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Urban population growth

The sources of growth in urban population change as economic development proceeds. At low levels of economic development and urbanization, 40% to 50% of growth results from migration from rural areas. When urban growth is most rapid, natural growth adds more to the population than migration. This is primarily because of a reduction in urban mortality rates, especially among mothers and children, owing to improved access to medical services. In addition, migrants' contribution to urban growth is greater than would appear from their numbers alone, since most of them are of childbearing age and thus they have a higher birth rate than the urban population as a whole.

Generally, it is the younger, able-bodied, and better educated people who migrate from rural areas to urban centres. Males predominate over females in Asia, but the reverse is the case in Latin America. In Asia and Africa males try to secure jobs and settle first, and then bring in their families.

The urban slums grow at a faster rate than the other established parts of the city (commonly twice as fast). Cities in Latin America may be growing at a rate of 4% to 6% a year, while the slums grow at a rate of 12% to 15%. The slum population of Nairobi, Kenya, is reported to be increasing by 25% to 30% a year, compared to the total city growth rate of 6% to 8%. In Manila, Philippines, the growth of slum population was found to be 7%, against 1.5% for the whole metropolitan area. A large part of this population is also floating and mobile, and difficult to reach through any services.

Effects of urbanization on hunger

Urbanization influences food production and consumption, causes urban-rural competition for natural resources, and introduces socio-economic changes. All these factors affect the nutritional status of the urban population.

Food production and natured resources

Very little is known about the impact of rural out migration on food production. Large shifts in working-age food producers reduce the size of the rural agricultural labour force and could thus cause seasonal labour shortages. At the same time, it increases the number of food consumers in the cities and the rural dependency ratio (i.e., the number of elderly persons and Young children supported by a working-age adult) 13]. With the decline in the size of the agricultural labour force, the productivity of the remaining workers must be increased so as to ensure a sufficient amount of food. Labour shortages are often met by fuller employment of previously unemployed persons, by mechanization, and by adjustments in the crop calendar. Available studies have rarely found a decline in production in rural areas due to out-migration; however, some FAO studies provide circumstantial evidence that high rates of rural-urban migration may be harming agricultural performance in sub-Saharan Africa.

The changing pattern of urban food demand necessitates substantial changes and diversification in the quality and quantity of agricultural products. For example, areas adjacent to the rapidly growing urban centres are specializing in fruits, vegetables, feed crops, and livestock products that are in great demand by the urban population.

Urbanization has also resulted in loss of agricultural land for urban use, water, and fuel. It has been estimated that 10 million hectares of arable land will be lost globally between 1980 and 2000 because of urban encroachment. Such losses are very significant for farming areas close to the fastest-growing cities. To offset them, less-fertile land will have to be brought under cultivation at higher cost.

Urban-rural competition for water use is even more complex. To meet the increasing demand, more and more water is being diverted for city use at the cost of agriculture. In addition, large quantities of water are polluted by industrial urban waste, as well as by agricultural waste and agro-chemicals. Unless these conditions are suitably resolved, water shortage will not only lead to a decline in agricultural production but also aggravate the unsanitary urban environment, which contributes to hunger.

The increasing demand for fuel wood is leading to rapid deforestation of land around the cities and is increasingly reducing the availability of fuel wood. As a result, the cost of fuel wood in urban areas has increased dramatically in recent years, especially in areas of Africa that are away from the equatorial zones, and in parts of Asia. This puts a heavy burden on the budget of urban families and reduces the amount available to purchase food.

Economic and social life

Urbanization transfers populations from a subsistence to a monetized economy. Migration also drains the rural area of its economically most productive population. In the cities these migrants sometimes find themselves ill-trained and poorly educated for the available jobs and suffer from at least temporary unemployment. Unless they have some kin to support and feed them during this transitional period, their nutrition may be compromised. As a result, new migrants usually cluster together in the cheapest, most overcrowded, and unserviced slums, and rely heavily on cheap staples and processed food that may not provide the best nutrition for their money. Even though they spend most (52%-68%) of their income on food, they have little choice as to what items they are able to buy.

