Healthy People, Healthy Cities, Healthy Economies

OXFORDThe forces that drove the growth of European and North American cities in the nineteenth and twentieth centuries are now driving urbanization in Brazil, China, India, Mexico, Russia, and other emerging-market countries. Because the growth of these cities has been accelerated and magnified by productive technologies, rapid internal migration, and high net reproduction rates, many have reached unprecedented sizes at breathless speed. Indeed, all but three of the world’s 20 largest cities are in emerging markets.

Many forecasts suggest that by 2030, the four largest emerging-market economies will have overtaken the G-7 in combined size, and that by 2050, today’s emerging-market economies will represent more than half the global economy and an even larger share of the world’s population. These forecasts all assume that economic growth will be generated in cities.

But will emerging-market cities be healthy enough to drive rapid economic growth? The issues that preoccupy health policymakers and practitioners in Lima, Cairo, Kolkata, and Jakarta reflect contrasting climates, geographies, histories, and cultures. Each city is ultimately a special case. But they share some generic features.

One is that the urban disease burden is shifting from infectious to chronic diseases – the so-called “diseases of affluence.” But the urban poor, faced with bad housing, limited infrastructure, and meager services, are vulnerable to epidemics, malnutrition-based childhood diseases, HIV/AIDS, malaria, tuberculosis, and mental disorders. They are also likely to be hardest hit by natural disasters, such as the floods and mudslides that devastated parts of Rio de Janeiro in January.