Public Health AffairsShelter and health [Archives:2005/881/Health]

September 29 2005

By Dr. Saleh Al-Habshi
Msc. in Public Health

A particular phenomenon in developed and developing countries since World War II has been the rapid population migration from the countryside to major cities. The bright lights of the city prove an irresistible attraction for poverty-stricken families living in the surrounding countryside. They converge in overgrowing numbers on the already over-crowded capital cities, only to face drastic shortcomings in housing, water supply, sewage disposal, local transport and job opportunities. Current patterns of growth of urban population and the proliferation of urban slums and scatter settlements offer a challenge to public health.

The United Nations Human Settlement Programme (UNHSP) reported that, almost half the world's urban population (at least one billion) lives in slums, with the highest percentage of them in Africa, Asia and Latin America. The UN General Secretary Kofi Anan said that slums represented the worst of urban poverty and inequality. The Millennium project identified urbanization as one of the most powerful trends in the world today. Humanity reached its first 1000 million in total population early in the nineteenth century and never looked back. Society has changed considerably since then, but living conditions have changed little for the vast section of mankind. Today, the globe is overpopulated by 6 billion people, and if action is delayed towards this situation, it is expected that the number will be doubled by 2050. The number of slum dwellers is also increasing posing a great burden to public health. A WHO report stated that the global urban slum population is expected to reach 2 billion by 2030, but recent natural disasters make it worse than expectations. The health effects on people who today occupy inadequate and degraded shelter are severe and pervasive, and the implications for the future are even worse. Many children die, more somehow survive, although adverse conditions of habitat are likely to have permanently damaged their chances of normal growth and development.

The extremely unsanitary, unhealthy and hazardous environment of slums contributes to the high mortality of children under five and maternal mortality in developing countries. Most of these deaths could be prevented if developing countries' standards of environmental hygiene and quality of health services could be brought up to those prevailing in industrialized world. The poor comprise the majority of urban population in developing countries, and their needs for housing and community services often outstrip the resources of governments to provide them. In essence, more and more of these urban poor are slipping beyond the reach of governmental support and must provide their own housing and community arrangements. The urban poor live in low quality, overcrowded, self-made shelter, which is only marginally served by public utilities and usually lacks an adequate water supply suitable for drinking and maintaining personal cleanliness. Their resources are not enough for the removal of excreta and other wastes, so that it is common to see rotting garbage, human faeces and associated insect and rodent infestations. Residents of slum areas have little or no access to health care, education, supervised food markets and other facilities, which make for a responsible quality of life and human development. These communities often suffer from greater exposure to dust, unpleasant smells, chemical and noise pollutions and the nature of the dwellings make them less able to withstand such hazards. The residents themselves may unwittingly contribute to disease through unhealthy traditional practices of food preparation, waste disposal and personal hygiene habits. Insufficient and degraded shelter is one result of massive demographic and economic trends, particularly in developing countries, where overpopulation occur due to high fertility rates associated with low public awareness.

In developed nations urban slum dwellers account for 6%. Governments and community efforts are directed to reduce this figure over there. Urban slum population in sub-Saharan Africa reached 71%, whereas it is 40% in Asia. The last two figures share responsibility in the occurrence of many diseases in those regions, like diaorrhea, pneumonias, tuberculosis and mental disorders.

The UN findings revealed that sub-Saharan Africa had the highest rate of slum dwellers with 71% of the urban population living in slums, followed by South Central Asia with 59%, East Asia with 36%, Western Asia with 33% and Latin America and Caribbean with 32%. Although the concentration of slum dwellers is highest in African cities, in number alone, Asia accounts for some 60% of the world's urban slum residents. The total number of slum-dwellers in the world has increased dramatically by about 36% since 1990.

Despite adequate shelter has been universally recognized as basic right for more than four decades, the overall conditions of shelter and basic services of the poor and disadvantaged in developing countries and for a significant number in industrialized countries are deteriorating alarmingly. Few governments today can claim to have national policies or programs that effectively meet the basic shelter and related needs of their people, especially those of the poor and disadvantaged. Initiatives should be there to secure renewed political commitment and effective action within and among nations to help the millions of poor, allover the world, to build or improve their shelter and neighborhoods to such a degree that, by the year 2015, it will be possible to integrate them with the process of economic development.

Health promotion in terms of the habitat essentially means ensuring decent shelter, nutritious food, safe water, hygienic disposal of wastes and access to efficient health services. Since health is beneficiary of economic and social development, health promotion will be most effective when it is included as an integral part of planning and development of shelter and communities. Ideally, the governments might be expected to ensure safe shelter and basic community services for all citizens. In reality, most countries are far from possessing the resources to achieve this ideal in the foreseeable future. It follows that efforts towards self-help and neighborhood help represent an important potential for development.

Historically, environmental manipulation has been one of the most effective tools of public health. Long experience has established that public health benefits are most freely and most rapidly achieved by applying design, engineering and construction practices which eliminate specific hazards. But governments can seldom afford improved housing and community services.

There are several WHO programs whose activities directly or indirectly relate to habitat and health, ranging from community water supply and sanitation to vector biology control and organization of health systems based on primary health care. A great deal is known about the relationship between housing and health. But it is evident that this information is generally not being used. The challenge for the years ahead is to integrate health information with programs aimed to developing housing and related community facilities and services. One step towards meeting this challenge was the setting up of a WHO program on Urban Development and Housing.

Interventions to improve shelter and put solutions for homeless population allover the world should take place. For that purpose housing-health interactions need to recognize three social ” facts of life”: First, that poverty is the major barrier to improved housing, so that the future of housing like that of health is generally bound up with a country's social and economic development. Second, that housing decisions are highly decentralized, not only in the fragmented responsibilities of many governmental agencies, but even more because most housing decisions are taken by builders and by families themselves. Third, that the health aspects of housing are poorly understood and weakly represented in governmental, community and family decisions.

Health advocacy in housing decisions should be strongly emphasized by health authorities, in alliance with other concerned groups, at all levels of administration and through multiple channels and media. In governmental sphere, health advocacy should be directed at a broad range of policies. Issues relevant to health go well beyond those bearing on housing itself. For policies and standards to be effective, extensive public and professional education is required to promote the provision and use of housing in ways that improve health status. Because so many individuals are engaged in the construction of housing, and virtually all people in its use and maintenance, education efforts have to be extensive and pervasive. Community involvement at all levels should support self-help, neighbor-help and communal cooperative actions in dealing with needs and problems of the human habitat. Although every dwelling belongs in some sense to its occupants, the community too has an interest in the condition and use of the housing that shelters its members. The essential objective of community involvement is to help people improve their condition in tangible and direct ways, as well as in the intangibles of better health.