The ability of the urban poor to purchase food is heavily dependent on competing demands of unavoidable non-food expenditures, such as transportation to work, housing, and remittances back home to support family members. In addition, the poor seldom have access to central markets without the expense of public transport, an expense they can ill afford. Thus they are compelled to buy food in small quantities from local shops at higher prices.

Since adults and older children are involved in money-making activities of some form or other, they have very little time to prepare food. Sometimes they have no suitable space for cooking or no money to buy fuel. Therefore, they rely greatly on processed foods or items that are easily prepared, which are not only expensive but occasionally of low nutritive value. As a result, they mostly buy food from the growing number of small local vendors, who may prepare food with little regard for safety or hygienic regulations and store it in a way that invites contamination by insects.

The most important social consequences of urbanization in terms of the nutritional welfare of young children is the decline of breast-feeding by mothers who have to work to support their families. The bottle is introduced early, often under the influence of aggressive commercial advertising for expensive purchased products. It has been estimated that in some countries a low-income family must spend about half of the household head's wages in order to feed a young child adequately. As a result of this high cost, commercial milk powders are often overdiluted. Because of lack of knowledge of cleaning and sterilizing the utensils, together with illiterate mothers' failure to appreciate the importance of cleanliness in child feeding, children's meals are usually unhygienically prepared. Thus, weaning and supplemental feedings are not only costly to the family but dangerous for the child. The inevitable consequences are gastroenteritis, underfeeding, marasmus, and even death.

In some urban communities large-scale introduction of bottle-feeding has already changed the prevalent type of protein-energy malnutrition (PEW) and the age of persons most frequently afflicted. Marasmus (a severe form of protein-energy deficiency) has become more frequent among younger children in urban areas. Frequently, mothers are not able to cope with the need to both care for children and earn an income. This has adverse effects on child nutrition. It must be stressed, however, that for many poor urban working mothers, who have to leave home very early for work and return home late, bottle-feeding has become absolutely necessary. In such circumstances, measures to facilitate proper management of bottle-feeding will be more helpful to child nutrition than advocating breast-feeding.

Rapid urbanization also signifies increased reliance on markets to supply food needs, which in turn means that marketing facilities must develop faster than the overall population growth rate. It is estimated that between 1980 and 2000 about 290 million additional tons of food grains (wheat equivalent) will have to be marketed to provide for the urban growth.

In most developing countries the traditional marketing system is characterized by inefficiency, high unit cost, and high food loss; yet it provides employment to a large number of people who are involved in small-scale sales. Modern marketing systems with better facilities for storage, processing, and packing are often located in the upper-class areas of the cities and thus bypass the urban poor.

Food consumption

Urbanization is usually accompanied by changes in consumption habits. Surveys undertaken in Tunisia and Brazil show that food staples of the traditional rural diet (mainly hard wheat and barley in Tunisia, and maize and rice in Brazil) have become less important in the urban diet. These items are replaced by new types of foods, particularly processed cereals such as bread and noodles, livestock products, and vegetables. The urban diet also includes more industrially processed items and sugar and fat. In addition, some nutritionally less desirable beverages such as soft drinks, tea, and even alcohol are becoming regularly consumed, particularly by middle- and high income groups.

These changes in food consumption patterns are modifying the urban food demand in developing countries, and are increasing their dependence on industrialized nations because these items must be imported (fig. 1). For example, in West Africa net wheat imports for 1976-1980 tripled over those for 1961-1965, making an average growth rate of 11.4% per year. Net rice imports grew at an average of 10.7% per year over the same period. Ninety per cent of these imports were meant for urban centres.

As a result of changes in consumption patterns, the quality of urban diet, particularly with respect to fat, animal protein, and vitamin A, has improved. These changes also have implications for the intake and use of certain micronutrients. For example, iron in the urban diet is easily assimilated because, in contrast to that in the rural diet, it is generally of animal origin. The implications of urbanization in relation to calcium and vitamin C are not yet clear [3].

Urbanization has consequences for food consumption patterns in rural areas as well. the families of migrants who remain in rural areas tend to make some changes in diet that are similar to the changes made by the migrants themselves, partly because they imitate habits of the urban migrants and partly because they have resources obtained from remittances to make such changes. These especially include increased consumption of tea, bread, biscuits, and soft drinks. It is not surprising to find increasing consumption of these products in many villages of Africa and Asia. As farmers specialize in crop production in response to changes in demand, the variety of food produced in local rural areas may become more limited, and this can adversely affect the diets of the low-income rural population.

