• Editors' Summary
• Credits

1. An Urban Future
2. The Urban Poor
• Insufficient Incomes
• Inadequate Housing and Services
• Health Burdens
3. Pollution and Health
4. Impact on the Environment
5. Making Urban Areas Work

• Figures
• Tables
• Side-bars
• Bibliography

• Developing countries face fastest urban growth
• Why urban areas are growing
• The poor have greatest health risks
• Heavy ecological footprints
• Improving urban governance
• Assuring water and sanitation
• Mumbai cleans up

• POPLINE
• Media/Materials Clearinghouse
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Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA

Around the world over 1 billion urban residents live in inadequate housing, mostly in slums and squatter settlements, where living conditions are poor and services are insufficient (137). One-quarter of all urban housing units in developing countries are temporary structures, and more than one-third do not conform to building regulations. The situation is worst in sub-Saharan Africa, where 60% of urban housing units are temporary structures, and about half do not conform to building regulations (134).

Urban slums include both high-density dwellings, such as high-rise apartments, and squatter settlements and shanty-towns, where people occupy vacant land and illegally build shacks for themselves (134). Many illegal settlements are built on land poorly suited for housing—for instance, on floodplains or on steep hillsides—and are especially prone to damage from natural disasters (132) (see Chapter 4, Impact on the Environment).

Slum residents usually lack security of tenure—that is, the right of legal access to and use of the land and buildings they occupy (133). Each year several million urban dwellers are forcibly evicted (132). An estimated 20 million to 40 million urban families are homeless, some because they have been evicted and some because they cannot afford any housing, even illegally (137).

It is particularly difficult for the urban poor to obtain tenure because property registration processes are inefficient, complicated, and expensive (137). The process is even more difficult in the case of informal settlements. Many governments hesitate to legalize them for fear of encouraging even more illegal settlement (3, 120).

Legal housing, however, usually is too expensive for the urban poor, or it is scarce (132). Outdated government regulations controlling land acquisition and construction of housing, coupled with rapid urban population growth, have made land scarce, which in turn has inflated housing prices. Estimates from various countries show that it would take low-income households 15 to 30 years of saving 30% to 50% of their incomes to afford a legal house meeting minimum standards. In reality, most of the urban poor earn too little to save any money at all (3). Furthermore, they lack access to credit from commercial lending institutions (132).

People in slums often must pay more for services than other urban residents, and they receive services of lower quality (137). The scarcity of public water supplies forces many low-income urban residents to use other water sources, often private water vendors who charge many times the public rate (136, 150). In Istanbul, Turkey, water from private vendors costs 10 times the public rate, while in Mumbai (formerly Bombay), India, vendors charge 20 times more (83). Poor households often spend 5% to 10% of their incomes to buy water (44, 136).

On average, the health of urban residents in developing countries is better than that of rural dwellers, in part because urban areas usually offer better health care and healthier living conditions than most rural areas.

Infant and child mortality rates are lower in urban areas than in the countryside. The average child born in an urban area has a much better chance of survival than does a rural child. In 54 of 57 countries with data from the Demographic and Health Surveys (DHS), infant mortality rates—deaths before age one per 1,000 live births—were lower in urban than in rural areas. Similarly, child mortality rates—deaths to children ages one to five per 1,000 children surviving to age one—were lower in urban than in rural areas in 56 of the 57 surveyed countries (30).

Within urban areas, however, the urban poor face many more health risks than the average urban resident. In 17 of 18 countries studied with DHS data, for example, infant mortality was higher in the less developed urban areas than in the more developed urban areas (with level of development indicated by access to piped water) (7) (see Figure 4). Health conditions for the urban poor are sometimes even worse than they are for the rural poor (7, 161, 163).

In large cities of developing countries, child mortality is highest among children whose mothers recently migrated from rural areas and those who live in low-quality housing (11). The extent of childhood illnesses is closely related to poverty levels and to the quality and extent of health care, clean water supply, and sanitation (132).

Access to services. The urban poor are more vulnerable to poor health and environmental hazards because they are more likely than others to lack adequate housing, sanitation, and other basic services (107, 132). In each of 32 developing countries with DHS data, poor urban households were less likely than other urban households to have access to basic services, including piped water, a flush toilet, and electricity. Poverty status was defined by household ownership of certain consumer items, such as a refrigerator and television, as well as housing quality, including the number of sleeping rooms (48).

Basic services needed for good health often do not reach the urban poor because municipal authorities do not recognize many informal settlements for political and administrative reasons, and thus these areas are not eligible for services. In some cases, slum areas are not classified as urban precisely because they lack services (120).

Also, as noted, the urban poor often settle on land not suitable for housing. Extending infrastructure such as roads, water mains, and sewer lines can be difficult because of rough terrain. Moreover, such neighborhoods often are developed haphazardly, without planning to allow space for infrastructure. In order to lay water or sewer pipes, the utility authorities often must remove or relocate many houses (120).

In addition, governments and donor agencies give low priority to providing such services as primary health care, basic education, family planning, water and sanitation, and nutrition, according to an analysis of 17 developing countries around the world (45). The UN and the World Bank agree that, on average, 20% of national budgets in developing countries and 20% of international aid should be allocated to extending these basic services to all people—both urban and rural. In the 17 countries studied, however, the average expenditure on these services was only 12% of total government spending—from 8% in Lebanon to 17% in Nepal. Similarly, in few instances did spending on basic services account for 20% or more of donor assistance (45).

In urban areas the poor usually suffer most from a lack of basic services but are the last to be included in urban planning and infrastructure improvements. Their disadvantage mainly reflects their lack of political power and influence (137).