After a trip to Baba Bhit Island, Dr Syed Wasif Ali writes about the impact of rampant urbanization and its impact on the health of urban dwellers in Karachi, but perhaps more generally about many parts of the world.

It is nothing strange or surprising to see long traffic jams for hours and flood in the city after rainfalls as our city is going through a phase of transmission and metamorphosis. The impact and consequences are no different than expected but yes at times goes to become more hysterical expressions which are nurtured by our callous indifferent attitudes and intolerance.

In recent years, environmental health science has broadened the scope beyond the effects of single pollutants on individuals to entire panorama of external factors that may affect public health and collectively the health of the society. There is a direct impact of environment on health and of the built environment—and on the human behavior.

Substantial scientific evidence gained in the past decade has shown that various aspects of the built environment can have profound, directly measurable effects on both physical and mental health, particularly adding to the burden of illness among ethnic minority populations and low-income communities.

Lack of sidewalks, bike paths, and recreational areas in congested overcrowded communities discourages physical activity and contributes to obesity and cardiovascular diseases; in other areas which have such amenities, the threat of crime keeps many people inside. Dilapidated housing is associated with exposures to lead, asthma triggers (such as mold, moisture, dust mites, and rodents), and mental health stressors such as violence and social isolation. Low-income and/or ethnic minority communities--already burdened with greater rates of disease, limited access to health care, and other health disparities--are also the populations living with the worst built environment conditions. Studies have shown that negative aspects of the built environment tend to interact with and magnify health disparities, compounding already distressing conditions.

Environmental health science is an important overlap of sociology, psychology, demography, urban planning, and architecture. City life poses routine risks of overcrowding, inadequate waste disposal, hazardous working conditions, polluted air, and street violence.

With more than half the world’s population projected to be living in urban centers by 2020, the dream of a better quality of life is being undermined by an increasing menace of urban violence. The current rate of urban growth in developing countries, 3.6% per year, is a result largely of influx from rural areas of migrants in search of a better life and have direct correlation with the degree of violence .There is hardly any one who some how or the other have not been affected by such acts .This violence ranges from street crime, such as muggings, mobile snatching, robberies, and carjacking; to kidnappings, murder, drug-related violence, and organized crime conducted by gangs; to assaults, sexual violence, and personal abuse. Exposure to violence is psychologically traumatic and damaging. It inhibits productivity and creativity of the individuals by inducing the state of learned helplessness and hopelessness, which ultimately affecting the collective growth of the society.

A healthy city is defined as one that continually creates and improves the physical and social environment and expands community resources for enabling the mutual support among population groups for living, but here urbanization is advancing rapidly, but government resources are not keeping pace with people's needs.

There is poverty, inadequate food and shelter, insecure tenure, physical crowding, poor waste disposal, unsafe working conditions, inadequate services, overuse of harmful substances, and environmental pollution. Unsustainable use of natural resources and environmental destruction pose threats to urban productivity and restrict future development options.

Our metropolis lacks the capacity to collect and process more than a small proportion of their sewage and garbage. The rural newcomers by and large lack habits of cleanliness. The migrants will eventually adapt to the requirements of life in the city, but it is not so certain that the cities will be able to adapt to the influx of rural migrants and to the lack of financial resources needed to confront severe existing and future problems.

Environmental hazards in urban areas mainly affect low-income people--especially women, children, and migrants--the people who are least able to avoid the hazards and or least able to deal with the illness or injury they cause. Poor people are priced out of safe, well-located, well-serviced housing and land sites. Hazards include biological pathogens; chemical pollutants; scarce, over-priced, or poor quality natural resources; physical hazards; natural resource degradation; and national/global environmental degradation. These preventable health burdens cause disease, accidents, and premature death. Biological pathogens have the most serious impact on human health. Crowded conditions, poor sanitation, and inadequate water supplies, poor facilities for preparing and storing food, and inadequate hygiene contribute to biological etiology of pathogen-induced ill health.

Common chemical pollutants in urban areas are lead, indoor air pollutants from fuel combustion, toxic hazardous wastes, and ambient air pollution. A shortage of fresh water is often why some urban households do not have a safe and adequate water supply. Common physical hazards in cities are traffic accidents; burns, scalds, and accidental fires and poisonings; falls; and floods. Overcrowding, poor building material, and settlements on dangerous sites are example of physical hazards.

Noise, overcrowding, inappropriate design, and stresses contribute to the growing psychosocial health problems of many urban dwellers in developing countries, especially adolescents and young adults.

Urbanization has led to increased productivity and economic diversification, but also deprivation, poverty, and marginalization. Environmental problems include those caused by widespread poverty and those caused by industrialization and a change in consumption patterns. The cumulative impact of these two causes has serious effects on urban dwellers, especially poor children. Low incomes, illiteracy, and inaccessibility to development opportunities further complicate problems. Slum dwellings have no ventilation or natural light and are most vulnerable. Slum dwellers suffer from dust, smoke, and noise pollution. Piles of garbage, potholes, stray animals, flies, and mosquitoes are common. Urbanization has increased disease-producing agent, e.g., toxic chemicals and car exhaust fumes. Lead emitted from car exhausts or industry causes reduced fine motor coordination, hyperactivity, lower IQs, and perceptual problems in slum children. Few slums have access to potable water and sanitation services. Children in slums are more vulnerable to diseases and deficiencies than their rural and other urban counterparts. Urban pressures weaken traditional family values and social control over children. Schools are not always available which further breeds to the vicious cycle of disparity. Interaction between children and parents, recreation, and cultural stimulation are all lacking.

Urban upgrading, poverty reduction, and pro-poor governance by increasing awareness of the link between urban violence, poverty, ineffective governance, and suitable options to mitigate urban violence and enhance public safety and security in urban areas is an immense need of today . Due to the lack of understanding of the complex nature of the problem and the link between poverty and violence has led to government policies that focus on repression and conventional policing measures, with a predictably little impact.

Vicious Cycle of Urban violence, poverty, and ineffective governance are inextricably linked and mutually reinforcing. Unless urban violence—and its manifestation of exploitation of the poor—are addressed as part of poverty reduction and governance improvements, programs to improve the lives of urban dwellers will have limited impact. Sporadic initiatives have to take a form to integrate urban social and physical strategies that mobilize effective partnerships led by urban governments and certain NGOS.

Innovative approaches are needed to address the multifaceted nature of violence and specific security needs of the urban poor. Without this, the vision of a better quality of life for city dwellers will remain just a dream.

- Dr Syed Wasif Ali is a practicing psychiatrist and can be reached at Mental Health Clinic, 90-A, Depot Lines, Behind Prince Cinema, Sadder, Karachi. Tel # 7217245, 7232423 Cell#0300 2125446

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