Don't Move to the City It Will Probably Kill You

(photo credit: gerry popplestone)

If you spend long enough in the developing world, you tend to see urbanization as a tragedy. People move from rural areas - where they have support networks, like skills, and kitchen gardens - to slums where they are painfully vulnerable to abuse and exploitation. You can actually starve to death in the city; in a village there is pretty much always a neighbor willing to give you a potato.

The New England Journal of Medicine (NEJM) has now officially quantified what everyone already knew, in an article in the current issue. People living in megacity slums are less healthy than people in rural areas. Most of the reasons for this are exactly what you would expect: bad water, poor sanitation, malnutrition, injuries, pollution and the impact of these felt strongly in the infant mortality rate. Also a couple of factors I wouldn't have expected - diabetes and hypertension rates are higher in urban areas, even in slums.

NEJM calls urbanization an emerging humanitarian disaster. I'm not sure I'd take it that far. City life does have advantages. Slum dwellers have better access to health care than most people in rural areas, they are less vulnerable to seasonal food shocks, and they have access to a broader range of employment options.

It's only going to be a humanitarian disaster if we build it that way. Historically, cities have been powerful engines for opportunity and human development. If we can manage to provide some basics in global megacities - access to drinking water, schools, health care - urbanization could be success story and not a tragedy. Since urbanization is pretty clearly the new organizing structure of human life, we really ought to make the best of it.