PUBLIC HEALTH CRISES OF CITIES IN DEVELOPING COUNTRIES*

At the Alma Ata Conference in 1978 and in the follow up programs urban health has received little attention [1]. The solution to Developing World Health problems, including Sub-Saharan Africa, was seen to lie in (PHC) the Primary Health Care approach which was generally interpreted to mean improvement of the health of rural communities. During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care projects in the rural areas. Many conferences have been held during that period to discuss the problems and successes of the efforts of implementation of PHC programs. Until the past five years urban health was not addressed as a special health problem. But it has been realized that 'Health for All' will not be achieved without re-orienting the systems to deal with urban health problem [2]. Big proportions of target rural populations for PHC have moved to urban areas carrying with them some of the rural cultures and all the attendant health problems. Urban based economic development in developing countries did not shift emphasis to the rural areas as *Originally prepared as a background paper for the Xlllth International Conference on the Social Sciences and Medicine, Hungary, 10-14 October 1994. did the PHC approach. Urban based development continued to generate the pull and push forces in urban and rural areas respectively. Infrastructure and employment opportunities are better in urban rather than rural areas. Population pressure in rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. The expansion rate has rendered ineffective all the city planning capabilities that our countries had. Unplanned settlements are the commonest expansion feature of our cities today. Current estimates show that by the year 2000 Sub-Saharan Africa will be about 40% urban, and about 60% of the city population will be living in slum areas or illegal settlements [2-4]. Table 1 shows the urbanization growth that has been experienced and that which is projected for low income countries and for selected countries of SubSaharan Africa. The table