urban health.pptx

urban health

1. Meaning of Urbanization Urbanization: Urbanisation is the increase in the proportion of people living in towns and cities. Urbanisation occurs because people move from rural areas (countryside) to urban areas (towns and cities). This usually occurs when a country is still developing

2. Characteristics of Urban area

3. Factors affecting rural to Urban Migration and its effects to rural lives with particular instances to Nepal

4. Types of Migration Internal Migration (migration within a country) International Migration (migration between countries)

5. Common push and pull factors for migration Push Factors Pull Factors  Lack of job opportunities  Political instability or conflict  Economic crisis Poverty Lack of agricultural land Religious discrimination Lack of schools & universities  Demand of workers  Employment opportunities  High exchange rate  Savings  Security High living standard Families & Friends Freedom

6. Determinants of Migration Push Factors Pull Factors Economic & Demographic  Poverty, low wages, unemployment  High fertility rates  Lack of basic health and education  Prospects of higher wages  Potential for improved standard of living  Personal or professional development Political  Conflict, insecurity, violence  Poor governance  Corruption  Human rights abuses  Safety and security  Political freedom Social & Cultural  Discrimination based on ethnicity,  gender, religion, and the like  Family reunification Ethnic ( diaspora migration) homeland  Freedom from discrimination

7. Economic Factor Because of the open border and historical linkages, India serves as the low cost and low return destination for Nepali migrants. A typical migrant worker to India pays Rs . 6,250 (USD 83) to migrate and find a job in India. This amount is roughly over two months of per-capita consumption in Nepal. They earn, on average, Rs . 6,400 (USD 85) a month, of which they save almost two-thirds.

8. Government of Nepal allowed private recruitment agencies to recruit workers to a selected set of countries, mostly in the Persian Gulf and a few others like Malaysia, Japan and South Korea, upon obtaining clearance from the Ministry of Labor. Nepal’s economic growth fell to 3.6% due to political uncertainties, shortfalls in public expenditure and low agricultural output in 2013. Growing trade deficit in the country continues to be financed by robust remittance transfers (World Bank, 2013).

9. According to the Central Bureau Statistics (CBS, 2011), the percentage of households receiving remittances increased from 23.4% in 1995/96 to about 55.8% in 2010/11 and the share of remittance in the household income increased from about 26.6% to 30.9 %. Weak performance of agricultural sector, high population growth and unstable political situation prompted many of the most productive members of rural households to migrate internally or internationally in recent years from Nepal (ADB, 2013).

10. Summarizing above findings it is observed that Nepal’s urban growth is primarily characterized by an increase in the number of municipalities, an expansion in the urban area, and a relatively steady increase in the urban population in the designated urban areas in the initial years, a rapid increase of population in recent years, and consistent increases in the percentage share of urban population to the total population and rural population

11. Process of Urbanisation Growth in the proportion of total population, which lives in urban places Urbanization proceeds in two ways : Multiplication of points of concentration Increase in size of individual concentrations

12. 11/29/2022 21 Important Measures of Urbanization in three dimension DEGREE OF URBANIZATION TEMPO OF URBANIZATION THE CONCENTRATION AND DISPERSION OF POPULATION

13. Degree of Urbanization Percentage of population in rural Areas Ratio of Urban to Rural Population Size of locality of residence of the median inhabitant. A-4 Mean City Population Size (MC )

14. 11/29/2022 23 A. DEGREE OF URBANIZATION A-1. Percent of population in urban area PU= U/P x 100 U  Urban population of the country P  Total population of the country

15. 11/29/2022 24 Limited use Data easily available   Several weakness Easy to calculate   Does not give any indication of the % of the population according to size Easy to interpret   Change in boundary of the locality from time to time Easy to understand

16. 11/29/2022 25 ( Source:CBS:390) Figures in parenthesis are the number of urban places. Size of Urban Place and Population POPULATION IN PERCENTAGE 1952/54 1961 1971 1981 1991 2001 100,000 over 44.7(1) 36.0(1) 32.6(1) 24.6(1) 39.3(3) 39.4(5) 50,000-99,999 - - 12.8(1) 18.1(2) 30.5(8) 24.4(11) 20,000-49,999 31.3(2) 34.8(3) 32.4(5) 47.8(13) 17.3(14) 32.0(34) Less than 20,000 24.0(7) 29.2(12) 22.2(9) 9.5(7) 12.9(8) 4.2(8) Total 100(10) 100(16) 100(16) 100(23) 100(25) 100(58) Above 20,000 76.0(3) 70.8(7) 77.8(7) 90.5(16) 87.1(25) 95.8(50) Urban growth by size of urban places 1952/54-2001

