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Child mortality

The mortality of children one to four years old in underdeveloped countries is more directly an expression of inadequate nutrition during and after weaning, with all its consequences, including infection-nutrition synergistic damage. Moreover, the ratio of mortality in infants to that in children one to four years old is a sensitive indicator of nutritional status land socioeconomic development). Excellent direct correlations on a country-to-country level have been found between this index and the United Nations Development index [50]. Separate data on urban and rural mortality rates for children in this age group are available from various UN Demographic Yearbooks from ten less-developed countries, seven countries with centralized economies and intermediate development, and nine developed countries.

For this age group as for infants, the differences in mortality rates between the less-developed and other countries are striking, as are the urban-rural differences in the less-developed countries. In urban areas the median value is 13 to 20 times as large as for the other countries; in rural areas it is 27 to 33 times as large.

Protein-energy deficiency

It can be argued that nutritional deficiencies are the most important determinant of poor health and mortality in the urban setting [40, 51] and that their eradication would have profound effects on the health and development of city dwellers. The generally used criteria for the diagnosis of protein-energy deficiency (PED) at the population level are estimations of the magnitude of energy deficiency, protein and specific nutrient intakes, and the prevalence of children below five of six years of age with inadequate growth defined by anthropometric measurements. This analysis is based on anthropometric criteria.

The diagnosis of chronic PED is based essentially on height-for-age deficits (below 2 SD of the median, below the fifth centile of the distribution, or 10% or greater deficit from the fiftieth centile) That of acute PED is based on weight-for-height deficits (below 2 SD of the median, below the fifth centile of the distribution, or 15% or greater deficit from the fiftieth centile). Acute PED is superimposed on chronic PED when both deficits coincide in the same child.

Relatively few sources of data report urban and rural prevalences of anthropometric deficits on a comparative basis. Table 8 presents data derived from country reports of the Office Nutrition of USAID [31-34, 52-59] tabulated in terms of percentage prevalence of chronic and acute PED, respectively, for children below five or six years of age by site of residence, and by either socio-economic condition (urban poor or total urban sample) of type of agriculture ( subsistence or cash).

In terms of chronic PED, the rural populations are either slightly or clearly worse off than their urban counterparts. The variability of its prevalence is quite striking: ranging from 8% to 60.8%, or a 7.6-fold difference, for the urban samples and from 15.6% to 72.2%, or a 4.6-fold difference, for the rural samples. The range of differences of chronic PED between urban and rural areas within any one country or region is no greater than twofold. With respect to acute PED also, the rural populations are generally worse off.

Tanner and Eveleth [60] referred to a series of studies on growth in urban and rural populations. In every case the urban population was taller and heavier than the rural. They expanded on the study of the city of Nowa Huta, Poland, where all the population had migrated from neighbouring rural or small urban towns when the city was established, 15 years before the study. The city dwellers under 15 years old were significantly taller and heavier than the children who had remained in the rural areas from which migration originated. Moreover, the children whose families had migrated from small towns were taller than those who had migrated from rural areas (fig. 2).

Growth patterns in stature for urban and rural samples from Greece, Romania, Finland, Costa Rica, and Jamaica were also analysed; all showed a progressive advantage for urban boys up to 14 to 16 years of age (fig. 3), the maximum difference being near ten inches in the case of Jamaica. The difference tended to decrease slightly by 18 years of age, since the urban boys reached maximal stature close to that age, while rural boys were still growing. In terms of relative heights among countries, Finnish boys were between three and six inches taller than other boys at age 18. Adult heights differed little between urban and rural samples from the same country, although urban adults tended to be taller than rural adults. For women, the study in Jamaica showed a stature advantage for girls up to 16 years old; after that age, rural and urban women attained the same height. In Costa Rica the urban sample remained about two inches taller at final heights Age 18).

FIG. 2. Mean heights of boys whose families migrated from towns and whose families migrated from villages, in the new town of Nowa Huta, Poland, 1967, compared with those of boys from Little Poland ( the origin of 78% of Nowa Huta immigrants ) 9-14 years old and from the rural villages of Kurpie and Suwalki at other ages (Source: Ref. 60.)

