which have particular health impact: transportation, governance, water and sanitation, safety, food security, water and sanitation, health care, emergency preparedness, and environmental issues. Each challenge is analysed in terms of its relationship with urban health. They are highly influenced by the complexity of megacities in terms of population size, geographical extension, social inequalities, and usually multiple and fragmented metropolitan governments. We conclude that given the variation among megacities and the extent of commonalities between megacities and other lower population settings, the relevance of the megacity as a category in urban health is limited. Yet the identification of these challenges, and the different ways in which they are being handled, is useful for shedding light on determinants of health and potential intersectoral interventions in a range of urban settings well beyond this group of cities.
India and China lift millions out of slums: UN
India and China have together lifted at least 125 million out of slums between 1990 and 2010, and improved the lives of slum dwellers more than any other country, a new UN report has said.
India has lifted 59.7 million people out of slum conditions since 2000. Slum prevalence fell from 41.5 per cent in 1990 to 28.1 per cent in 2010. This is a relative decrease of 32 per cent, the study found, according to the report called State of the World’s Cities 2010/2011.
“Lessening poverty and improving conditions in slums are part of India’s urban development policy,” the report said, pointing out four main reasons for it.
First, building the skills of the urban poor in their chosen businesses, and by providing them micro-credit. Second, providing basic services and development within slum settlements, thus improving living conditions.
Third, providing security of tenure to poor families living in unauthorised settlements, improving their access to serviced low-cost housing and subsidised housing finance. Fourth, encouraging the poor to take part in decision-making and community development efforts.
China has made the greatest progress on this front with improvements to the daily conditions of 65.3 million urban residents, the report said.
Proportionally, China’s urban population living in slums fell from 37.3 per cent in 2000 to some 28 per cent in 2010, a relative decrease of 25 per cent.
“Despite growing inequality due to the country’s rapid economic advance, China has improved living conditions by embracing economic reforms and implementing modernisation policies that have used urbanisation to drive national growth,” the report said.
Overall, the report finds that 227 million people in the world have moved out of slum conditions since 2000. At the same time, the study also stresses that 55 million new slum dwellers have been added to the global urban population since 2000.
“However, this achievement is not uniformly distributed across regions,” said Anna Tibaijuka, head of the UN Human Settlements Programme.
“Success is highly skewed towards the more advanced emerging economies, while poorer countries have not done as well,” she said.
Overall, the UN report finds that the number of people living in slums has risen from 777 million in 2000 to 830 million in 2010, and warns that unless urgent steps are taken the number could rise to 900 million in 2020.
Source – http://www.business-standard.com/india/news/indiachina-lift-millions-outslums-un/88943/on
Progress on sanitation & drinking water – 2010 update
Access to safe drinking water improving; sanitation needs greater efforts
Link - Progress on Sanitation and Drinking-Water –2010 Update Report
15 MARCH 2010 | GENEVA | NEW YORK — With 87% of the world’s population or approximately 5.9 billion people using safe drinking-water sources, the world is on track to meet or even exceed the drinking-water target of the Millennium Development Goals (MDGs), according to the new WHO/UNICEF Joint Monitoring Programme (JMP) report Progress on Sanitation and Drinking-Water –2010 Update Report, released today.
More needs to be done for sanitation
However, with almost 39% of the world’s population or over 2.6 billion people living without improved sanitation facilities, the report also points out that much more needs to be done to come close to the sanitation MDG target. If the current trend continues unchanged, the international community will miss the 2015 sanitation MDG by almost one billion people.
Improvements
The good news is that open defecation – the riskiest sanitation practice of all – is on the decline worldwide, with a global decrease from 25% in 1990 to 17% in 2008, representing a decrease of 168 million people practicing open defecation since 1990. However, this practice is still widely spread in Southern Asia, where an estimated 44% of the population defecate in the open.
Joint Monitoring Programme report
The JMP report presents the current status and trends in 209 countries or territories towards reaching the drinking-water and sanitation MDG target, along with an assessment as to what these trends reveal.
“We all recognize the vital importance of water and sanitation to human health and well-being and their role as an engine of development. The question now lies in how to accelerate progress towards achieving the MDG targets and most importantly how to leap a step further to ultimately achieve the vision of universal access”, said Dr Maria Neira, WHO’s Director for the Department of Public Health and Environment.
This report provides the clearest picture to date of the current use of improved sanitation facilities and improved sources of drinking-water throughout the world. The report is aimed to be used by policy-makers, donors, governmental and nongovernmental agencies to decide what needs to be done and where to focus their efforts to achieve these goals.