Extent of hunger and malnutrition in the cities

Even though reliable statistics on urban hunger and malnutrition are not currently available, there is no doubt that hunger and malnutrition are severe contributors to, and consequences of, the urban poverty syndrome. As poverty in urban areas is mainly con centrated in the overcrowded shanty towns and slums, the brunt of nutritional deprivation is borne by their inhabitants and, among them, particularly by mothers and young children and unemployed immigrants. A study comparing nutrition and health factors in planned residential quarters with those in urban slums in Manila, Philippines, showed, among other things, that in the slums the frequency of low birth-weight was five times higher, infant mortality was three times higher, the prevalence of severe and moderate malnutrition and anaemia was twice as high, and per capita energy intake about 200 kcal lower than in the prosperous quarters of the city [4]. In New Delhi, 40% to 55% of the bustee (shanty town) children have been found to suffer from various grades of malnutrition. Mortality rates of children below five years of age were found to reach 444 per 1,000 in certain castes in which nearly all women work in unskilled jobs [5]. In Abidjan, the probability of dying between one and four years of age is 1 5 times higher in rudimentary slum areas than in high-rise housing areas, where mortality is comparable to that in developed countries.

FIG. 1. Urbanization and food imports ( Source: FAO Policy Analysis Division)

It is unfortunate that the seriousness of health and nutrition problems often goes unnoticed by city planners and decision-makers. Often squatters or slum inhabitants do not even appear in the city statistics because many of them may be floating and not registered as residents. Even if they are included, their real states of health and nutrition are obscured by the enormous differences that exist between their status and that of the proportionately smaller middle and upper socioeconomic groups [5].

Recent food-consumption data from urban areas of developing countries are scarce, and data comparing urban and rural consumption are even scarcer and are available for a very limited number of countries. In each of 1 3 countries for which such data are available, covering all developing regions, per capita dietary energy intakes were higher in rural than in urban areas (table 2) [6]. In three of these for which data are available by income group (Brazil, India, and Tunisia), these urban-rural differentials persisted across all income groups.

Table 3 provides an estimate of the percentage of the urban population that is undernourished, calculated from the distribution of dietary energy consumption data available for eight countries. Rural rates of undernutrition are also given for comparison. The method involves calculating from the distribution of dietary energy supply the number of people whose intake falls below certain minimum levels of energy requirements set by an FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements as cutoff points below which people should be designated undernourished. These levels of requirements allow for only a minimum level of activity, below which maintenance of health is not possible, and thus provide a very conservative estimate of undernutrition.

TABLE 2. Per capita energy intakes in urban and rural areas of selected developing countries

  Year Energy intake (kcal) Urban as % of rural
Rural Urban
Tunisia 1980 2,452 2,247 92
Trinidad and Tobago 1970 3,011 2,850 95
Chad 1965 2,467 2,113 86
Dahomey 1966/67 2,141 1,908 89
Morocco 1970/71 2,888 2,521 87
Brazil 1960 2,640 2,428 92
Bangladesh 1962/63 2,254 1,732 77
Pakistan 1965/66 2,126 1,806 85
Republic of Korea 1969 2,181 1,946 89
India 1975 2,090 1,480 71
Thailand 1974 1,821 1,504 83
Indonesia 1976 1,885 1,633 87
Algeria 1978 3,210 2,138 67

Source: Ref. 6.

The table shows that up to one-fourth of the urban population in these countries under the most conservative of the two estimates, and up to one-third according to a higher but still conservative estimate, are afflicted by undernutrition. The range of variations among the countries is large, 5% to 27% at the lower and 6.5% to 38% at the higher level of estimate. These variations may be due partly to differences in the time period covered by the data and partly to differences between the regions. Clearly, these limited data do not warrant a global estimate, but they provide a glimpse of the magnitude and severity of urban hunger in these countries.

The table also indicates that in only five of the eight countries were undernutrition rates higher in urban than in rural areas. The reverse was the case in the other three. This shows that dynamics of undernutrition and malnutrition may differ among populations and countries, and strongly suggests the need for further research to determine the extent and causes of urban hunger.

