In the next 27 years, health experts are predicting that close to 70 per cent of the world’s population will live in urban areas and this would have a significant impact on health outcomes.

Urbanization has been described as a leading global trend of the 21st Century with most of the future urban growth said to take place in developing countries.

The World Health Organization (WHO) on October 29, 2021, issued a statement on urban health from its headquarters, saying that currently over half of the world’s population lives in urban areas and “this is set to rise to 68 per cent by 2050.”

Ghana’s capital, Accra is already choking with lots of people in the city. There is an overflow of people moving into areas such as Madina, Adenta, Ashaiman and La Paz in the Greater Accra region.

Kasoa and Gomoa Buduburam in the Central region, Kumasi and nearby communities in the Ashanti region are bursting at the seams with the influx of huge populations on a daily basis. Peri-urban communities are under threat from the spillover in these metropolitan areas.

People moving from rural to urban areas to live is not new but what is worrying is how societies are adapting to this rapid change.

A little over 30 years ago, Kasoa and its adjoining community, Gomoa Buduburam, were virtually sleeping rural communities.

Today, these two communities are battling with the huge influx of people from all over the country and from countries such as Nigeria, Sierra Leone and Liberia.

The picture that greets people upon arriving in Kasoa is a scene of rubbish heaps, along the main road and under the fly-over bridge. Rubbish heaps and poor sanitation services are a common scene in almost every urban area in the country. 

Kasoa is now one of the fastest-growing urban areas in the country with huge vehicular congestion, fumes from smoke, human traffic, and street hawking, and it has become a hot spot for crimes.

Mushrooming churches and schools coupled with brisk commercial activities, land guard activities, and poorly managed sanitation services are all part of the current story of Kasoa.

How do all these play out on the health of the people and what are the implications of urbanization on the health outcomes of all urban dwellers across the country?

Health outcomes

Social, environmental and economic factors determine the well-being of urban populations. Urban systems, which consist of various sectors such as housing, transport, energy, spatial planning, water and sanitation, urban agriculture and waste management, are other determinants of good health.

While it is true that urbanization can bring health and economic benefits, rapid and unplanned urbanization can have many negative social and environmental health impacts, which hit the poorest and most vulnerable the hardest.”

To commemorate World Cities Day in October last year, the WHO in a statement said, “Unplanned urbanization can have negative social and environmental health impacts.”

“These include not only issues linked to climate change, pandemics and non-communicable diseases (NCDs) but also to malaria and other vector-borne diseases,” it added.

The health indicators on Kasoa and the Awutu Senya East Municipality provides an interesting picture.

Mr. Patrick Quainoo, the Health Information Officer of the Awutu Senya East Municipal Health Directorate, in an interview with Ghana Business News, explained that malaria, upper respiratory tract infection, acute urinary tract infection, typhoid, hypertension, diabetes, anaemia, diarrhea, and gynaecological issues are among the top causes of ill health in the municipality.

He however explained that non-communicable diseases (NCDs) are the main causes of deaths in the area mainly because people are reporting late to health facilities with these conditions. Majority of people with these NCDs are usually not aware that they have these conditions.

According to him, people suffering from infectious conditions such as malaria will normally report to a health facility once they see the sign and symptoms but with NCDs, people are not even aware that they have these conditions.

He added that some reasons why infectious diseases such as typhoid, malaria and diarrhea are part of the leading causes of ill health have got to do with a  convergence, made up of a triangle of people, the environment and the diseases causing organism meeting.

Social factors are also responsible for these trends. He mentioned eating habits, insanitary conditions and crowded areas, fueled by urbanization, as some of the reasons for the disease and mortality trends.

On interventions, he said a multi-sectoral approach is what the authorities are using to addresses these issues. For instance, the National Malaria Elimination Programme is leading efforts through interventions such as larviciding and the distribution of treated bed nets.

He explained that the Health Promotion Units under the Ghana Health Service have a protocol to roll out various programmes and offer public education by sometimes using special events such as World Malaria Day and World Diabetes Day to educate and empower the public.

Public health facilities including all accredited private health facilities, numbering about 30 in the Awutu Senya East Municipality are partners supporting various health interventions in the district.

Adding that health officials in the Awutu Senya East municipality have partnered with local media houses such as Pink FM, Lucky T.V and Obaatanpa in the area to run health promotion programmes.

