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C h a p t e r 1 Women’s Health and the City: A Comprehensive Approach for the Developing World Julio Frenk and Octavio Gómez-Dantés Women living in cities in the developing world face an increasingly complex set of health challenges that can be met only through innovative and comprehensive strategies. This chapter discusses the nature of these challenges and some strategies to address them. We begin by examining the impact of urbanization on the health of women in developing nations. Next, we address potential responses to the health needs of women in the developing urban world, building on the lessons from the primary health care (PHC) movement. Following this, we discuss potential obstacles to the implementation of these responses and present examples illustrating how such obstacles can be successfully overcome. Urbanization and Women’s Health In response to major health threats in European cities in the nineteenth century (cholera, typhoid fever, tuberculosis), modern public health was born and networks of public health offices were established (Hamlin 2009). This progress nourished the sanitary reforms that yielded unprecedented improvements in living and working conditions in urban European centers, which led to the ensuing decline in mortality rates and a steady increase in life expectancy. The image of modern cities as places where order, tranquility, and cleanliness reigned, and where previously deadly diseases were under control, won general acceptance. This image was challenged by the explosive growth of cities in lowand middle-income countries in the second half of the twentieth century , which was the product of high birth rates, declining infant mortality figures, and massive immigration waves. This uncontrolled 16 Julio Frenk and Octavio Gómez-Dantés growth has resulted in a high exposure to health risks by city dwellers , especially those living in slums, who frequently suffer from higher exposures to these risks than people living in rural areas (Montgomery 2009). This epidemiological vulnerability is due not so much to a lack of resources as it is to “maldevelopment”: a lack of consistency between the needs of a specific population and the responses generated to meet them (Touraine 1992). Many cities in developing nations lack planning procedures and regulatory mechanisms, have adopted inadequate urban models, and suffer from badly implemented policies. The essential characteristic of maldevelopment is the juxtaposition of problems. In developed societies, new problems tend to replace old ones. In contrast, in maldeveloped societies, old and new problems coexist , fighting for public resources and for a place in the public agenda. Health reflects better than other fields this pattern of development. Whereas rich countries experience a substitution of old for new patterns of disease, the developing world simultaneously faces a triple burden of ill health: first, the unfinished agenda of common infections, malnutrition , and reproductive health problems; second, the emerging challenges represented by noncommunicable diseases, mental disorders, and the growing scourge of injury and violence; and third, the health risks associated with globalization, including the threat of pandemics like AIDS and influenza, the trade in harmful products like tobacco and other drugs, the health consequences of climate change, and the dissemination of harmful lifestyles leading to the epidemic of obesity. This protracted health transition is compressed in urban environments , especially in slums. Limited access to safe drinking water, inadequate sewer facilities, and insufficient waste disposal—all common in slums—help disseminate common infections, which are responsible for the more than 3 million deaths in girls under 5 that occur annually worldwide (WHO 2009b; Brocklehurst and Bartram 2010). Health services tend to be understaffed and lack basic resources, a fact that explains many of the 350,000 annual maternal deaths that occur worldwide in pregnancy and childbirth. “Maternal deaths,” according to the Web page of the Averting Maternal Death and Disability Initiative at Columbia University, are “symptoms of health systems in crisis” (AMDD 2010). At the same time, urban lifestyles expose women to risk factors linked to noncommunicable ailments, including heart disease, diabetes, cancer , and mental disorders. Cardiovascular diseases are the main causes of death and disability in women aged 60 years and over in low- and middle-income countries. Annually, 4.5 million women in developing regions die from stroke and ischemic heart disease, the same number as Women’s Health and the City 17 those who die from HIV/AIDS, tuberculosis, and malaria combined (4.6 million women in 2008) (WHO 2009b; Kaiser Family Foundation 2010). Diabetes is also a major challenge. This disease is responsible for the deaths of almost 400...

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Additional Information

ISBN
9780812205084
Related ISBN
9780812243536
MARC Record
OCLC
793012562
Pages
328
Launched on MUSE
2012-01-01
Language
English
Open Access
No
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