urban health.pptx

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

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

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

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

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

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.

• 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).

• 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).

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

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

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

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

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

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

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

11/29/2022 26
Table :Size class distribution of municipalities and their population,Nepal 2011, census
Size class
distribution
Municipalities Population
No. Per cent Size Per cent
200000 and plus 4 3.1 1,652,845 23.0
100000-199999 7 5.4 873,598 12.1
50000-99999 28 21.5 1,895,554 26.3
40000-49999 19 14.6 850,327 11.8
30000-39999 25 19.2 855,406 11.9
20000-29999 33 25.4 833,353 11.6
Less than 20000 14 10.8 238,431 3.3
Total 130 100 7,199,514 100
(Source: cited by Subedi, BP in CBS, 2014:121 , Vol. III).
“ 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 popn, whatever change in
definition of the urbanization.

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

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
Municipal
ities
Number
Population Per
cent
Cumulativ
e%
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 (Qi) 19 14.6 850,327 11.8 38.6(PPI )
50000-99999 (Qi + 1) 28 21.5 1,895,554 26.3 64.9(PPi + 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

11/29/2022 30
PPi 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
Qi  is the upper limit of the locality size i, just
under 50%
MI = 49999 + (99999-49999)
𝟓𝟎− 𝟑𝟖.𝟔
𝟔𝟒.𝟗 − 𝟑𝟖.𝟔
= 49999 + 50000 11.4/26.3
= 49999 + 21673.0 =71,672
Qi Qi 1 Qi
50 PPi
PPi 1 PPi
=
MI

11/29/2022 31
A-4 Mean City Population Size (MC):
It is the average of the sizes of the
cities
=
MC
= 1
m
i
Ci
2
P
where Ci is the population in the ith localities;
P is the total population of the country;
m is the total number of localities

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
1.7 2.2 2.8 5.9 13.9
(Source :CBS 1995:252)

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) 0 132,027 363,507 461,187 956,721
1991 (33) 0 269,367 598,528 827,824 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).

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.

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

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.

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.

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

• 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.

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.

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.
• 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.

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

• 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.

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

• 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

• 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

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

Rural/Urban health appraisal method
• Participatory Rural Appraisal
• Rapid Rural Appraisal

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.

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.

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)

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

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.

• 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.

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

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

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

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

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