17. 11/29/2022 26 Table :Size class distribution of municipalities and their population,Nepal 2011, census “ According to Davis in 1969 a better urban comparison can be made by looking at the population living at different cities according to the size of pop n , whatever change in definition of the urbanization.

18. 11/29/2022 27 A-2 RATIO OF URBAN TO RURAL POPULATION UR = U / R Where U  Urban population of the country R  Rural population of the country This measure measures another aspect of urbanization and is better measure of urbanization

19. 11/29/2022 29 Ex:Population distribution by categories of localities (Municipalities) Nepal , 2011 Here 50000-99999 (see above table) is the median class since it contains 50 percent of population. In order to obtain the median value, the formula mentioned above is applied as. Size class distribution Municipalities Number Population Per cent Cumulative% Per cent Size Less than 20000 14 10.8 238,431 3.3 3.3 20000-29999 33 25.4 833,353 11.6 14.9 30000-39999 25 19.2 855,406 11.9 26.8 40000-49999 (Q i ) 19 14.6 850,327 11.8 38.6(PP I ) 50000-99999 ( Q i + 1 ) 28 21.5 1,895,554 26.3 64.9 ( PP i + 1 ) 100000-199999 7 5.4 873,598 12.1 77.0 200000 and plus 4 3.1 1,652,845 23.0 100.0 130 100.0 7,199,514 100.0

20. 11/29/2022 30 PP i  is the cumulative percent of the pop. for the locality size just under 50% PP i+1  is the cumulative percent of the next locality size category Q i  is the upper limit of the locality size i , just under 50%

21. 11/29/2022 31 A-4 Mean City Population Size (MC): It is the average of the sizes of the cities where C i is the population in the i th localities; P is the total population of the country; m is the total number of localities

22. 11/29/2022 32 Level of Urbanization in Nepal 1952/54 to 2001 CENSUS YEAR 1952 /54 1961 1971 1981 1991 2001 Per cent of population in urban places 2.9 3.6 4.0 6.4 9.2 13.9 Ratio of urban –rural population (000) 29.4 37.0 41.0 68.0 101.0 165.4 Size of locality of residence of median inhabitant (000) 46.9 40.1 47.5 46.9 82.5 Mean city population size (000) 1.7 2.2 2.8 5.9 13.9 ( Source :CBS 1995:252)

23. The Distribution of population : 11/29/2022 33 Several methods for analyzing the distribution of population over a country's boundary exist. We discuss here only frequently used methods . Distribution of urban population by regions, Nepal 2014 Census Census year Mountain Hill* Kathmandu valley Tarai Nepal 1981 (23) 132,027 363,507 461,187 956,721 1991 (33) 269,367 598,528 827,824 1,695,719 2001 (58) 43,705 720,311 995,966 1,467,897 3,227,879 2011 (130) 168,388 1,726,021 1,426,641 3,878,464 7,199,514 (Source: Cited by Subedi, BP in CBS, 2014:119 , Vol. III).

24. Important Measures of Urbanization Tempo of Urbanization:  This indicates the rate of change brought about by urbanization. It is computed on the basis of annual population growth rates. Demographer tries to find out how the urban change had occurred and whether it was linear, geometric, exponential or hyperbolic.

25. Methods Annual change in percentage points But it is affected by degree of urbanization As the countries with a very high level of urbanization cannot show much further change despite the possibility that the process of urban growth can continue

26. Strength of Urban setting in Promoting Public health New data on the health of city-dwellers in almost 100 countries show that as the world’s urban population continues to grow, health inequities - especially between the richest and poorest urban populations - are a persistent challenge, according to a report by WHO and the United Nations Human Settlements Programme (UN-Habitat). For example, only half of households in urban areas of 91 countries with comparable data have access to piped water, with the richest 20% of households being 2.7 times more likely to have access to piped water than the poorest 20%. In Africa, this ratio is closer to 17 times .