FIG. 3. Mean heights of boys in urban and rural areas in Greece, Romania, and Finland ( Source: Ref. 60.)

The urban-rural difference in growth disappeared in a United States sample when income levels were paired, except for the low-income rural group, which remained smaller than all the others. This was also the case for urban and rural populations in Bombay. In Nigeria and Costa Rica, urban slum dwellers had the same heights as rural rwellers. Finally, in Tokyo, the well-known secular increases in height has been greater in the rural population ( who were smaller before). To quote Tanner and Eveleth [60]:

In the economically impoverished urban areas of Asia, Africa, and South America the shanty-town slum dwellers are mostly not larger than their rural counterparts, though children living in the middle-class areas of the cities are. In general urban-rural differences mirror the differences seen between children in different social classes, whether in the urban or rural population.

However it does have to be borne in mind that outbreeding is greater in towns than in rural villages and that if heterosis for stature occurs in man, as it may, then this in itself would cause the adult height (though not the rate of maturation} to be greater in the towns. In addition those people who migrate from the villages to settle in towns are usually not a random sample of the village population, but may be taller and heavier than average. Thus some part of the greater adult stature of the urban population, where it occurs, may be due to these selective genetical mechanisms. Thus it seems highly probable that most, if not all, urban-rural differences are due to the economic differential between town and country dwellers, resulting in the better feeding of the well-off.

Table 9 compares data from urban and rural populations in seven Latin American countries and Jamaica [61, 42]. Urban populations are "better nourished" than their rural counterparts, but in some cities the prevalence of PED is as high as in poor rural areas. No clear predominance of early PED in the urban populations was observed [42]. Others, however, have reported early malnutrition as typical of the urban setting because of early weaning and introduction of the milk-formula bottle with all its consequences [62, 63, 50]. Earlier PED in the urban setting has also been reported in Bangkok [64]; Accra, Ghana [65]; Harere and Chitungwiza, Zimbabwe; and Togo [66]. In Bangkok marked growth retardation, wasting, and small head circumference occurred early, before six months of age, and persisted in the urban environment even though older children (after about 18 months of age) grew in height better than their rural counterparts. In Togo more wasting (marasmus and marasmus-kwashiorkor) is reported in the urban setting. In Accra the type of PED is no different in urban and rural settings; it just appears earlier in the former.

TABLE 9. Percentages of children under five years old with weight-for-age deficits, classified by the Gomez scale, in selected urban and rural populations

Source: Ref. 42.

The process of acculturation, urbanism, and modernism to which poor rural immigrants are subjected in the slums and their nutritional repercussions on children were studied in Beirut 167]. Families carefully matched for income, composition, education, and so on demonstrated a progressive improvement in nutritional status, food practices, and general life-style as time elapsed living in the urban slum.

Although PED is found in the urban environment, that setting is more conducive to better nutrition even though these advantages tend to disappear among new immigrants (who actually bring their rural habits and problems to the city for some time) and among the urban poor.

Nutritional anaemias

The available evidence [33, 32, 55, 59, 53] indicates that, in general, the prevalence of nutritional anaemias is lower for urban children and mothers than for their rural counterparts; however, with the exception of Yemen, the differences between the two populations are minimal. The range of prevalences within each setting is several times greater than the urban rural differences, again with the exception of Yemen. There is no apparent reason for this susceptibility of the Yemenite populations.

There is often a higher prevalence of anaemia and of deficiency of erythropoietic factors (particularly iron) among migrants to Western industrial cities than among established urbanites. The migrants initially have the anaemia and iron status of the population in the area from which they came. Often, as acculturation proceeds, the diet becomes more varied, parasite loads decline, and the haematological status improves [68].

A gradient has been observed in the iron reserves of Guatemalan women of reproductive age according to their residence: urban middle-class women in Guatemala City (in the highlands) had higher reserves than rural highland women, who in turn were better off than their lowland counterparts. This gradient was independent of parity in the sample studied.

Other vitamin and mineral deficiencies

Few studies have specifically addressed urban-rural differences in vitamin and mineral deficiencies. Vitamin-A deficiency affects populations in both areas, particularly children suffering from malnutrition, diarrhoea, and infectious diseases [69-71], although mild deficiency may occur in non-malnourished, non-infected children [72]. Actual prevalence and incidence vary both in urban and rural settings by country, season, and method of diagnosis, reported prevalences being as high as 45% in the total populations [73].

