Nutrition and Health in the Urban World

The way in which people eat is a major determinant of their nutritional stores and status, but issues of life style, health and pollution modify and influence the nutriture of individuals and populations. Each of these factors contributes to the distribution of the simultaneous under- and overnutrition states that characterize nutrition transition.

Labor market shocks impact on maternal pursuits, child work, and schooling. Rural children have traditionally worked on both household and farm chores as part of an integrated family-production pattern. In urban areas, mere economic survival often obligates families to send children to work in factories at low wages, exposing them to occupational risk and interfering with their formal education. To the extent that urban mothers seek income-generating activities outside of the home, monetary resources may be bolstered by child-rearing and child-caring and meal provision can be disrupted. Breast-feeding is one form of meal provision, i.e., that for the infant, that can be influenced adversely by maternal work obligations. In general, less exclusive breast-feeding and shorter total lactation are seen in urban mothers as compared to their counterparts in the countryside.

Urban poverty and undernutrition are growing, in part because of the influx of migrants. Spatial distribution of the pockets of poverty can often be identified on a map of the city. The unempowered and abjectly poor tend to congregate in the least desirable and most precarious areas of the urban landscape. It has been established that such groups have scarce municipal services and low incomes. The relative social power of women in such households is vastly inferior to that of the men. True food insecurity is a legitimate concern in these zones of urban poverty.

Finally, pollution, some of which has its negative effect on the population by contaminating the food supply, cannot be ignored. In Jakarta, where leaded gasoline is still the norm, individuals spending time on the streets became contaminated. Poor air quality (smog) can provoke respiratory distress with a cascade effect on appetite, regular eating, and nutrient retention.

Nutritional Deficiencies of Urban Populations

At a physiological level, nutritional status is a function of the intake, absorption, and retention of nutrients. Any of the micronutrient deficiencies common to human populations can be seen in residents of towns and cities. Household food insecurity or poor caring practices can explain low intakes of total macronutrients or diets with poor micronutri-ent density and bioavailability. To the extent that sanitation may be better in the urban setting, disease-related wastage of nutrients may contribute less to the process of general undernutrition reflected in poorer growth and higher prevalences of stunting and wasting.

Iron deficiency is prevalent in infants, young children, fertile women, and pregnant and lactating women, independent of social class or setting. If lead exposure is present in the cities, this can aggravate iron status, especially of the young. In the broadest generality, micronutrient deficiencies are less frequent among urban populations, but a residual prevalence of poor status with respect to ribo-flavin, zinc, folic acid, and vitamin B12 is common in low-income segments of urban populations. Intervention programs are logistically more accessible to urban populations, but relief agencies often direct and target their assistance to the countryside, bypassing the problem that may exist around their headquarters in Third World capitals.

Social determinants related to poverty in urban communities and households constitute the underlying reasons for impaired growth and poorer anthropometric indices. Discrepancies in women's status, that is their social and economic power relative to men in the same households and societies, has a profound influence on the status of their children and the risk of the latter to suffer stunting and wasting. Greater equality between the sexes generally results in overall improved prenatal, obstetrical, and child care, better complementary feeding and treatment of illness, and higher immunization rates. Urban settings would generally tend to foster less traditional social views and provide women with more options for self-realization. Moreover, campaigns and programs for empowering women through education and entry into the work-force would be logistically easier to maintain in towns and cities. Hence, both the better general nutritional status of children in cities may be a consequence of trends toward a greater equality of women and improved decision-making power in favor of their children's nutritional evolution.

Survival through and beyond infancy and preschool years with generally more favorable nutritional status than one's rural counterparts is likely to be reflected in continued better nutriture into childhood and adolescence. A phenomenon of family disintegration, more commonly seen in urban communities, has led to the proliferation of street children who live in the street or of the street. Several aspects of the stereotypical portrait of their life style, including abuse of glue and illicit drugs and participation in child prostitution, would point to increased risks of organic damage and sexually transmitted disease, including HIV/ AIDS. On the other hand, through the various modalities of obtaining income from legitimate sales and tasks, to extorsion, theft, and prostitution on the illegitimate side, street children have more disposable income than other urban children from equally humble origins but dependent on meager household means. Little research into comparative nutritional status of street children in the urban setting has been conducted, but fragmentary findings suggest that their income and ingenuity provides them with a more diverse diet than their homebound peers.

The urban elderly are another generational group of concern in terms of their risk to suffer nutritional deficiencies. To the extent that their age, per se, makes them more susceptible to undernutrition and social isolation, with the weakening of extended family traditions, and afflicts more urban than rural elders, their situation in the urban context can be more nutritionally precarious.

HIV/AIDS can be more of an urban or a rural health problem depending upon the country in question, its patterns of transmission, and the specific differences of urban and rural culture. Wherever it occurs, for HIV-infected individuals their disease represents a double burden for their nutrition. On the one hand, the ravages of the infection interfere with appetite, disrupt metabolism and deplete nutrient reserves; on the other hand, lost income and the cost of treating the illness jeopardizes individual food budgets and poses the risk of household food security.

Nutritional Excess in Urban Populations

The most important nutritional excesses to consider are those of overweight. This is officially defined as a body mass index (BMI) of >25 kg/m2. For children, overweight begins at the 85th percentile of normative curves and obesity at the 95th percentile, as defined on the 2000 BMI charts of the US Center for Disease Control and Prevention.

Physical activity patterns are altered from the traditional rural focus role of food production. Even construction and manufacturing work requires increasingly less physical effort. Household chores are favored by electrical labor-saving devices and home delivery of goods and services such as fuel and water. For both adults and children, sports and active recreational pursuits are being replaced by television watching and computer entertainment, including internet, in urban settings. Much of the increase in the number of overweight individuals in cities is ascribed to sedentariness. A new and troubling association of stunted child-overweight mother pairs has been identified, but it is not restricted to urban families. However, low stature seems to be a risk factor for overnutrition as confirmed in China, Singapore, Brazil, and Mexico, especially in their urban areas.

The tendency not only to eat away from home but also omit specific meals is an innovation of modern urban life; family integrity at mealtimes is more traditionally observed in rural areas Not consuming breakfast is a habit surging in urban households and with it comes proven deficits in attention span and school and work performance. Paradoxically, breakfast-skipping behavior is found to be associated with generally less physical activity and more sedentary life styles and is also linked to excess weight gain. Moreover, higher usage of alcohol and tobacco are found in those who regularly skip the breakfast meal.

Vitamin or mineral excess as a public health problem is rare. It generally occurs as the result of excessive consumption of micronutrient supplements, and this would be more likely to take place in the urban setting.

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