Available data on physical evidence of hunger and malnutrition pertain almost exclusively to young children, and hardly any quantitative data are available on adults. Results of eleven recent surveys of nutritional status of children are shown in table 4. The frequency of child malnutrition as measured by three anthropometric indicators of nutritional status is substantially higher in rural than in urban areas. However, stunting (an indicator of chronic malnutrition) and underweight (an indicator of both acute, and acute and chronic malnutrition) seem to predominate in both areas. A minimal amount of wasting (an indicator of recent malnutrition) indicates a certain degree of adaptation by children to match their weight for height under continuing adverse nutritional circumstances. The frequency of PEM has been reported to be higher in rural than in urban areas of Algeria, Morocco, and Senegal.

TABLE 3. Extent of undernutrition in eight selected developing countries

  Per capita
dietary energy
supply (kcal)
Percentage of population undernourished
Estimate Aa Estimate Bb
  Urban Rural Urban Rural Urban Rural
Brazil (1974/75)  
South Region 2,451 2,954 6,6 5.4 13.3 9.2
Northwest Region 2,244 2.063 27.1 21.6 38.6 41.4
India (1971/72) 2.539c 2,924c 12.7 12.4 19.5 18.7
Egypt (1980/81)d 3.037 3.182 5.0 8.2 6.5 11.7
Indonesia (1976)d 2.680 2,658 15.3 16.6 19.9 21.9
Sri Lsnka (1980/81) 2,095 2,257 18.7 14.8 26.2 22.5
Sudan (1978/79)d 2,841 2.284 12.0 14.1 17.0 19.8
Thailand (1975/76)d 1,173 2,179 24.4 17.1 31.8 24.4
Tunisia (1975) 2,228 2,474 9.2 5.4 16.8 10.4

a. based on a threshold of 1.2 times the BMR Basal metabolic rate-the energy
requirement at complete rest, relaxed, 12 hours after the last meal for adults and adolescents, and on actual intake per kilogram of body weight for children up to 10 years old; extra allowance. added for pregnancy.
b. As for estimate A, but using a threshold of 1.4 times the BIER for adults and adolescents.
c. Per consumer unit.
d. soused on unpublished data obtained through IFPRI.

Source: FAO Statistics Division.

In Ghana, the weights of the adult population in urban areas were found to be higher than those of the rural population. Among urban adults, unemployed immigrants had the lowest weights. Thus, the available evidence indicates that average food consumption is lower and estimates of undernutrition are generally higher in urban areas, while physical malnutrition in children is markedly worse in the rural population. Although the causes of this apparently paradoxical situation are not definitely known, a number of reasons may be suggested. It is possible that foods eaten outside home and unpurchased calories derived from begging and collecting market refuse by urban poor, which can contribute to urban energy intake, were not accounted for in the available consumption statistics. It may be hypothesized, however, that, in a few cases, apparently lower urban food consumption is due to the lower energy demand or requirements for activity. In the absence of intake data for both rural and urban children, it is not possible to compare the dietary basis of their nutritional status. Better access to medical facilities, better quality and a steadier supply of food, and a probable lower requirement of energy due to the sedentary nature of occupation in the cities all may have contributed to the better nutritional status of urban children.

Measures to combat hunger in the cities

It appears clear from the above that hunger and malnutrition that arise in the cities as a consequence of rapid urbanization in developing countries have many facets but the basic cause is poverty. Too many people are added to the cities too soon, so their numbers exceed available jobs, housing, market facilities, and medical, water, and sanitary services, particularly in slum areas where migrants settle. All this creates special problems and conditions that raise the price of food, cause undesirable changes in food habits, and sometimes compel people to eat less nutritious convenience foods. Long-term solutions will depend on providing jobs and services to match the requirements of a growing urban population. Obviously, this will take generations and in fact may not be realized in many developing countries in the foreseeable future. Urgent actions are therefore needed to avert serious situations in the near future.