The decline in breast-feeding, which is predominantly an urban phenomenon, aggravates the situation in infancy [71, 74]. On the other hand, the previously discussed greater variety of foods and more opportune complementary feedings in urban settings serve as protective practices. The concomitant increase in frequency of infection in non-breast-fed infants certainly is an aggravating factor. Several studies on the liver vitamin-A reserves of healthy victims of accidental death have been done in less-developed nations, all showing some degree of deficiency [75-79].

In Thailand, levels of vitamin A in both serum and liver were lowest among the poor, particularly farmers and unskilled labourers, suggesting more similarity by socio-economic group than by urban-rural location. About one-third of migrant children of Mexican-American origin among Colorado farm workers have been shown to have low vitamin-A serum concentrations (and low zinc levels by serum and hair analysis), compard to only 7.5% among the healthy stable population in the same region [80, 81]. Thus even in developed countries, vitamin-A deficiency (and also general undernutrition) occurs in at-risk populations, such as poor migrants.

TABLE 10. Prevalence of non-insulin-dependent diabetes mellitus among Indians, Melanesians, and Polynesians in rural and urban settings

Sources: Refs. 82-84.

Chronic nutrition-related diseases

Modernization, westernization, and urbanism play a decisive role in modifying life-styles and diet, which in turn contribute significantly to the development of obesity, non-insulin-dependent diabetes mellitus ( see table 10), and cardiovascular disease (fig. 4). It is also apparent that the Western diet and obesity added to environmental factors determine the prevalence of certain cancers. Consequently, the epidemiological pattern of chronic nutrition-related diseases could be interpreted as reflecting the degree of westernization of a society.

At some risk of over-simplification, we may say that the degree of westernization and urbanism in the process of urbanization in less-developed Countries in contrast to the traditional rural way of life, and the level of cultural transition in the urban setting, appear to be closely associated with the epidemiology of nutrition-related diseases. Recent poor migrants to urban areas who are traditional in their diet and lifestyle exhibit nutrition-related pathologies that are more characteristic of rural culture (deficiency diseases and infectious processes being prominent}, while those whose social and economic evolution lead to modernism and acculturation to a Western diet and lifestyle tend to exhibit the disease patterns associated with this new culture. The process of rapid urbanization characteristic of many countries in transition also leads to an epidemiological transitional state in which both types of pathology co-exist [87-89], together with other indications of transition, including changes in birth and mortality rates and patterns.

FIG. 4. Age-related dynamics of atherosclerosis plaques in selected populations from developed and developing nations, derived from autopsy studies. X = prevalence rate at age 20. ( Source: Ref. 85.)

Acknowledgements

Special appreciation is expressed to Dr. A. Horwitz,R. Trowbridge, B. Popkin, J. Mason, and J. D. Wray for their advice and encouragement, to Robert Giometti, Julie Long, and Gina de Trejo for their help in the preparation of this paper, and to Adelina F. Viteri and J. Katona-Apte for their patience.

References

1. Growing HL. The demography of the city. In: Beyer GH, ed. The urban explosion in Latin America: a continent in process of modernization. Ithaca, NY, USA: Cornell University Press, 1967:71-116.

2. Notestein FW. Population: the long view. In: Schultz TH, ed. Food for the world. Chicago: Chicago University Press, 1945:3657.

3. Easterlin RA. The economics and sociology of fertility: a synthesis. In: Tilly C, ed. Historical studies of changing fertility. Princeton, NJ, USA: Princeton University Press, 1978: 57-133.

4. United Nations Department of International Economic and Social Affairs. Patterns of urban and rural population growth. New York: United Nations, 1980.

5. Popkin BM, Bisgrove EZ. Urbanization and nutrition in low income countries. In: Symposium on nutritional effects of urbanization. Washington, DC: PAHO, 2-6 March 1987.

6. Beyer GHE. The urban explosion in Latin America: a continent in process of modernization. Ithaca, NY, USA: Cornell University Press, 1967.

