Editorials

Slums, climate change and human health in sub-Saharan Africa

Sub-Saharan Africa is the least urban- sanitation in 2000.4 In eastern Africa tion creates flood-prone conditions by
ized region in the world. Only 39.1% in 2006, open defecation was the only covering the ground with pavement
of the region’s population lives in cities.1 sanitation practice available to 33% and buildings, and by building urban
However, the region’s urban popula- of the population.1 This contributes drains, causing runoff water to move
tion is projected to more than double to the contamination of water and more rapidly into rivers than under
to 760 million by 2030.1 The rate of land within cities as well as to many natural conditions.10 The urban poor
urbanization makes it very challenging of the waterborne diseases prevalent in build houses of weak, inadequate
to manage. A recent paper in the New slums.4 materials, often against hillsides that
England Journal of Medicine argued that Flooded areas and ditches, latrines are subject to landslides during heavy
urbanization is a “health hazard for and septic tanks are key reservoirs that rains.8 More than 70% of flood deaths
certain vulnerable populations, and this perpetuate cholera, malaria, dengue in the Mozambique floods of 2000 oc-
demographic shift threatens to create a and yellow fever in urban areas.8 Infec- curred in urban areas.6 The Luis Cabral
humanitarian disaster.” 2 tious disease outbreaks are also precipi- slum neighbourhood in the capital city
Urbanization in Africa is linked tated by the high population density of Maputo was completely destroyed
to poverty. Globally, nearly 1 billion found in these areas, with overcrowding and water and sanitation services were
people live in slums, and this number triggering epidemic-prone infections disrupted causing outbreaks of dysen-
is projected to double to 2 billion in like pertussis and influenza.2,8 tery and cholera.10
the next 30 years.3 The United Na- Children bear a disproportionate Urban outdoor pollution in Africa
tions Human Settlements Programme burden of disease in slums. In Ethiopia is responsible for an estimated 49 000
(UNHABITAT) defines a slum as an and the Niger, rates of child malnutri- premature deaths annually.1 Slums are
urban area with a lack of basic services tion in both urban slums and rural often located near factories and busy
(sanitation, potable water, electricity), areas are around 40%.4 Immunization roadways thus rendering their inhabit-
substandard housing, overcrowding, coverage in slums in the Niger is 35% ants vulnerable to a high burden of
unhealthy and hazardous locations, compared with 86% in non-slum ur- respiratory disease. Exposure to elevated
insecure tenure and social exclusion.3 ban areas.4 In Nairobi, where 60% of concentrations of ozone is associated
In sub-Saharan Africa, 71.8% of urban the city’s population live in slums, child with increased hospital admissions
dwellers live in slums, the highest mortality in the slums is 2.5 times for pneumonia, chronic obstructive
proportion in the world.4 greater than in other areas of the city.7 pulmonary disease, asthma as well as
Over the coming decades, the Droughts are associated with a with premature mortality.5 As summer
effects of climate change will also be lack of access to water supplies for temperatures rise, the concentration
progressively felt across the African consumption and sanitation, as well of ground-level ozone is increasing in
continent. Climate change and urban- as with poor agricultural productiv- most regions of the world.5
ization will interact, with unpredictable ity. Water scarcity will increase for African slum dwellers are particu-
effects. The Fourth Assessment Report of both urban and rural populations in larly vulnerable to the negative health
the Intergovernmental Panel on Climate Africa over the next century. Climate effects of rapid urbanization and global
Change stated that “urbanization and change is expected to bring more climate change. Further research is
climate change may work synergistically frequent and longer droughts to the required to understand the impacts of
to increase disease burdens.” 5 region.9 Drought in rural areas may climate change on the health of slum
A significant share of ill health in be a major trigger for in-migration to dwellers as well as to design appropri-
slums stems from poor access to sanita- urban areas, further stressing urban ate adaptation policies. When plan-
tion and clean drinking water. In 2000, infrastructure.5,10 Falling agricultural ning public health interventions in
30–50% of African urban dwellers productivity in the region could place Africa one must consider the dynamic
lacked a safe water supply.6 Even where increased strain on local food markets, relationship between climate change
it is available, access to safe water is thus increasing rates of malnutrition and urbanization and their impact on
often unaffordable for the urban poor. in slums. vulnerable urban populations. ■
Slum dwellers in cities in east Africa Because climate change is associ-
pay 5–7 times more for a litre of water ated with more extreme precipitation References
than the average North American.7 events and rising sea-levels, African Available at: http://www.who.int/bulletin/
Across Africa, 45% of the urban cities will also experience more severe volumes/87/12/09-073445/en/index.html
population lacked access to improved and more frequent flooding. Urbaniza-

a
Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Correspondence to Brodie Ramin (e-mail: [email protected]).

886 Bull World Health Organ 2009;87:886 | doi:10.2471/BLT.09.073445

References
1. The state of Africa’s cities. Nairobi: United Nations Human Settlements 7. Commission on Social Determinants of Health. Closing the gap in a
Programme; 2008. generation: health equity through action on the social determinants of health.
2. Patel RB, Burke T. Urbanization – an emerging humanitarian disaster. N Engl J Geneva: World Health Organization; 2008.
Med 2009;361:741-3. PMID:19692687 doi:10.1056/NEJMp0810878 8. Unger A, Riley LW. Slum health: from understanding to action. PLoS Med
3. United Nations Human Settlements Programme. The challenge of slums: 2007;4:e295. doi:10.1371/journal.pmed.0040295
global report on human settlements. London: Earthscan Publications; 2003. 9. Boko M, Niang I, Nyong A, Vogel C, Githeko A, Medany M, et al. Africa. In:
4. United Nations Human Settlements Programme. State of the world’s cities Parry ML, Canziani OF, Palutikof JP, van der Linden PJ, Hanson CE, eds.
2006/7. London: Earthscan Publications; 2006. Climate change 2007: impacts, adaptation and vulnerability. Contribution of
5. Confalonieri U, Menne B, Akhtar R, Ebi KL, Hauengue M, Kovats RS, et al. Working Group II to Fourth Assessment Report of the Intergovernmental Panel
Human health. In: Parry ML, Canziani OF, Palutikof JP, van der Linden PJ, on Climate Change. Cambridge: Cambridge University Press; 2007.
Hanson CE, eds. Climate change 2007: impacts, adaptation and vulnerability. 10. Douglas I, Alam K, Maghenda M, McDonnell Y, Mclean L, Campbell J. Unjust
Contribution of Working Group II to Fourth Assessment Report of the waters: climate change, flooding and the urban poor in Africa. Environ Urban
Intergovernmental Panel on Climate Change. Cambridge: Cambridge 2008;20:187-205. doi:10.1177/0956247808089156
University Press; 2007.
6. Satterthwaite D, Huq S, Pelling M, Reid H, Lankao PR. Adapting to climate
change in urban areas: the possibilities and constraints in low- and
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Bull World Health Organ 2009;87:886 | doi:10.2471/BLT.09.073445 A