The world crossed a significant population threshhold a few years ago, when for the first time in history the majority of people were living in urban areas. Today, on UN World Habitat Day, it is timely then for us to consider again more sustainable approaches to urban development. This year’s theme – ‘Better City, Better Life’ – speaks to a truly gloomy contemporary world housing situation against which the UN is left to only envision: ‘a sustainable urban world which harnesses the potential and possibilities, mitigates inequalities and disparities and provides a home for people of all cultures and ages, both rich and poor’.
But how can this be realistically achieved?
City populations are growing and the developing world is experiencing 95% of this urban growth resulting in estimates of about 4 billion urban inhabitants or 60% of the world population by 2030. According to UN-HABITAT, 65 million people will be added to the urban resident count each year between 2000 and 2015. If the present situation is anything to go by, the future looks bleak for many of these future residents as currently nearly a third of the global urban population live in urban slums.
Due to its rapid and often unplanned nature amongst disadvantaged populations, urbanization is often associated with adverse health outcomes.
Poor housing environments contribute to ill health through poor amenities, shared facilities, overcrowding, inadequate heating or energy inefficiency. Yet these issues do not only affect the developing world. In England alone, 1.4 million children live in bad housing while 7.7 million homes in England fail to meet the Government’s Decent Homes Standard, which sets a minimum standard for housing.
Cold, damp, mouldy, and overcrowded living conditions pose the highest risks to health. One of the most worrying implications of inadequate housing/living conditions in the UK is its effect on tuberculosis transmission. More than 8000 new cases of TB are reported each year in the UK, and 2008 saw a 2.2% increase in cases from the previous year. Particularly shocking is that the highest rates of TB in London – found in areas such as the borough of Brent in northwest of the city – are comparable to rates found in some developing countries.
It is no coincidence that in the same area – according to the 2001 Census – 22,991 children were living in overcrowded households. The facts are thus unavoidable. A report by London Assembly’s Health Council has insightfully stated that TB is, and always has been, a disease engendered by poverty. This work has confirmed that social and economic deprivation, particularly bad housing, is a breeding ground for TB bacteria. In sum: an individual’s chances of developing active TB are exacerbated by poor living
conditions, in particular overcrowding and poor ventilation.
So then where can the better cities and better lives start happening? ARCHIVE sees improved housing/living conditions as a central strategy for preventing disease transmission. Improved housing elicits improved health, better shields against the effects of climate change and helps scale-up lifestyles. One of the most disproportionately affected communities in the UK is refugees and migrants who provide the focal point for ARCHIVE’s Northwest London project. Statistics confirm the UK situation which we are confronting: the majority of TB cases occur in the non-UK-born (72%) and those aged 15-44 years (61%). This project therefore seeks to make these at-risk communities cogniant of the relationship between poor living conditions and the prevalence of active TB.
Community capacity needs to be built to achieve primary prevention by publicizing the importance
of fixing housing-related health hazards before they cause poor health. Practical solutions do exist to identify accessible and affordable tools that can make and keep every home healthy. Of course there are policies insisting that housing be decent and environmentally safe for all – but are these actually being heeded within the London private rental market when the financially disadvantaged make for particularly vulnerable tenants? Improving urban living conditions globally, especially in the areas of housing, water and sanitation will go a long way towards reducing health risks. So from today onwards, let us indeed not just to contemplate, but to take action, to achive better cities, and better lives.
Diana Inegbenebor is a researcher on ARCHIVE’s UK team. She trained as a physician and has clinical experience in Nigeria. Diana received a Masters degree in Tropical Medicine and International Health, and a Diploma in Tropical Medicine and Hygiene, from the London School of Hygiene and Tropical Medicine (LSHTM). She is a fellow of the Royal Society of Tropical Medicine and Hygiene (RSHTM) and a member of the Global Health Council.