7. Pearse A. Urbanization and the incorporation of the peasant. In: Field AJ, ed. City and country in the third world: issues in the modernization of Latin America. Cambridge, Mass, USA: Schenkman Publishing, 1970:257283.

8. Berry BJL, ed. Urbanization and counter-urbanization. Urban affairs annual review. Vol. 11. Beverly Hills, Calif, USA: Sage Publications, 1967.

9. Gugler J. Internal migration in the third world. In: Pacione M, ed. Population geography: progress and prospect. London: Croom Helm, 1986:194-223.

10. Cadwallader M. Migration and intra-urban mobility. In: Pacione M, ed. Population geography: progress and prospects. London: Croom Helm. 1986:257-283.

11. McGee TG. The urbanization process in the third world. London: G. Bell & Sons, 1971.

12. Preston SH. Urban growth in developing countries: a demographic reappraisal. Population Devel Rev 1979;5: 195215.

13. Domike AL. Industrial and agricultural employment prospects in Latin America. In: Field AJ, ed. City and country in th third world: issues in the modernization of Latin America. Cambridge, Mass, USA: Schenkman Publishing, 1970: 137163.

14. Buvinic M, Lycetter MA, McGrevey WPE. Women and poverty in the third world. Baltimore; Md,USA: Johns Hopkins University Press, 1983.

15. United Nations. Report on the world social situation 1957. New York: United Nations, 1957.

16. Lipton M. Urban bias revisited. J Dev Studies 1984;20: 139166.

17. Gilbert A. The housing of the urban poor. In: Gilbert A, Gugler J. eds. Cities, poverty and development. London: Oxford University Press, 1984:81-115.

18. Green LP, Milone VM. international urbanization survey: urbanization in Nigeria, a planning commentary. Cited by Fair TJD, Davies RJ. Constrained urbanization: white South Africa and black Africa compared. In: Berry BJL, ed. Urbanization and counter-urbanization. Beverly Hills, Calif, USA: Sage Publications, 1976.

19. Morse RM Recent research on Latin American urbanization: a selective survey with commentary. Lat Am Res Rev 1965; 1:1 58.

20. Morse RM. Trends and issues in Latin American urban research, 1965-1970. Lat Am Res Rev 1971 ;7:3-25, 1976.

21. Leeds A, Leeds A. Brasil and the myth of urban rurality: urban experience, work and values in "squatments" of Rio de Janeiro and Lima. In: Field AJ, ed. City and country in the third world: issues in the modernization of Latin America. Cambridge, Mass, USA: Schenkman Publishing, 1970:229-285.

22. Getulio Vargas Foundation. Food consumption in Brazil: family budget surveys in the early 1960s. Rio de Janeiro: Getulio Vargas Foundation, 1970.

23. Florencio CA. Comparison of the determinants of nutrient intake of rural and urban families. Ecol Food Nutr 1980; 10:97-104.

24. Foxley A, Raczynski D. Vulnerable groups in recessionary situations: the case of children and the young in Chile. In: Jolly R. Cornia GA, ads. The impact of world recession on children. New York: Pergamon Press, 1984: 53-76.

25. Food and Agricultural Organization. Income elasticities of demand for agricultural products, estimated from household consumption and budget surveys. Rome: FAD, 1983.

26. Food and Agriculture Organization. The fifth world food survey. Rome: FAO, 1986.

27. Musgrove P. Consumer behavior in Latin America: income and spending of families in ten Andean cities. Washington, DC: Brookings Institute, 1978.

28. Beaudry-Darisme MN. Hayes-Blend LC, Van Veen AG. The application of sociological research methods to food and nutrition problems on a Caribbean island. Ecol Food Nutr 1972;1:103-119.

29. Tomkins AM, Dunn DT, Hayes RJ, Bradley AK. Seasonal variations in the nutritional status of urban Gambian children. Br J Nutr 1986;56:533-543.

30. Schurch B. Urbanization and nutrition in the third world: an introductory overview. In: Schurch B. Favre AM, ads. Urbanization and nutrition in the third world: an annotated bibliography. Lausanne: Nestle Foundation, 1985.

