Threats to Health among the Urban Poor

The topic of health among urban poor is a critical global issue since approximately one third of the world's poor live in cities (McDade & Adair, 2001). At least 80% of urban areas are in underdeveloped areas of the world that often lack adequate infrastructures (Kendall et al., 1991), meaning that there are too few or sufficiently developed public health care, sanitation, and transportation systems in these areas to provide people with basic living necessities and consistent health care. Health among the urban poor in the United States and other developed countries is in some ways distinct from health in poor urban areas in the developing world. Yet the experiences of the urban poor in industrialized and developing countries have commonalities, particularly in regards to morbidity and mortality rates. For example, Fullilove, Green, and Fullilove (1999) cite research demonstrating that survival rates among inner city men over the age of 40 in the United States are lower than those of similarly aged men in Bangladesh. In this section, I will briefly synthesize findings on compromised health and disease among the urban poor. The following health issues are not all specific to urban health, but considered in concert with other biological, cultural, and structural variables, are salient to the holistic picture of health among the urban poor.

The population density found most often in closely inhabited urban centers and settlements is a critical condition for epidemics such as the plague, measles, influenza, poliomyelitis, tuberculosis, and the HIV/AIDS pandemic to thrive, spread, and exist at endemic levels (Armelagos, Ryan, & Leatherman, 1990). The devastating spread of HIV/AIDS through both urban and rural areas of the world has been further facilitated by factors including migration for employment, and the interconnection between sex work, and high-mobility occupations such as truck driving (e.g., Decosas & Padian, 2002; Voeten, Egesah, Ondiege, Varkevisser, & Habbema, 2002). Large-scale societies with high birth rates permit a rapid production and replacement of disease hosts (Schell, 1996). Because of the dense concentration of people in urban centers, sanitation has been a past problem for now-industrialized countries, and remains a persistent problem for less developed countries. Although all urban dwellers are exposed to environmental pollutants and toxins (Schell, 1996), the poor do not always have the option of living in asbestos-free or lead-free housing. The most obvious result of burgeoning populations in urban areas worldwide is the lack of habitable, economically priced shelter, forcing the poor into overcrowded conditions (Bashem, 1978). Overcrowding has been linked to health problems stemming from inadequate sanitation services, the rapid spread of communicable disease, and stress. Research done among African Americans in the United States has demonstrated that stress levels, high among poor groups experiencing the effects of racism, have a noticeably negative effect on health (Dressler, 1990, 1993).

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