A National Policy Challenge: Urbanization, Poverty and Health in Africa

Transcription

1 A National Policy Challenge: Urbanization, Poverty and Health in Africa Jean Christophe Fotso, PhD President, International Society for Urban Health (ISUH) Head, Pop & RH, APHRC, Nairobi, Kenya 20 th IUHPE World Conference on Health Promotion Geneva, Switzerland, July 11-15,

2 An Urbanized World For the first time in history, more than 50% of the world s population lives in urban areas Proportion expected to reach 70% by 2050 Not surprising: 2010 World Health Day - Urbanization and Health Infrastructure, institutional capacity and living conditions in LMIC S cities are already challenged Urban health challenges: Water, sanitation and air pollution Unhealthy diet, physical inactivity and NCDs Violence, injury alcohol/tobacco use, disease outbreak 2

3 SSA s Urban & Rural Populations 1,800 1,600 1,400 Pop in millions 1,200 1, Total Urban Rural Source: United Nations 3

4 SSA s Urban & Rural Populations Percentage (%) Urban Rural Source: United Nations 4

5 SSA s Urban & Rural Populations Pace of increase Total Urban Rural Source: United Nations 5

6 Urban Growth amidst Poor Economic Development [1] Speed of urbanization has outpaced the ability of governments to provide essential social and health infrastructure. Africa s urbanization & cities are not serving as engines of growth & structural transformation, but are part of the cause and major symptom of the economic and social crisis that has enveloped the continent (WB, 2000). Large proportions of the urban population in most SSA countries are living in life and health threatening homes or neighborhood from urban advantage to urban penalty 6

7 Urban Growth amidst Poor Economic Development [2] The locus of poverty is gradually shifting from rural to urban areas, as the number of poor and is increasing more quickly in cities than in rural areas The private sector is far more present in the supply side of urban health systems in cities than in rural areas More monetized urban health care Urban access to basic public services is generally good. For the urban poor, these are either deficient or inexistent. 7

8 Urban Growth amidst Poor Economic Development [2] Health and other social averages mask the conditions of the urban poor. Where data exist: Large and often widening gap between the poor and the non-poor in various aspects of health and wellbeing in urban areas Generally the urban poor exhibits worse health outcomes that the rural population The locus of poverty is gradually shifting from rural to urban areas, as the number of poor and is increasing more quickly in cities than in rural areas 8

9 Majority of urban residents in SSA live in slums, with poor social services and livelihood opportunities 120% 100% 99% 92% 80% 72% 79% 71% 60% 50% 40% 32% 33% 20% 0% World Sub- Saharan Africa Nigeria Ethiopia DRC South Africa Kenya UNHABITAT, 2003 Tanzania 9

10 Poor access to health services 10

11 Poor access to sanitation 11

12 What to Do? - Population Perspective Reposition population, FP and RH on the policy and development agenda FP enhances social development by alleviating poverty; improving the environment, water, and sanitation; and increasing access to education. FP programs are essential to achieving development targets including the MDGs (Gates F s FP Strategy) Deliberate efforts to target the urban poor and reduce urban health inequities Failing to appropriately target the growing urban poor population and improve their living conditions and health status may result in lack of progress towards the MDGs and other development goals 12

13 Actions to Reduce UHI GRNUHE Urban planning: Reconnecting UP & PH; Integrated city-wide planning Improving social conditions: Working conditions & community empowerment; Cities safer thru UP Action on climate change Integrated action on planning and design, social conditions and climate change Urban governance Monitoring and evaluation Source: GRNUHE s Report, July

14 What Can Cities Do? WHO Promote urban planning for healthy behaviors and safety Improve urban living conditions, including access to adequate water and shelter for all Involve community in local decision-making Ensure cities are accessible and age-friendly Make urban areas resilient to emergencies and disasters Source: WHO,

15 Thank you 15