Geography Reference
In-Depth Information
Space constraints mean that the examples discussed have only focused on de-
veloped countries to show that even in areas where there are extensive heath care
programmes there is room for major improvements in targeting the most unhealthy
places. A far, far bigger problem exists in the developing world where at least of the
third of their population, over 860 million in total, live in informal shanty towns.
Many of these places desperately need updated and modern versions of the types
of services, from clean water supply to sewage and other utilities, that were cre-
ated in the European urban improvements of the nineteenth century, deficiencies
which lead to poor hygiene and debilitating illnesses. These informal settlements
are characterized by high levels of deprivation, due to poverty, with flimsy informal
housing—whose rents often take up a third of the non-food expenditure—unem-
ployment, limited skills or education, low environmental quality, often with high
crime, and with many residents, especially the elderly, having few social contacts
and high levels of loneliness. Also, many of these areas lack proper property rights.
This situation is often made worse by the presence of toxic outputs from nearly
factories that ignore any environmental regulations even where they exist. But it is
often argued that these slums, not all populated initially by rural migrants, should
be welcomed as they provide the opportunity for improvement, unlike rural areas.
Some have shown improvement, but the idea of the slum being a temporary way-
station on the way to prosperity is increasingly being challenged. A large survey of
slum dwellers (Marx et al.
2013
) has confirmed that many people get trapped in
these areas, leading to generational poverty and also illness, despite the opportuni-
ties that enable some to escape. Even in the cities of middle income countries there
are still many slum areas, for example in Buenos Aires about 10 % of the population
lives in the 56 shanty towns called
villas miserias
. Most of them lack schools, medi-
cal facilities, basic utilities and have poor drainage, so heavy rain causes flooding,
and have limited employment and higher levels of ill-health. In 2011 the city cre-
ated the Secretariat of Habitat and Inclusion to coordinate the efforts to incorporate
these areas into the city and upgrade their facilities, but its efforts are handicapped
by a small budget. One of its schemes is a so-called
urban acupuncture
programme
that adds sports facilities, plazas and community centres to the deprived areas to act
as focal and service points. However the programme has not been as effective as
promised because the Secretariat is underfunded and is seen as a top-down agency.
This often ignores the grass root organizations that have developed in these areas
which emphasize that their real need is also for more adequate social housing and
basic services, including health care. Elsewhere attempts are being made to provide
more community facilities and to connect slum areas, which are often isolated on
hillsides with few roads, with other parts of the city, such as by the gondolas in
Bogota. In many other slum areas, such as in Rio de Janeiro, the problem of safety
is paramount because of their control by local gangs. This is being tackled by what
amounts to a blanket invasion by security services, followed up by stimulation of
grass roots organizations, the provision of local community and a school facilities,
and a permanent police presence to guarantee safety.