27. Strength of Urban setting in Promoting Public health About 3.7 billion people live in cities today. A further 1 billion people will be added by 2030, with 90% of the growth being in low- and middle-income countries. This intensifies the need to realize the Sustainable Development Goal (SDG) target of ensuring universal health coverage (UHC): that all people obtain the health services they need without suffering financial hardship when paying for them, by 2030 . (WHO, 2016)   An analysis of nine indicators for 94 countries-- which shows that vast inequalities in health service coverage persist, despite urban areas reporting higher coverage of services than their respective national average levels.

28. Accountability of health services The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the ‘urban advantage’, the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts

29. Urban health systems must respond to rapid demographic, social and disease transition while also contending with a plurality of providers and a need to stimulate a multisectoral response to address the wider determinants of health in order to make health service accountable to Public. ► Rapid urbanisation presents challenges to traditional conceptualisation of health systems. ► Conceptualisation of urban health system must consider multisector responses, engagement with a plurality of providers, the role of local governments and engagement of urban residents, particularly the poor. ► Data and evidence, and technological advances in e-health, can provide the glue to hold together this complex urban health system.

30. Accountability of health Information Health information flow must be addressed to everyone. Huge population might make information impossible to gain making people more prone to disease/ health risks About 3.7 billion people live in cities today. A further 1 billion people will be added by 2030, with 90% of the growth being in low- and middle-income countries. This intensifies the need to realize the Sustainable Development Goal (SDG) target of ensuring universal health coverage (UHC): that all people obtain the health services they need without suffering financial hardship when paying for them, by 2030.

31. Accountability of water and sanitation As urbanization increases single people become less concerned. Number of people in the area grow while people gettng access to water and sanitation decreases. Scarcity become the major problem in city areas. O nly half of households in urban areas of 91 countries with comparable data have access to piped water, with the richest 20% of households being 2.7 times more likely to have access to piped water than the poorest 20%. In Africa, this ratio is closer to 17 times.

32. Adverse Effects of Urbanization in Health Accidents in Urban areas: The Global Status Report on Road Safety 2018 published by the World Health Organization states that more than 1.35 million people die each year on the world’s roads In recent decades, the number of motor vehicles in the world has risen from 0.85 billion in the year 2000 to 2.1 billion in 2016 , leading to an increased exposure to traffic for most people. This motorization has grown hand in hand with urbanization. Since 1950, the urban population of the world has rapidly increased, so that in 2018, 55% of the world’s population live in urban areas . However, the percentage of urban population varies from country to country being as much as 82% in Northern America or 74% in Europe

33. Some already known facts are verified: serious and minor accidents happen with higher frequency in urban than in rural areas and they follow daily patterns that reflect the working schedule of residents in E&W (two peaks of different height during weekdays, the short one corresponding to the morning rush hour and the tall one, to the evening rush hour; less accidents during the weekends and almost no accidents at nights). Fatal accidents happen more often in rural areas, perhaps due to the characteristics of rural crashes, the demographics of rural drivers, their typical behaviours or the higher difficulty to access medical care after a crash. Fatal accidents in urban roads also tend to be more evenly spread throughout the day. At night, the number of fatal accidents is lower, possibly with the exception of Friday and Saturday nights.

34. Waste generation and disposal in Urban areas Waste in the city is a transversal theme; it affects water quality, causes flooding (e.g., urban storm waterlogging due to trapped waste in water drainages), generates public health issues by hosting disease vectors, affects the perception of public space (e.g., as a space of neglect and lack of citizenship) and furthers the sense of exclusion. But waste also has other social, economic and environmental facets, which will be discussed further on. Post-consumer waste generation has more than doubled worldwide, between 1971 and 2002

35. While Western Europe and North America on average already experienced municipal solid waste (MSW) rates between 1.4 and 1.8 kg/capita/day over the past decade, the population in many large cities in the global South is now also reaching values between 1 and 1.4 kg/capita/day . The urban lifestyle contributes to higher waste generation not only in people’s homes but also outside. Particularly the food service industry thrives on disposables. Today, people consume more in the streets and their consumption leaves more disposable waste in public waste bins. In 2012, urban residents globally generated about 1.2 kg/capita/day of MSW, compared to 0.64 kg in 2002

