Common Myths and Misperceptions About Urbanization and Strategic Health Communications Opportunities
Myth 6: Urban populations have a more damaging impact on the natural envi- ronment than small rural settlements Planned cities have important potential in
preventing environmental degradation. Concentrating population in relatively small areas (50 % of the earth’s population on 3 % of its land) relieves pressure on fragile ecosystems and minimizes agriculture on marginal land. However, urban sprawl can undermine these benefits. Sprawling cities can take up needed agricultural land, biodiverse land, and other needed green space. This occurs through periurbaniza-
K. Berzins et al.
34
tion (growth along the edge of a city, or along transportation routes between cities), which is often unplanned, and frequently occurs as the poor are pushed from the center to peripheries of cities. Peripheral settlements are frequently not served by city sanitation and water, and are far from health and education facilities, and are subject to destruction by governments due to their illegal status. Better city planning can mitigate the effects of sprawl, as well as minimize the impact of pollution pro- duced by cities (UNFPA 2007).
While urban residence has the potential to minimize negative impact on the environment, urban residents (particularly the poor) face multiple threats from the environment, such as pollution, and will face impact from climate change, such as natural disasters and rising sea levels, disproportionate to their relatively low car- bon emissions. These threats will have an impact on their health outcomes. Coastal cities, particularly those in low-income countries, are highly vulnerable to the ef- fects of climate change, in terms of rising sea levels and stronger storms, as well as salt water invasion of aquifers providing vital water resources to urban residents (UNFPA 2007). Increasing temperatures and urban living conditions also increase the risk of emerging and reemerging infectious diseases, as evidenced by urban den- gue outbreaks in Latin America and Asia (Campbell-Lendrum and Corvalán 2007).
Health Communications Policy Recommendation: The Case of Clean Water and Sanitation A social marketing intervention designed to develop safe water products that were both produced and marketed locally in Peru and Nicaragua was successful at helping people in both periurban and rural areas make the link between disease and the quality of their water as well as empowering them with tools to correct the situation. The communications component of this program was significant in that the population was more responsive to locally branded products. This example demonstrates the need for policymakers and health officials to include those living on the outskirts of cities in water and sanitation planning, so that health communi- cation interventions can work simultaneously to educate and motivate residents to improve the surrounding environment and health of the community (Armand et al.
1998).
Conclusion
In the coming decades, policymakers and health program planners will have to ad- dress the health needs of an increasingly urban world. The needs of smaller cities and towns should be at the center of policies and campaigns to address urbanization.
In addressing these efforts, policymakers should be sure not to oversimplify urban contexts. It is important to keep in mind that:
• Urban growth is fueled by internal growth in addition to migration.
• Smaller cities are sites of the most urban growth in the developing world.
• Urbanization poses health-related challenges and opportunities related to envi- ronmental degradation and climate change.
3 Urbanization, Population, and Health Myths: Addressing Common … 35
• People living in cities have many obstacles to health education and services.
• Urban areas should increasingly be a focus of poverty alleviation programs.
• Cities provide opportunities for improved health outcomes, including for HIV/
AIDS prevention and treatment and sexual and reproductive health.
Through targeted and evidence-based programs, policymakers and health-care offi- cials can use strategic health communications to anticipate and address the needs of their growing cities. Urbanization can provide many opportunities, such as access to education, widened economic choices for men and women, increased access to health care, access to a wide range of media, and new social networks for the urban poor. The successes of the strategic health communication described in this chapter can help guide efforts to make the most of these new prospects. As the examples in this chapter show, a range of strategic communication approaches are appropriate.
Indeed, all forms of communication will be needed to tackle the challenges.
The demand for access to high-quality health services will continue to increase.
As policymakers and health officials make these services more available, strate- gic health communications techniques designed to engage the public are needed to help populations understand and utilize services. The urban poor, recent migrants, women, young people, and married couples represent just a small sample of groups within growing urban areas who require specific messaging and engagement to meaningfully improve their health outcomes.
References
Academy for Educational Development (AED). (n.d.a). “Social Change.” http://www.globalhe- althcommunication.org/strategies/social_change. Accessed 13 July 2010.