“We need to not only focus on reaching the water and sanitation MDG targets but also on achieving them with equity, ensuring that the most vulnerable groups and those hard to reach share in the successes achieved elsewhere,” said Dr Tessa Wardlaw, UNICEF’s Chief of Statistics and Monitoring.
Rural areas lagging
Despite the world’s population being almost equally divided between urban and rural dwellers, the vast majority without access to water and sanitation live in rural areas. Seven out of ten people without basic sanitation are rural inhabitants and more than eight out of ten people without access to improved drinking-water sources live in rural areas.
Disparity between rich and poor
A similar disparity is found between the poor and non-poor. A comparison between the richest and poorest 20% of the population in sub-Saharan Africa reveals that the richest are more than twice as likely to use an improved drinking-water source and almost five times more likely to use improved sanitation facilities. Although there is insufficient data at present, country data available confirms similar disparities elsewhere.
“With only five more years to go until 2015, a major leap in efforts and investments in sanitation is needed today in order to have an impact by the time we carry out our end-of-MDG evaluation,” said Robert Bos, Coordinator, Water, Sanitation, Hygiene and Health at WHO.
Unsafe water, sanitation and hygiene claim the lives of an estimated 1.5 million children under the age of five each year. Lack of access to water, sanitation and hygiene affects the health, security, livelihood and quality of life for children, impacting women and girls first and most. They are much more likely than men and boys to be the ones burdened with collecting drinking-water.
About the JMP
“With almost 884 million people living without access to safe drinking-water and approximately three times that number lacking basic sanitation we must act now as one global community to ensure water and sanitation for all,” said Ms Clarissa Brocklehurst, UNICEF Chief of the Water, Sanitation and Hygiene (WASH).
The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation is the official UN mechanism tasked with monitoring progress towards MDG Target 7c on drinking water supply and sanitation. The report includes information from household surveys and censuses completed during the period 1985–2008. A record number of nearly 300 datasets were added to the global database for this year’s report. Importantly, the newer data have not yet registered the impact of the International Year of Sanitation (2008), which it is hoped will make a significant difference to the rate of progress towards the MDG sanitation target.
World Bank – Density and disasters: economics of urban hazard risk
Density and disasters: economics of urban hazard risk, Dec. 2009. Policy Research Working Paper.
Link: Full-text (pdf, 1.54MB)
S. Lall
Today, 370 million people live in cities in earthquake prone areas and 310 million in cities with high probability of tropical cyclones. By 2050, these numbers are likely to more than double. Mortality risk therefore is highly concentrated in many of the worlds cities and economic risk even more so. This paper discusses what sets hazard risk in urban areas apart, provides estimates of valuation of hazard risk, and discusses implications for individual mitigation and public policy. The main conclusions are that urban agglomeration economies change the cost-benefit calculation of hazard mitigation, that good hazard management is first and foremost good general urban management, and that the public sector must perform better in generating and disseminating credible information on hazard risk in cities.
World Bank – Short-term impact of higher food prices on poverty in Uganda-
The short-term impact of higher food prices on poverty in Uganda, 2010.
Policy Research Working Paper.
K. Simler.
Link to: Full-text (pdf, 866KB)
World prices for staple foods increased between 2006 and 2008, and accelerated sharply in 2008. Initial analysis indicated that the adverse effects of higher food prices in Uganda were likely to be small because of the diversity of its staple foods, high level of food self-sufficiency, and weak links with world markets. This paper extends the previous analyses, disaggregating by regions and individual food items, using more recent price data, and estimating the impact on consumption poverty. The analysis finds that poor households in Uganda tend to be net buyers of food staples, and therefore suffer welfare losses when food prices increase. This is most pronounced in urban areas, but holds true for most rural households as well. The diversity of staple foods has not been an effective buffer because of price increases across a range of staple foods. The paper estimates that both the incidence and depth of poverty have increased — at least in the short run — as a result of higher food prices in 2008, increasing by 2.6 and 2.2 percentage points, respectively. The increase in poverty is highest in the Northern region, which is already the poorest in Uganda. The need for mitigating social protection measures appears to be greater than previously recognized. Not only are the negative impacts larger, but they are also much more widespread geographically. This suggests the need for continued close monitoring of the situation, including monitoring the adequacy of existing safety nets and feeding programs.
Childhood lead exposure in Kampala, Uganda
Environ Health Perspect. 2010 Mar 1.
Childhood Lead Exposure After the Phase-out of Leaded Gasoline: An Ecological Study of School-Age Children in Kampala, Uganda.