Dr. Engelbert Nonterah, Senior Epidemiologist at the Navrongo Health Research Centre in the Upper East region, speaking with Ghana Business News, in an interview on urbanization, noted that urban areas are experiencing epidemiological transition related to lifestyles and other issues.

He touched on changing lifestyles such as people moving away from non-traditional foods to eating highly processed and fast foods, little physical exercise and the high intake of calories and the inability to burn fat.

Other lifestyle issues are smoking and high alcohol intake, which can all have an impact on the health of urban dwellers.

He added that even areas such as Navrongo, seen as peri-urban, are following trends and unhealthy lifestyles with fast food joints becoming common.      

He noted these lifestyles are fueling the increasing incidence of cardiovascular diseases.

Dr. Nonterah, who is also a medical doctor with the Navrongo War Memorial Hospital in the Upper East region, explained that urban dwellers are also at risk of increasing cases of cancer and chronic respiratory diseases, which are associated with air pollution, fumes from vehicles and other sources, e-waste disposal and other waste disposals.

Other dangers to the health outcomes of urban dwellers are the poor waste disposal, which brings along health conditions such as diarrheal diseases.

Staying on track

The WHO has already issued a caution saying that an estimated 91 per cent of people in urban areas breathe polluted air and added that the rising non-communicable disease burden, the persistent threat of infectious disease outbreaks and an increased risk of violence and injuries are key public health concerns in urban areas.

Urban dwellers are also highly vulnerable to the effects of climate change because of their dependence on fossil fuels for transport, cooking and heating.

Dr. Nonterah offered some suggestions that policymakers and other stakeholders must work on to help shape the lifestyles of urban dwellers.

He said creating more spaces such as parks to help people exercise, or relax to burn out stress or calories.

Others are the creation of bicycle tracks exclusively for bicycle riders to ride or travel safely, while exercising at the same time to improve their health outcomes.

He touched on greenhouse and backyard vegetable farming, saying it must be encouraged so that healthy eating habits can adopted.

Dr. Nonterah said prevention is better than cure so screening for early detection for NCDs through at wellness clinics should be part of the strategy for promoting good health.

He said health authorities must deploy outreach programmes in marketplaces such as Makola, Agbogbloshie and Mallam Atta by using mobile clinics for screening for these diseases at regular intervals.

Urban dwellers must also support all these efforts with 30 minutes personal workouts during weekdays or a two-hour exercise at weekends. This is in addition to adopting healthy lifestyles.

Even as the WHO leads the way in sounding the alarm bell on the threat of rapid urbanization, other stakeholders are buying into the agenda to protect the health of the urban populations.

The School of Public Health of the University of Ghana is leading a “Community-led Responsive and Effective Urban Health Systems” (CHORUS) project, which is running until 2026.

It is a multi-country research programme focusing on building resilient urban health systems with funding from the United Kingdom’s Foreign, Commonwealth and Development Office.

The project is looking at research that responds to the practical challenges of delivering equitable health services in urban areas of four countries: Bangladesh, Ghana, Nepal and Nigeria.

The project is seeking to understand, explore and evaluate interventions to build resilience and respond to the health challenges of the increasingly rapid and uncontrolled urbanization across low and middle-income countries (LMICs). 

It is also focusing on strengthening systems to prevent and respond to the double burden of communicable and non-communicable diseases and identifying, reaching and engaging the urban poor to benefit from health interventions.

What all health experts are saying is that the physical environment, sanitation, safe water, clean air, and roads all contribute to good health.

Employment issues, working conditions, personal behaviour, balanced eating, keeping active, smoking, drinking, and dealing with life’s stresses work together to affect health outcomes.

 “We desperately need to get ahead of the challenges that are impacting the health and well-being of people living in cities,” noted Dr. Etienne Krug, Director of the Department of Social Determinants of Health at the WHO, in a statement to commemorate World Cities Day, last year.

“Strong urban policies must prioritize health, to ensure resilient and vibrant communities for people to live, work, go to school and play, all while protecting those who are most vulnerable,” he added.

Urban health is a growing priority for everybody because the WHO has noted that “the interlinked nature of urban health challenges means that action in one sector can have benefits for many others.”

By Eunice Menka
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