Slum areas of fast-growing cities in developing countries are failing to benefit from the better and cheaper health services that are supposed to be derived from economies of scale, experts said at the International Conference on Urban Health held in Manchester, United Kingdom, earlier this month (5-7 March).
The main obstacle is a shortage of local data sets, which would reveal issues to prioritise in each slum, the conference heard.
“I’m stunned by how very little data there are on the causes of death in many African cities, for example Dar es Salaam,” says David Satterthwaite, senior fellow at UK-based research organisation the International Institute for Environment and Development.
His own research, presented at the meeting, he showed the main causes of mortality in 2012 in the slums of Tanzania’s largest city to be HIV, pneumonia, flu, malaria and diarrhoea. These are all preventable diseases, but they may only receive proper attention if studies identify them as key causes of death, he says.
“Most international agencies have no urban policy and have ignored urban health statistics for 40 years, and then they use spurious statistics that suggest things are better than they really are.”
David Satterthwaite, International Institute for Environment and Development
Another problem is that local governments, the bodies that can act most directly to improve sanitation and healthcare, are unable to access much of the relevant data from national surveys carried out by public officials, often due to red tape, Satterthwaite says.
He urges scientists and doctors to ditch their “obsession” with working with national governments and start collaborating with local authorities and organisations representing those living in informal settlements or slums, since they are in the best position to provide information on what is most urgently needed at specific locations.
Currently, more than 30 developing countries, including Cambodia, India, Kenya, Namibia, the Philippines and South Africa, have federations of slums dwellers that campaign for better living conditions.
A greater focus on local collaboration would also help international aid agencies working to improve slum dwellers health. These too often lack the right information or fail to measure progress in an inadequate way, he says.
“Most international agencies have no urban policy and have ignored urban health statistics for 40 years, and then they use spurious statistics that suggest things are better than they really are,” Satterthwaite says.
“Many reports say that a long list of developing countries have access to ‘improved water’, but that also includes places where people have to queue for hours to have access to a public tap or standpipe. Those reports do not measure if the water is safe or if there is water in the pipe or even if it is affordable,” he says.
In South-East Asia, where some 43 per cent of people live in slums, more research is needed on issues such as their mental health, Mala Rao, professor of international health at the University of East London, United Kingdom, tells SciDev.Net.
Rao agrees there is a lack of local data, but she stresses that action should still be taken. “These are very startling evidence problems,” she says. “The time of waiting for data is over. Now it is about leadership and perseverance to bring about change.”
Data collection in urban areas should also be interdisciplinary; involving epidemiologists, toxicologists, urban planners and environmental scientists among other experts, according to Sotiris Vardoulakis, air pollution and climate change group leader at the UK government agency Public Health England.
Involving slum dwellers in data collection will also help to avoid using methods that were successful in one place, but could fail in another community, Jason Corburn, associate professor of city and regional planning at the University of California, Berkeley, United States, tells SciDev.Net.