Graber LK, Asher D, Anandaraja N, Bopp RF, Merrill K, Cullen MR, Luboga S, Trasande L. Yale University School of Medicine.
Background: Tetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country’s capital.
Objectives: To determine blood lead (BLL) distributions among Kampala schoolchildren, and identify risk factors for elevated blood lead levels (EBLL; >/=10 microg/dL).
Analytical Approach: Using a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4-8 year old children, representing communities with different risks of exposure.
Results: The mean BLL was 7.15 microg/dL; 20.5% were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLL and likelihood of EBLL. Distance <.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 microg/dL, p<.0001) and likelihood of EBLL (OR=4.71, p=.0093). Dust/soil lead was not significantly predictive of BLL/EBLL.
Conclusions: Lead poisoning remains highly prevalent among school-aged children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. While African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.
Migration and Child Immunization in Nigeria: Individual- and community-level contexts
Vaccine-preventable diseases are responsible for severe rates of morbidity and mortality in Africa. Despite the availability of appropriate vaccines for routine use on infants, vaccine-preventable diseases are highly endemic throughout sub-Saharan Africa. Widespread disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria.
This study assessed the individual- and community-level explanatory factors associated with child immunization differentials between migrant and non-migrant groups.
Methods: The proportion of children that received each of the eight vaccines in the routine immunization schedule in Nigeria was estimated. Multilevel multivariable regression analysis was performed on a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics.
Results: The pattern of full immunization clusters within families and communities. Findings provide support for the traditional migration hypotheses, and show that individual-level characteristics, such as, migrant disruption (migration itself), selectivity (demographic and socio-economic characteristics), and adaptation (health care utilization), as well as community-level characteristics (region of residence, and proportion of mothers who had hospital delivery) are important in explaining the differentials in full immunization among the children.
Conclusions: Migration is an important determinant of child immunization uptake. This study stresses the need for community-level efforts at increasing female education, measures aimed at alleviating poverty for residents in urban and remote rural areas, and improving the equitable distribution of maternal and child health services.
Author: Diddy Antai Credits/Source: BMC Public Health 2010, 10:116
World Urban Forum, March 22-26, 2010 – Brazil
The theme for Rio 2010, The right to the City– bridging the urban divide is in harmony with UN-HABITAT’s flagship report, State of the World’s Cities 2010-2011. 
Link: http://www.unhabitat.org/categories.asp?catid=584
Concepts that will drive the discussions in Rio include the right to the city, bridging urban income gaps, reducing inequality and poverty, participatory democracy, cultural diversity in cities, women-friendly cities, sustainable urban development equal access to shelter, health, water, sanitation and infrastructure services. And of course the right to the inclusive city.
Under the Millennium Development Goals for poverty reduction by the year 2015, governments agreed that these combined with good urban planning, and good governance are the best way foreward for a better urban future.
An agenda of events and discussions will bring to life the ideas drawn from concept documents by international specialists in each of the strategic areas. The idea is to improve the debate at the main sessions and networking events. In this way, the Forum will promote a dialogue and build common commitments that result in new solutions for our cities.
To rethink our urban utopia is the main task. Our challenge now is to learn with the rest of the world, taking into account the needs of our partners so that best practices and actions are multiplied in every city, creating a better world where everyone can live with dignity, respect and citizenship.
Peepoo – Disposable toilet for urban slums
For Pennies, a Disposable Toilet That Could Help Grow Crops
An architect and professor in Stockholm has developed a biodegradable bag that could serve as a single-use toilet in the developing world. A Swedish entrepreneur is trying to market and sell a biodegradable plastic bag that acts as a single-use toilet for urban slums in the developing world.
Once used, the bag can be knotted and buried, and a layer of urea crystals breaks down the waste into fertilizer, killing off disease-producing pathogens found in feces.
The bag, called the Peepoo, is the brainchild of Anders Wilhelmson, an architect and professor in Stockholm.
“Not only is it sanitary,” said Mr. Wilhelmson, who has patented the bag, “they can reuse this to grow crops.”
In his research, he found that urban slums in Kenya, despite being densely populated, had open spaces where waste could be buried.
He also found that slum dwellers there collected their excrement in a plastic bag and disposed of it by flinging it, calling it a “flyaway toilet” or a “helicopter toilet.”
This inspired Mr. Wilhelmson to design the Peepoo, an environmentally friendly alternative that he is confident will turn a profit.
“People will say, ‘It’s valuable to me, but well priced,’ ” he said.