Academy for Educational Development (AED). (n.d.b). “Social Marketing.” http://www.globalhe- althcommunication.org/strategies/social_marketing. Accessed 13 July 2010.
Armand, F., Crowley, H., & Faura, P. (1998). Social marketing for household disinfection of water.
Population Services International. http://www.bvsde.paho.org/bvsacg/i/fulltext/symposium/
ponen5.pdf. Accessed 13 July 2010.
Campbell-Lendrum, D., & Corvalán, C. (2007). Climate change and developing country cities:
Implications for environmental health and equity. Journal of Urban Health, 84(1), i109–117.
Gupta, N., Katende, C., & Bessinger, R. (2003). Association of mass media exposure on family planning attitudes and practices in Uganda (Working Paper 03-67, Page 4). MEASURE Eva- luation. www.cpc.unc.edu/measure/publications/pdf/wp-03-67.pdf. Accessed 13 July 2010.
Johns Hopkins Bloomberg School of Public Health, the Center for Communication Programs (JHUCCP) (2003). A field guide to designing a health communication strategy. Uganda’s DISH Project: A case study of an integrated communication strategy. http://www.jhuccp.org/
pubs/fg/02/13-appendix2.pdf. Accessed 13 July 2010.
Marie Stopes International Australia. (n.d.) Problems Facing Internal Migrants Accessing Sexual and Reproductive Health Services [PDF document]. http://www.pgpd.asn.au/docu- ments/SOWP%20seminar%20presentations/MSISeminarSpeech.pdf. Accessed 13 July 2010.
Montgomery, M. (2009). Urban poverty and health in developing countries. Population Bulletin, 64.2. Population Reference Bureau. 8.
Ravallion, M., Chen, S., & Sangraula, P. (2007). The urbanization of global poverty. World Bank Research Digest Vol. 1(Number 4).
K. Berzins et al.
36
Sayles, J., Pettifor, A., Wong, M., MacPhail, C., Lee, S., Hendriksen, E., Rees, H., Coates, T.
(2006). Factors associated with self-efficacy for condom use and sexual negotiation among South African Youth. JAIDS Journal of Acquired Immune Deficiency Syndromes, 43(2), 226–233.
UN News Centre. (18 March, 2010). Over 200 million escape slums but overall number still rising, UN report Finds. http://www.un.org/apps/news/story.asp?NewsID=34119 & Cr=mdg & Cr1.
Accessed 13 July 2010.
The United Nations Children’s Fund (UNICEF) Regional office for South Asia. (2005). Strate- gic communication—for behaviour and social change in South Asia. Kathmandu, Nepal.
http://www.unicef.org/rosa/Strategic_Communication_for_Behaviour_and_Social_Change.
pdf. Accessed 13 July 2010.
United Nations Educational, Scientific and Cultural Organization (UNESCO). (n.d.). “HIV co- ordination, adolescent reproductive and school health: Advocacy, IEC & BCC.” http://www.
unescobkk.org/education/hivaids/projects/adolescent- reproductive-sexual-health-arsh/infor- mation-resources-publications/advocacy-iec-bcc/. Accessed 13 July 2010.
United Nations Human Settlements Programme (UN-Habitat). (n.d.). Fighting HIV/AIDS in Blantyre, Malawi. http://ww2.unhabitat.org/programmes/hiv/malawi.asp. Accessed 13 July 2010.
United Nations Population Fund (UNFPA). (2007). Smaller cities: Home to half the urban popula- tion. In state of world population 2007: Unleashing the potential of urban growth. New York.
http://www.unfpa.org/swp/2007/english/chapter_1/smaller_cities.html. Accessed 13 July 2010.
United Nations. Department of Economic and Social Affairs/Population Division. (2012). World urbanization prospects: The 2011 Revision. New York.
World Health Organization (WHO). (2010). Urbanization and health. http://www.who.int/bulletin/
volumes/88/4/10-010410/en/index.html. Accessed 7 May 2010.
World Health Organization (WHO). (n.d.). Tuberculosis (TB). Advocacy, Communication and So- cial Mobilization (ACSM). http://www.who.int/tb/people_and_communities/advocacy_com- munication/en/index.html. Accessed 29 May 2012.
37