TABLE 4. Percentage of malnourished children under five years old according to different indicators-rural and urban areas, selected countries

  Low height for agea Weight for heights Weight for ages
  Rural Urban Rural Urban Rural Urban
Brazil (1975) 21.9 16.6 2.2 2.3 21.9d 16.6d
Cameroon (1978) 22.4 15.5 1.1 0.7 23.0 12.2
Egypt (1978) 23.8 15.0 0.7 0.5 9 9d 6 1d
Haiti (1978) 28.6 15.7 6.4 3.8 29 5d 14.6d
Lesotho (1977) 23.7 17.2 4.3 3.0 24.9 17.3
Liberia (1976) 20.2 13.8 1.6 1.7 25.5  
Mauritius (1982) 27.9 9.2 16.1 0.8 - -
Nigeria (1983) - - 21.1 21.1 - -
Sierra Leone (1978) 26.2 17.4 3.2 3.2 32.4 24.3
Togo (1977) 20.4 11.4 2.2 0.8 16.5d 8.9d
Yemen Arab Republic(1978) 42.1 33.0 6.7 2.1 47.0d 22.8d

a. Below 90% of reference standard- Indicator of malnutrition of long duration (chronic)
b. Below 80% of reference standard -Indicator of recent malnutrition (acute.
c Below 80% of reference standard-Indicator of acute, chronic, O. acute and chronic
d. Below 75% of the reference standard.

Source Ref. 6.

Basic data

As the relative importance of causes of hunger and malnutrition is likely to vary from city to city depending on the sequence and consequences of urbanization, it will be imperative to obtain certain basic data to help diagnose the problem, formulate strategies, design interventions, and implement programmes and evaluate their performance. These data should be able to indicate the type and severity of hunger and malnutrition, its basic causes, groups at risk, the magnitude and extent of the problem, and areas in which it exists. They should include information on demography such as socio-economic status and physical environment, food behaviour, marketing and distribution systems, and nutritional status. The data requirements will vary according to the type of intervention to be implemented.

Types of interventions

At least five types of measures can be taken to alleviate the growing menace of urban hunger.

Measures to reduce the rate of urbanization

The migration of population from rural to urban areas is a natural consequence of economic growth and therefore cannot be stopped. The speed of urban growth is, however, accentuated by the almost universal urban bias in development planning that provides for the concentration of industry, higher education, medical facilities, subsidized food and housing programmes, and political power. There is urgent need to modify such policies to slow migration in order to promote the orderly development of both urban and rural areas.

Improvements must be made in rural infrastructure and provison of services, including electricity. In addition, health and educational facilities must be expanded to improve the quality of rural life.

Rural industries must be developed to provide employment. Labour-intensive, agro-based industries will be particularly suitable for providing jobs for surplus agricultural labour.

Family planning services are needed in both rural and urban areas-in rural areas to reduce the population and thus out-migration, and in urban areas to reduce natural growth.

Population can be redistributed by creating satellite towns near large towns and planning small towns in rural areas, and encouraging people to settle there instead of clustering into the large cities. In experience to date, however, such ventures have been costly and less successful than expected.

Measures to improve food and agricultural production, marketing, distribution, handling, and food control

Direct policy measures can be undertaken in the marketing and nutrition components of a country's food system to help adjust to the changes brought about by urbanization.

More food will have to be produced by relatively fewer people as urbanization proceeds. Production patterns will have to change to meet changing consumption patterns and to produce greater varieties of food. This will require expanding extension services, increasing the availability and use of inputs, mechanizing production, and instituting suitable land-reform measures in favour of rural poor and small-scale farmers.

The main aims of marketing improvement will be to reduce marketing and distribution costs and to ensure stable supplies. Action must be taken to improve storage, processing, and marketing facilities and distribution networks. Providing space for local markets and bazaars near residential areas, particularly slum areas, and developing wholesale markets in strategic locations in cities will help to set up a chain of distribution that will reduce prices and ensure the availability of food.

Food subsidies, food stamps, and food rationing are some of the steps various governments around the world have taken to stabilize food prices and ensure supply, particularly during times of crisis. Other methods to control food and implement standards for its preparation and sale, particularly in the slum areas, are urgently needed in developing countries where these measures do not exist, and must be strengthened where they do exist.

