ABSTRACT
This chapter examines urbanization in developing countries and associated health problems. It can be argued that the most important philosophy guiding the development of health policy and planning in developing countries during the 1980s was primary health care (see Chapter 12). Most of the discussions and literature on primary health care have been related to rural areas of developing countries and have rarely addressed the problems of the rapidly growing cities. Typically up to 80 per cent of developing countries’ national health budget is spent in cities. This is due to the major hospitals of the country being located in the cities and the priority given to, and expensive nature of, tertiary (hospital) care. When examining equity (distributive justice) in health care at a national level, it was often argued that rural areas deserved priority attention due to the inequity of this ‘urban bias’ (Lipton 1976). During recent years, however, more attention has been focused upon equity within Third World cities themselves. It has been recognized that there is an equally urgent need to develop primary health care within cities as there is in rural areas. The rapid rates of urbanization and the associated growth of poor urban populations have prompted health policy-makers and planners to raise questions about the appropriate way in which to develop urban primary health care. This chapter highlights the relevant demographic trends in this debate, describes the health problems that need to be tackled and summarizes recent research and policy directions.