31. Office of Nutrition, USAID. Bolivia: national nutrition survey. Washington, DC: USAID, 1981.

32. Office of Nutrition, USAID. United Republic of Cameroon: national nutrition survey. Washington, DC: USAID, 1978.

33. Office of Nutrition, USAID. Arab Republic of Egypt: national nutrition survey. Washington, DC: USAID, 1978.

34. Office of Nutrition, USAID. Swaziland: national nutrition survey. Washington, DC: USAID, 1983.

35. Basta SS. Nutrition and health in low income urban areas of the third world. Ecol Food Nutr 1977;6: 113-124.

36. Gugler J. Internal migration in the third world. In: Gilbert A, Gugler J. ads. Cities, poverty and development: urbanization in the third world. Oxford: Oxford University Press, 1984:49-64.

37. De Lima-Guimaraes JJ, Fischmann A. Desigualdades na mortalidade infantil entre favelados e não favelados no município de Porto Alegre, Rio Grande do Sul, em 1980. Bol Of San Pan 19B6;101:19-36.

38. Chabot MJ, Garfinkel J. Pratt MW. Urbanization and differentials in white and nonwhite infant mortality. Pediatrics 1975;56:777-781.

39. Wise PH, Kotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston. N Engl J Med 1985;313:360-366.

40. Puffer RR, Serrano CV. Patterns of mortality in childhood. Scientific publication no. 262. Washington, DC: PAHO/WHO, 1973.

41. Meegama SA. Socio-economic determinants of infant and child mortality in Sri Lanka: and analysis of post-war experience. Scientific report no. 8. Voorburg, Netherlands: International Statistical Institute, 1980.

42. Burke M, York M, Sands I. Interamerican investigation of mortality in childhood: report on a household sample. Scientific publication no. 386. Washington, DC: PAHO/WHO, 1979.

43. Mott FL. Infant mortality in Kenya: evidence from the Kenya fertility survey. Voorburg, Netherlands: International Statistical Institute, 1982.

44. Somoza JL. Illustrative analysis: infant and child mortality in Colombia. Voorburg, Netherlands: International Statistical Institute, 1980.

45. Moser K. Levels and trends in child and adult mortality in Peru. Voorburg, Netherlands: International Statistical Institute, 1985.

46. Mardones RF. Identification of risk for infant mortality in Chile. Report to the National Science Foundation, USA, 1986.

47. Nag M. Impact of social development and economic development on mortality: a comparative study of Kerala and West Bengal. Working paper no. 78. New York: Population Council, 1981.

48. Jayawardena K. The plantation sector in Sri Lanka: recent changes in the welfare of children and women. In: Jolly R. Cornia GA, eds. The impact of world recession on children. New York: Pergamon Press, 1984: 142- 158.

49. Macedo R. Brazilian children and the economic crisis: evidence from the state of Sao Paulo. In: Jolly R. Cornia GA, eds. The impact of world recession on chidren. New York: Pergamon Press, 1984:33-52.

50. Monckeberg F. Mardones RF, Valiente S. Evolución de la desnutrición y mortalidad infantil en Chile durante los ultimos 20 años. Working paper for WHO. University of Chile: INTA, 1984.

51. Dubos R. Savage D, Schaedler R. Biological Freudianism: lasting effects of early environmental influences. Pediatrics 1966;38:789-800.

52. Office of Nutrition, USAID. Nepal: nutrition status survey. Washington, DC: USAID. 1975.

53. Office of Nutrition, USAID. Sri Lanka: nutrition status survey. Washington, DC: USAID, 1976.

54. Office of Nutrition, USAID. Liberia: national nutrition survey. Washington, DC: USAID, 1976.

55. Office of Nutrition, USAID. Togo: national nutrition survey. Washington, DC: USAID, 1977.

56. Office of Nutrition, USAID. Republic of Haiti: national nutrition survey. Washinoton. DC USAID 1978

57. Office of Nutrition, USAID. El Salvador: national nutrition survey. Washington, DC: USAID, 1978.

58. Office of Nutrition, USAID. Sierra Leone: national nutrition survey. Washington, DC: USAID, 1978.

59. Office of Nutrition, USAID. Yemen Arab Republic: national nutrition survey. Washington, DC: USAID, 1979.

60. Tanner JM, Eveleth PB. Human growth. In: Harrison GA, Gibson GB, eds. Man in urban environment. Oxford: Oxford University Press, 1976.

