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A f t e r w o r d Susan M. Wachter Global urbanization is a revolutionary force, easily one of the most important transformations in human history. It is, at once, responsible for both an unprecedented increase in the standard of living for many and also systemic inequality. The dual nature of this transformation and the resulting need to assure that the life chances of the most vulnerable, including women and children, improve, present a global challenge. The development and market forces driving global urbanization can be placed in a larger frame. Picture the world before capitalism. Workers produce almost everything necessary for survival—and, if possible, a bit of recreation—but do not specialize in one task or career. It is a world of subsistence. Only a few are privileged to own their own land. In many countries, the majority of the population serve as feudal serfs to the landlords, in exchange for which they receive protection from outside dangers and a minimal share of the land’s yield. It is also a world that does not move forward. According to the renowned classical economist Thomas Robert Malthus, increases in the standard of living are unsustainable: If a community’s income per capita increases, families use that extra money to feed more mouths. The population grows until income per capita falls back to its original level (Malthus 1789). Now imagine the upheaval this world experiences with the potential of economic growth. Within firms, each worker specializes in part of the production process, and together they create more valuable products than they did by themselves. Technological progress allows income to grow faster than the population. This transition occurs in cities. Families migrate from rural to urban regions because they want the chance of work and a standard of living beyond subsistence. But in fact, while economic development occurs, the rural-to-urban migration overwhelms the city’s ability to provide even basic services for its new residents. Indeed, urban unemployment 274 Susan M. Wachter is high, and a large underclass fills the new slums. Women and children are particularly at risk. Collective action is needed to address the underside that accompanies urban economic growth. Having many people in one place increases vulnerability to the spread of disease and to natural disasters. Massive urban migration requires public services for the corresponding increase in the numbers of urban poor. Inadequate housing, malnourishment , lack of potable water or sanitation, and lack of other basic services are for too many the unfortunate reality of global urbanization. In the next decades, more than a billion more people will migrate to cities. Viewed through this lens, alleviating global poverty, improving public health, and achieving gender equality are daunting challenges, in both size and complexity. These challenges are not, as some observers contend , mere by-products of corrupt officials or lawless states, nor are they caused by inferior industrialization or cultural deficiencies. The problems discussed in this book are systemic and market driven. Recent efforts to solve these problems have come up woefully short. In September 2010, the United Nations held a summit to review progress on the Millennium Development Goals, which include eradicating extreme poverty and hunger, promoting gender equality and empowering women, and improving maternal health. Jeffrey Sachs, the economist leading these efforts, specified women and health as “major gaps” in this progress (Commonwealth News and Information Service 2010). These underwhelming results should not come as a surprise. As William Easterly has documented exhaustively, the capitalist world has been trying to “aid” the “backward” world since colonial days, with little to show for it (Easterly 2001, 2006). But even Easterly does not deny that targeted programs have strong track records. The chapters in this book have documented proven methods to close those gaps: Chapter 1. Julio Frenk and Octavio Gómez-Dantés use Mexico’s recent health reforms as an illustration of how developing nations can improve their citizens’ well-being simply by changing the organizational priorities and increasing insurance coverage. Chapter 2. Ruth Levine illustrates that we have the tools to prepare for the demographic, epidemiologic, environmental, and economic trends in the developing world and to take appropriate near-term policy action to invest in women. Chapter 3. Varina Tjon-A-Ten, Brad Kerner, Shweta Shukla, and Anne Hochwalt explain how critical compulsory education is to female health and development and how third parties can en- Afterword 275 courage female education in the developing world by offering free health products, especially related...


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