Response of health systems to urbanization in developing countries.

Equity in access to health care is now accepted as a basic ethical principle for health development. The glaring inequalities in health suffered by poor people living in slums are a strong justification for urgent action. The problem is rapidly increasing.

PIP: With the industrial revolution, peasants began moving into towns in industrializing countries, beginning a slow, but steady process of urbanization. At the beginning of the 19th century, just 3% of the world's population lived in towns. However, after the Second World War, large numbers of people migrated to urban areas at rapid rates, especially in the newly independent and Latin American countries. By 2015, approximately 20% of the urban population in developing countries will be living in 27 megacities and an additional 28% will be living in approximately 700 cities with populations larger than 500,000. Weak administrative structures and limited resources will be the norm in many of these cities as populations grow rapidly and uncontrolled. In the shantytowns of developing countries, health hazards are associated with the prevailing poverty, lack of water and sanitation, and substandard housing; changes in living conditions and lifestyles; chronic diseases related to modernization; lung diseases; accidents; mental and psychosomatic disorders; and social instability, cultural and social alienation, and the social and mental ill-effects of degrading living conditions and extreme crowding. While urban health care absorbs the bulk of most national health budgets, up to 85% of those funds are spent on curative services delivered through large specialist hospitals located in the cities. Many people in the surrounding shantytowns and slums have no access to cities' services or do not use them because they do not respond to their needs. The health services which are available tend to be poorly managed. Political will can, however, lead to improved urban health.

Tell the world!

Mass media--friend or foe? Radio, television, and/or the printed word regularly enter most of the world's households. With a better understanding between health workers and those who produce what we hear, see and read, positive messages could do much to change the habits the jeopardize health. Clear, accurate information is the first step towards improvement.

New hope for safe motherhood.

PIP: In Africa 150,000 or 700 out of every 100,000 women die in childbirth every year. Meeting in Niamey (Niger), health workers, representatives of women's organizations, and policy makers from 22 French-speaking African countries appealed to the international community to help them halve Africa,s maternal mortality and morbidity by year 2000. The delegates watched a video in which a woman, hemorrhaging during her 7th delivery, attended only by an old neighbor, dies after a 2-hour journey by oxcart to a hospital where there is not enough blood on hand to save her. Only 36% of deliveries in Africa are attended by trained personnel. The World Bank has estimated that an investment of $1/person in health care would reduce maternal mortality by 20% and $2 would reduce it by 66%.^ieng