Ill-health and poverty: a literature review on health in informal settlements

Abstract

This paper reviews the literature on health in the informal settlements (and "slums") that now house a substantial proportion of the urban population in Africa, Asia and Latin America. Although this highlights some important gaps in research, available studies do suggest that urban health inequalities usually begin at birth, are reproduced over a lifetime (often reinforced by undernutrition), and may be recreated through vulnerabilities to climate change and a "double burden" of communicable and non-communicable diseases. The review begins with a discussion of papers with a life-course perspective on health, poverty and housing, before considering recent literature on chronic poverty and ill-health over time. It then discusses the literature on the cost, quality and access to care among low-income groups, and the under-recognized threat of unintentional injuries. This includes recent literature that discusses where low-income residents may suffer an "urban penalty" rather than benefiting from urban bias -although there are also studies that show the effectiveness of accessible, pro-poor health care. The concluding section examines emerging risks such as non-communicable diseases and those associated with climate change. It notes how more gender-and age-sensitive strategies can help address the large inequalities in health between those in informal settlements and other urban residents. With greater attention to the multi-faceted needs of low-income communities, governments can create interventions to ensure that urban centres fulfil their enormous potential for health.

The puzzle of mobility and access to the city in Sub-Saharan Africa

“…In Douala, for example, private healthcare centres and clinics are widely distributed within the city, but they are less common in the districts with poor access, far from public transport routes. Accessibility problems thus exacerbate the difficulties in obtaining healthcare that are caused by the deficiencies inherent in the healthcare sector and appear to have a particularly severe impact on the residents of peripheral zones with poor access (Sverdlik, 2011).…”

Influence des facteurs environnementaux et démographiques dans la cooccurrence de la diarrhée et de la fièvre chez les enfants dans cinq quartiers périphériques de Ouagadougou (Burkina Faso)

“…Dans la plupart des villes africaines, on estime à entre 40 et 70 % la proportion de la population vivant dans ce type de quartiers (UN-Habitat, 2014). Le développement des bidonvilles pose des défis considérables à la santé en milieu urbain (Sverdlik, 2011). Les enfants de ces quartiers sont plus vulnérables à la morbidité et à la mortalité que les enfants résidant dans les quartiers plus aisés de la ville (Egondi et collab., 2013 ;Fink, Günther et Hill, 2013).…”

Living conditions and public health status in three urban slums of Lagos, Nigeria

“…13 Other studies from countries like Bangladesh and Kenya show that children living in informal urban settlements are particularly vulnerable to infectious diseases such as diarrhoea, cold and cough and high rate of under-five mortality. 11,[14][15][16][17][18][19] This disadvantaged and vulnerable groups of people are generally aware of illnesses and treatment, however their healthcare seeking behavior is largely limited by the lack of financial resources. 22 It is important to note that slum dwellers are human capital who contributes greatly to the economies and work forces of their respective countries.…”