61. World Health Organization. Contemporary patterns of breast feeding. Geneva: WHO, 1981:79-91.

62. Kanawati AA, McLaren DS, Abu-Jawdeh I. Failure to thrive in Lebanon. l. Experience with some simple somatic measurements. Acta Paediatr Scand 1971;60:309-316.

63. Robbin-Coker DJD, Jalloh MAS. Infant feeding and protein calorie malnutrition in Freetown. J Trop Pediatr 1975; 21(1B):1415.

64. Khanjanasthiti P. Wray JO. Early protein caloric malnutrition in slum areas of Bangkok Municipality 1970-71. J Med Assoc Thai 1978;57:357-366.

65. Grimble RF. A study of the pattern of clinical protein energy malnutrition in Accra from 1970 to 1978. J Trop Pediatr 1981;27:12-14.

66. Excler JL, Nicolas E, Mojon M. La malnutrition protéino-énergétique en milieu urbain Africain (Togo): facteurs étiologiques du kwashiorkor et du marasme-kwashiorkor. Med Trop 1985;45: 155- 161.

67. Asali AR, Kanawati AA, McLaren DS. Nutritional profile and length of residence in a slum suburb of Beirut. Ecol Food Nutr1978;6:251-256.

68. Bindra GS, Gibson RS. Iron status of predominantly lactoovo vegetarian East Indian immigrants to Canada: a model approach. Am J Clin Nutr 1986;44:643-652.

69. Oomen HAPC, McLaren DS, Escapini H. Epidemiology and public health aspects of hypovitaminosis A: a global survey of xerophthalmia. Trop Geogr Med 1964;16:271-315.

70. Khan MU, Hague ME, Khan MR. Nutritional ocular diseases and their association with diarrhea in Matlab, Bangladesh. Br J Nutr 1984;52:1-9.

71. Stanton BF, Clemens JD, Wojtyniak B. Khair JT. Risk factors for developing mild nutritional blindness in urban Bangladesh. Am J Dis Child 1986;140:584-588.

72. Tielch JM, West KP, Katz J. et al. Prevalence and severity of xerophthalmia in southern Malawi. Am J Epidemiol 1986; 124:561 -567.

73. Valverde V, Delgado HL, Noguera A, Flores R. Malnutrition in tropical America. In: White PL, Selvey N. eds. Malnutrition: determinants and consequences. New York: Alan R. Liss, 1984: 1 - 14.

74. Cohen N. Measham C, Khanum S. Khatum N. Ahmed N. Xerophthalmia in urban Bangladesh. Acta Paediatr Scand 1983;72:531 -536.

75. Suthutvoravoot S. Olson JA. Plasma and liver concentration of vitamin A in a normal population of urban Thai. Am J Clin Nutr 1974;27:883-891.

76. Abedin Z. Hussain MA, Ahmad K. Liver reserve of vitamin A from medico legal cases in Bangladesh. Bangladesh Med Res Council Bull 1976;2:42-51.

77. Flores H. Araujo CRC. Liver stores of vitamin A in infants and pre-school children deceased in Recife. In: Resumos temos livres, Xl Congresso Internac. Nutr. Rio de Janeiro 1978:203.

78. Arroyave G. Aguilar JR, Flores M, Guzman MA. Evaluación del programa nacional de fortificación de azucar con vitamina A. Scientific publication no. 384. Washington, DC: Pan American Health Organization/World Health Organization, 1979.

79. Olson JA. Liver vitamin A reserves of neonates, pre-school children and adults dying of various causes in Salvador, Brazil. Arch Latinoam Nutr 1979;29:521-545.

80. Chase HP, Kumar V, Doods JM, et al. Nutritional status of preschool Mexican-American migrant farm children. Am J Dis Child 1971;122:316-320.

81. Chase HP, Hambidge KM, Barnett SE, Houts-Jacobs MJ, Lenz K, Gillespie J. Low vitamin A and zinc concentrations in Mexican-American migrant children with growth retardation. Am J Clin Nutr 1980;33:2346-2349.

82. Martin FIR, Wyatt GB, Griew AR, Haurahelia M, Higginbotham L. Diabetes mellitus in urban and rural communities in Papua New Guinea. Diabetologia 1980;18: 369-374.