Nutrition intervention programmes

Since in many countries economic development by itself might take a long time to reach the low-income groups who are particularly at risk of hunger in the urban slums, direct intervention programmes particularly aimed at vulnerable groups (young children, and pregnant and lactating mothers) are urgently needed to save millions of lives. Several programmes have been tried over the years in various parts of the world. These have been most effective when combined with primary health care programmes providing basic health care.

Special feeding programmes are a direct form of nutrition intervention. They include supplementary feeding for mothers and pre-school children, nutrition rehabilitation, and school feeding. Some are operated on a large scale, in which case they are usually supported by food aid.

Supplementary feeding programmes may provide meals on site or distribute rations from a central point at regular intervals for use at home. They generally cover the vulnerable groups such as women during the last trimester of pregnancy and for six months during lactation, and children six months to five years old. On-site programmes require more infrastructure and therefore cost more, but they ensure that the beneficiaries acturally consume the food. Take-home programmes can potentially cover wider areas and reach more beneficiaries, but there is leakage through sharing with other family members and sometimes selling or exchanging all or part of the ration. Other problems include low participation and sporadic attendance, the difficulty of targeting the programme to the people most in need, and, occasionally, failure to maintain the ration size. Costs vary widely from country to country and are generally quite high.

In general, supplementary feeding programmes are more likely to be cost-effective if they are targeted to the most malnourished (pregnant and nursing women, and children six months to three years old); if the food supplement is sufficient to provide a substantial part of daily requirements (say, one-third to one-half) and thus the incentive for regular participation; if the intended beneficiaries actually consume the supplement; if criteria are established for entry into and exit from the programmes on the basis of degree of malnutrition and response to feeding; and if the programmes are integrated with other inputs, including nutrition education and primary health care.

Community kitchens are organized by some communities in developing countries to feed preschool children. In 1977, 135,000 children in the slum areas of Calcutta, India, were fed daily in this way. By pooling their resources, communities were able to buy staple foods in bulk in some cases, which made meals cheaper than those prepared by individual families at home.

The most critical nutritional problem in poor urban areas is feeding infants up to three years of age. As the mothers generally work, the children are often left with an older sibling, who is rarely able to prepare the necessary weaning food. Community crèches are a solution for this problem. In many organized communities, particularly in Latin America, mothers have set up local crèches to which they make a small contribution in both food and labour, which enables even the poorest to ensure that their children will be cared for in their absence. Mobile crèches in New Delhi care for young children and infants at construction sites. In some countries by regulation, industries that employ over a specified number of female workers must provide crèches for their children.

School feeding programmes are logistically easy to organize and have been widely adopted. Their effectiveness in terms of nutritional impact has not been conclusively established, although evidence suggests that catch-up growth in previously undernourished preschool children can be achieved if sufficient food supplements are provided in the first primary school years. Teachers also constantly report increased school enrolment and attendance, and increased alertness, attentiveness, and performance by the children. On the other hand, poorer children are the least likely to attend school, particularly those who have to help their families to earn a living and those living in squatter areas, where classrooms are rarely provided, and are the most likely to drop out. Also, school feeding programmes can only operate for a part of the year.

When a school lunch is served, it may replace that meal at home. It may or may not be better, but it at least ensures one good meal a day for children who might not otherwise get one because the mothers are at work. For this reason alone, school feeding programmes are an effective and important nutrition intervention. Like other supplementary feeding programmes, they may also release a share of the limited household food supplies for the rest of the family. They are a useful vehicle for nutrition education provided there is sustained interest on the part of teachers.

Nutrition rehabilitation programmes are designed to rehabilitate moderately malnourished infants and young children by providing them with an adequate diet based on locally available foods. At the same time, their mothers are taught how to prepare this diet so that they can continue it at home when the child recovers. Day-care centres, on-site feeding at a convenient central point, food-preparation lessons for rehabilitation at home, and residential centres attached to hospitals are among the ways in which nutrition rehabilitation is pursued. Such nutrition rehabilitation is a temporary, emergency intervention. It can have lasting results only if the families have the resources and motivation to continue the improved feeding practices. it should always be followed up as soon as possible by integrated nutrition and primary health care programmes, which are preventive as well as curative and offer great potential long-term benefits.