36. In developing urban areas massive wastes generally consist of domestic garbage, organic litter, plant leaves, branches, logs, spoiled agricultural produce, crop residues, bad food materials, pieces of paper, polythene bags, rags, vehicle scraps, used tires, dusts, mire, plastics, glass, blood, bones, animal skins, hides, leather, urinary and fecal materials These waste are mostly dumped somewhere, some even use developing coutry as a dumping site (African nation), Other use ocean as a dumping area Beside that other waste are incinerated, direcly poured in the water Some waste are reused, recycled like making brick of plastic. But these trends are fewer

37. Violence In essence, the rise in urban violence is a response to changes in global and sub-national demographics, growing inequality in urban areas, and increasingly unstable political conditions in developing countries .  Today, around a billion people live in sub-standard conditions in urban slums and informal settlements, largely without access to basic services such as housing, running water, sanitation, health, and education. In many such areas, the volatile combination of poverty, youth unemployment, inequality, marginalization, poor governance  and weak rule of law has created a fertile ground for the proliferation and expansion of criminal networks, recruitment into gangs and rebel groups, and social and political unrest. It is also not a coincidence that different violent groups – insurgents, terrorists, narco -traffickers, and criminal gangs – are increasingly choosing to target and fight in cities. Cities have always held significant strategic, political, psychological, economic, and logistical value, serving as the epicenter of government power, industrial and financial activity, and cultural life.  The rise in urban violence is likely to continue ,as political, criminal, social, and interpersonal violence will increasingly intersect, overlap, and converge in fragile, densely populated cities

38. Rural/Urban health appraisal method Participatory Rural Appraisal Rapid Rural Appraisal

39. Rural/Urban health appraisal method PARTICIPATORY RURAL/URBAN APPRAISAL Appraisal – The finding out of information about problems, needs, and potential in a village/town. It is the first stage in any project. Participatory – Means that people are involved in the process – a “bottom-up” approach that requires good communication skills and attitude of project staff. Rural – The techniques can be used in any situation, urban or rural, with both literate and illiterate people.

40. Participatory Rural Appraisal PRA as an approach and methods for learning about rural life and conditions from, with and by rural people. PRA extends into analysis, planning and action. PRA closely involve villagers and local officials in the process.

41. Principle Avoids unnecessary data Relaxed and Non biased Trangualization Learning from and within the people Learning rapidly and progressively Community people as investigator and us as facilitator ( Information from inside by insiders)

42. How to identify nature of medical care demand in Urban and Rural Resource Map • Social Map • Wealth Ranking Objectives: • Local Perceptions of Malnutrition Mapping Objectives: • Venn Diagram on Institutions • Resource Cards Seasonal Calendar • Income and Expenditure Matrix • Daily Activity Clocks • Focus group discussion: Constraints and Opportunities to achieving Nutrition and Household Food Security • Semi Structured Interview: Household Case Study • Community Workshop • Daily Evaluation and Planning Meeting

43. Rapid Appraisal Rapid Appraisal is a research approach that has been applied in different settings. It covers a variety of methods and techniques, but all these tend to have the following characteristics in common 1. greater speed compared with conventional methods of analysis; 2 . working in the ‘field’; 3 . an emphasis on learning directly from the local inhabitants; 4. a semi-structured, multidisciplinary approach with room for flexibility and innovation; 5 . an emphasis on producing timely insights, hypotheses or ‘best bets’ rather than final truths or fixed recommendations.

44. This general framework was further developed for application in the health field by Rifkin and Annett firmly based on the HFA2000 philosophy. They proposed an approach to understanding the health needs of urban communities, which strengthens the principles of equity, participation and multispectral co-operation.

45. Last For 4-8 days

46. Information pyramid The information regarding these must be identified for Urban/ Rural appraisal

47. Beginning process Tells what problem are not how much the problem is It is a need based community assessment

48. 3 Principal must be addressed in rapid appraisal Collection of minimal and required data quickly Identify the information which is needed and acceptable ways of getting the information Third is to involve community in rapid appraisal.

49. The data can be gathered from Existing written records Observation and Interview

50. Thank you