83. Zimmet P. Type 2 (non-insulin-dependent) diabetes-an epidemiological overview. Diabetologia 1982;22:399-411.

84. Taylor R. Zimmet P. The epidemiology of diabetes. In: Mann J. Pyorala K, Teuscher A, eds. Diabetes: a clinical perspective. Edinburgh: Churchill, Livingstone, 1982: 391 -399.

85. World Health Organization. Prevention of coronary heart disease. Report of a WHO expert committee. World Health Organization technical report series 678. Geneva: WHO, 1982.

86. Puffer RR, Griffith GW. Patterns of urban mortality. Pan American Health Organization/World Health Organization scientific publication no. 151. Washington, DC: PAHO/WHO, 1968.

87. McGlashan ND. Causes of death in ten English-speaking Caribbean countries and territories. Bull Pan Am Health Org 1982;16:212-223.

88. McGlashan ND. A West Indies geographic pathology survey. University of Tasmania, 1982.

89. Omram AR. The epidemiologic transition. Milbank Mem Fund (I 1971 ;49:509-538.

Urbanization and hunger in the cities

Anwar M. Hussain and Paul Lunven

Urbanization is an inevitable consequence of socioeconomic development and industrialization. In developing countries it is proceeding at such a fast rate that it is outpacing the growth of services and employment. The result is teeming slums in city centres and shanty towns on their peripheries. Many of their inhabitants are compelled to live in a state of intense deprivation, and thus disproportionately bear the brunt of hunger and malnutrition in the cities.

Naturally, such unprecedented growth of urban populations has consequences for hunger and malnutrition. To put the issue into proper perspective, it is necessary to understand the magnitude of and trends in urbanization, as well as the characteristics of settlements themselves, and the direct and indirect effects of hunger on the persons who inhabit them. The greater the knowledge of these aspects, the more successfully vulnerable groups will be identified and measures and policies to combat urban hunger implemented.

Magnitude of and trends in urbanization

Developing countries constituted 75% of the world population in 1980. It is projected that they will be the source of all net additions to the world rural population and 84% of the net additions to the world urban population between 1980 and 2000. During this period it is likely that the urban population in developing countries will rise from about 31% of the total to 44% (table 1) [1]. Two of three urban residents and nine of ten rural residents of the world will be in the developing countries by 2000. This projected rate of urban growth is particularly striking be cause there is no historical precedent for the sheer numbers of people being added to the urban sectors in these countries [21.

Not only is the world becoming increasingly urbanized, but United Nations projections show that by 2000 a large part of the population will be concentrated in major urban centres of growth called "primate cities." By 1980 at least one in four of the population of Argentina, Iraq, Peru, Chile, Egypt, the Republic of Korea, Mexico, and Venezuela lived in a primate city. It is projected that by 2000 there will be 79 such cities in the world with populations greater than 4 million. Of these, 59 will be in the developing countries and will account for one-fourth of the population of these nations [1].

Large differences exist in the degree of urbanization in the various regions of the developing world, but these are likely to decrease by the year 2000. Some differences will persist, however, particularly between other regions and Latin America, which has almost reached the level of urbanization in developed countries. By the year 2000 three of four persons in Latin America and two of five in Asia and Africa will live in urban areas.

Characteristics of urban settlements in developing countries

Physical characteristics

In contrast to the planned cities of the developed countries, rapid growth of population in the developing world has overloaded the existing physical facilities in large cities [3]. The resultant pattern comprises four distinct physical parts:

-an old central area of the city, mostly decaying, with a heavy concentration of people and outdated services;
-a planned middle-class area with reasonably adequate services;
-a prosperous elite area with all modern amenities;
-a periurban area, unplanned, unserviced, and extremely densely populated (four to five times higher than the average in some cities for which statistics are available, e.g. Calcutta and Manila).

It is mainly the periurban areas and decaying city centres that attract most of the new migrants and become the geographical location of hunger in the cities.

TABLE 1. Projected urban and rural population growth by region, 1980-2000

a. Figures in parentheses are percentages.
b. Includes Melanesia, Micronesia, and Polynesia.

Source: Ref. 1

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