Nutrition education is a basic component of most intervention programmes. Its aim is to motivate people to change their food behaviour so as to make better use of existing and potentially available resources. Although it is obviously of less use in urban areas where malnutrition results solely from inadequate purchasing power, it can be of some help even here by teaching people, especially the urban poor, to make the best use of their limited money by purchasing the cheapest combination of nutritious foods and making better combinations of weaning foods for children. Nutrition education must be tailored to the specific situation and use the most appropriate combination of communication methods. For its effects to be long-lasting, it should be integrated with formal education, especially in primary school curricula and teacher training, and should emphasize the foods available at home.

Closely related to nutrition education and often an integral part of it are programmes to improve food handling, preservation, and preparation at the household level. These can substantially increase available food supplies by reducing losses and providing greater food safety insurance. Improved preparation methods not only reduce waste and spoilage but also improve the nutritional value of food by making certain nutrients more available or by conserving others, such as vitamin C. Providing more efficient fuel systems such as gas would make food preparation speedier. Better utensils and methods are essential in order to economize on precious firewood or other fuel, which is becoming increasingly costly and scarce as a result of urbanization in many areas of the world. Attention also must be given to safer methods of food preservation in the household in order to reduce food-borne infections.

The practice of breast-feeding is rapidly declining in urban areas because most poor urban mothers have to work to support their families. Suitable commercial weaning foods are often unavailable in many developing countries and may be costly and beyond the reach of the urban poor. Mothers must be induced to breast-feed as long as possible, and also be taught how to manage bottle-feeding properly. At the same time they should be encouraged to prepare suitable weaning foods from ingredients available at home. Daytime caretakers and crèches should also be included in these teaching demonstrations. This can be best achieved through local health services and home visits.

Eliminating specific nutrient deficiencies should be among the easier and less costly nutrition interventions since deficiencies are localized geographically. They include deficiencies of iodine (causing goitre), iron and folic acid (causing anaemia), vitamin A (one of the causes of blindness in children), and vitamin D (which can cause rickets where there is insufficient exposure to sunlight}. Specific nutrients may be added to food {fortification), distributed as tablets or capsules, or given by injection to alleviate deficiencies caused by inadequate intake of a particular nutrient.

The success of fortification programmes depends mainly on the choice of a carrier that is regularly consumed by the target group, on producing a fortified product that is no less acceptable than its unfortified equivalent (if there is a price difference, this may have to be covered by the government), and on properly controlled, and usually centralized, processing.

Food subsidies are in use in many developing nations and take several different forms. Some countries, especially in the Far East, have dual price systems under which food is available at less than market price at fair-price or ration shops. In Africa, marketing major staple food crops is often a government monopoly, and subsidies are provided either explicitly or implicitly by financing marketing board losses.

In general, untargeted subsidies are most widespread and easiest to administer, but they mostly benefit urban consumers who purchase all their food. Also they are wasteful in that their benefit goes to the better-off as well as to the poor.

Even such general subsidies can be made to some extent "self-targeting" by subsidizing commodities principally eaten by the poor. Dual price systems can limit access to the lower price by locating outlets in the poorest areas and issuing access or ration cards to eligible groups, as well as by supplying lower qualities of the subsidized commodities. Food-stamp programmes, where a stamp or coupon has monetary value and can be exchanged for certain food items, are another way to limit access to needy groups. So far, however, there is little experience with food stamps in developing countries. They have recently been introduced in Colombia (where they were subsequently withdrawn), Jamaica, and Sri Lanka (in replacement of a long-standing rationing scheme).

As food subsidies have become very costly in many countries, emphasis is increasingly on more sharply targeted approaches, even though they are administrative more demanding than general food subsidies. Particularly for this reason, the feasibility of using the administratively simple commodity self-targeting approach should always be considered when alternative means of targeting are being examined. Alternatives include means testing and the use of exclusion criteria such as visible characteristics of households or individuals (e.g., age, unemployment) and geographic location (e.g., residence in poor neighbourhoods).