He plans to sell it for about 2 or 3 cents — comparable to the cost of an ordinary plastic bag.
In the developing world, an estimated 2.6 billion people, or about 40 percent of the earth’s population, do not have access to a toilet, according to United Nations figures.
It is a public health crisis: open defecation can contaminate drinking water, and an estimated 1.5 million children worldwide die yearly from diarrhea, largely because of poor sanitation and hygiene.
To mitigate this, the United Nations has a goal to reduce by half the number of people without access to toilets by 2015.
The market for low-cost toilets in the developing world is about a trillion dollars, according to Jack Sim, founder of the World Toilet Organization, a sanitation advocacy group.
As far as toilets go, “the people in the middle class have reached saturation in consumption,” said Mr. Sim, who calls himself a fan of the Peepoo. “This has created a new need, urgently, of looking for a new customer.”
Since 2001, his organization has held an annual World Toilet Summit, and Mr. Sims said he was excited that in recent years there had been an emergence of entrepreneurs devising low-cost solutions.
At the 2009 meeting, Rigel Technology of Singapore unveiled a $30 toilet that separates solid and liquid waste, turning solid waste into compost. Sulabh International, an Indian nonprofit and the host of the World Toilet Summit in 2007, is promoting several low-cost toilets, including one that produces biogas from excrement. The gas can then be used in cooking.
But Therese Dooley, senior adviser on sanitation and hygiene for Unicef, said that inculcating sanitation habits was no easy task.
“It will take a large amount of behavior change,” Ms. Dooley said.
She added that while “the private sector can play a major role, it will never get to the bottom of the pyramid.”
A sizable population, poor and uneducated, will still be left without toilets, Ms. Dooley said, and nonprofits and governments will have to play a large role in distribution and education.
Meanwhile, Mr. Wilhelmson is pushing ahead with the Peepoo.
After successfully testing it for a year in Kenya and India, he said he planned to mass produce the bag this summer.
Focus on Palms and Undercover Bugs to Combat Chagas Disease
The first systematic study of surveillance techniques for the insect vector of Chagas disease in Amazonia, conducted by researchers from the Fiocruz Instituto Leônidas e Maria Deane, the Smithsonian Tropical Research Institute, the London School of Hygiene and Tropical Medicine and colleagues, concludes that tall palm trees with large amounts of debris on their crowns and stems should be targets for disease surveillance and control.
Chagas disease, caused by a parasite transmitted by blood-sucking bugs, results in severe heart, digestive and neurological lesions. Chagas disease is endemic in Latin America where Trypanosoma cruzi infects about 7.5 million people. “The burden of Chagas disease in the Latin American-Caribbean region is still consistently larger than the combined burden of malaria, leprosy, the leishmaniases, lymphatic filariasis, onchocerciasis, schistosomiasis, viral hepatitides B and C, dengue, and the major intestinal nematode infections,” write the authors of the study, published Mar. 2, 2010 in the open-access journal, PLoS Neglected Tropical Diseases.
However, in Amazonia, where there are at least 100,000 infected people, insecticide-based control is not feasible because the insects seldom breed within houses. Most transmission occurs when triatomine bugs emerge from their natural habitats–usually palm trees–and fly into houses, attack rural workers or contaminate food or food-processing equipment.
Ascertaining whether a palm tree is infested is problematic. The small, cryptically-colored bugs easily go undetected. The authors asked whether all palms are equally likely to harbor triatomine bug colonies – while explicitly acknowledging that no detection technique works perfectly. Then, they determined whether palm infestation rates were associated with environmental differences at the regional, landscape, or individual palm tree level. Their study also asked whether palm tree management could lower palm infestation rates.
Building upon analytical methods recently developed by wildlife biologists, the study emphasizes that a disease vector is not necessarily absent from a site where it was not detected during a survey. Such ‘detection failures’ are pervasive – a feature that is inherent to all vector studies. The robust methodology described in this paper is generally suited for investigating vector occurrence and ecology when detection is imperfect.
Based upon this study, vector surveillance teams can now draw upon clearly defined detection criteria. Surveillance teams should consider the circumstances at the origin of a disease outbreak or an isolated acute case. A ‘high-risk’ palm tree will very likely be found near the residence of the patients or near an unprotected fruit press used to prepare contaminated juice. These recommendations are consistent across different Amazon sub-regions and landscapes. Finally, the study suggests that simple environmental management practices, such as removing organic debris from the crowns and stems of peri-domestic palms, may substantially reduce the risk of vector-human contact.
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