Targeting may also be achieved by using institutions such as co-operatives, mother-and-child health centres, schools, and places of work for the distribution of free or subsidized food. These approaches are, however, mainly directed to the traditionally vulnerable groups, young children and pregnant and lactating mothers. It seems important that other food subsidy programmes should also be maintained in favour of other poverty groups, particularly unemployed immigrants. A major impact of subsidies is to improve the real income of the poor, only part of which will be used to raise their food consumption. Productive income-generating programmes may also be an alternative in some cases. Food-for-work programmes for urban areas particularly involving unemployed immigrants would be a useful approach.

Urban agriculture

The careful use of all available land in towns and cities for cultivation of food crops has been undertaken in some countries as a means of increasing the overall food supply of lower-income groups, with only minimum capital outlay. Although it may not contribute substantially to producing staple foods, it can be substantially helpful in providing micronutrients through vegetables cultivated in backyards, at the side of railways tracks, canals, and ponds (as floating vegetables in ponds ), and in patches of vacant land. Vegetables can also be cultivated in pots on the balconies of houses.

Several countries provide interesting examples. China has been very successful in growing vegetables in urban areas, and its cities are 85% self-sufficient in vegetables. Zambia, where relatively larger plots of land are available in urban areas, has an urban agricultural programme that provides seeds and technical assistance, and encourages communal organizations in the city to promote gardening. It is estimated that 10%-20% of Zambia's perishable food is currently produced within cities. In Ethiopia, vacant land was put under a local administrative unit to be cultivated by unemployed persons in the locality and the products are sold at low prices.

Although such projects cannot be undertaken equally well everywhere, they have good potential to make significant improvements in the diet of the urban poor. Measures must also be taken to encourage the growth of green belts around cities to produce vegetables and limit encroachment on fertile agricultural lands by the expanding cities. In addition, wherever feasible, small-scale home-level livestock rearing (e.g., poultry or rabbits) might also significantly add to women's income and improve nutrition and health.

Measures to improve health care and environmental sanitation

Health care facilities in the cities usually bypass the slums. Facilities must be created to care for everybody, particularly mothers and children. Growth charts should be used to monitor children's progress; immunization against common childhood diseases must be done; prompt treatment for diarrhoea, particularly with oral rehydration, should be made available. Women must be given health and nutrition education and education on hygienic feeding. Family planning advice must also be a part of the package.

Measures must be taken to improve the supply of potable water and to improve waste disposal and housing facilities. It is necesary to enforce hygienic regulations on the growing numbers of food vendors and petty traders in the slum areas.

Co-ordination of policies and programmes

The measures suggested for combating urban hunger are necessarily multidisciplinary, and to be effective they must be implemented in a co-ordinated manner and developed into a long-term comprehensive programme to maximize their benefit. The community must be involved and encouraged to become an active partner in development. Policies to reduce rural migration must be combined with programmes for creating employment, developing food marketing, improving housing, sanitation, and health, and, above all, establishing nutrition interventions aimed particularly at the most vulnerable groups. Urban hunger should be tackled as a national problem, because the problems of urban and rural hunger are inextricably intertwined through the flow of people, goods, and services and therefore both areas must be addressed simultaneously.


The long-term solution to urban malnutrition lies in reducing urban poverty, which in turn depends on providing jobs and services to match the requirements of the growing urban population. Short-term measures should include reducing the rate of urbanization; improving food production, marketing, distribution and handling, and control; establishing direct nutrition intervention programmes such as supplementary feeding, crèches for mothers, nutrition rehabilitation, nutrition education, and food fortification; and improving health care and sanitation. These measures will always be necessary to provide for those who are bypassed by general economic development and reside in the slums and shanty towns.


1. United Nations. Estimates and projections of urban and city population, the 1980 assessment. New York: United Nations, 1982.

2. Austin JE. Confronting urban malnutrition. World Bank occasional paper no. 28. Washington, DC: World Bank, 1980.

3. Food and Agriculture Organization. The state of food and agriculture-urbanization: a growing challenge to agriculture and food systems in developing countries. Rome: FAO, 1984.

4. Basta S. Nutrition and health in low-income urban areas of the third world. Ecol Food Nutr 1977;6: 115.

5. Nelson J. Periurban malnutrition, a neglected problem. Assignment Children 1978;43 :25.

6. Food and Agriculture Organization. The fifth world food survey. Rome: FAO, 1985.

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