Urbanization and the Challenges of Noncommunicable Diseases

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Copyright, Trung Kien, Nicolas Lainez, Guy Wallbank, Nguyen Hung & Seweryn Zelazny 

Over the past 50 years, the world has seen an explosion in population size from less than 3 billion in 1950 to 7 million in 2011 (United Nations 2008; UN 2011). This population swelling has caused massive rural-to-urban movement, a trend that is expected to continue particularly in the developing countries of Asia and Africa. Migrants from rural areas may bring with them communicable diseases which can spread rapidly throughout cities where overcrowding is rampant and healthcare infrastructure is strained (or nonexistent). Furthermore, migrants may find themselves living in slum conditions without access to safe drinking water, durable housing or healthcare facilities. In these settings, disease may spread effectively unchecked.

Communicable diseases pose an intuitive danger to health of urban migrants; however, the threat of noncommunicable diseases is also growing and must not be overlooked. One of the primary challenges that must be overcome in order to address this issue is the low-quality housing or slums that migrants may be forced to inhabit due to socioeconomic isolation. Residential hazards are common in such areas and tobacco smoke, or poor ventilation or the presence of mold or cockroach allergens can lead to respiratory infections, for example, as can environmental pollution such as chemical residue or air pollution.

Other noncommunicable diseases that pose a large threat to rural-to-urban migrants are centered in large part around cultural differences. Mental health issues, for example, can arise due to stress involving the act of migrating (leaving the known for the unknown) and the socioeconomic stigmatization that can occur as migrants are forced to live on the fringes of large urban cities.  In addition, rural-to-urban migrants may be faced with a completely new set of cultural norms upon moving; the wide availability of cheap (and unhealthy) food, cigarettes, and alcohol poses a major threat to the health of migrants who may not be aware of the dangers of excessive use of these goods. Picking up these habits may be a form of cultural assimilation for a migrant, or a show of status for those coming from rural areas with little access to such goods [I]. However, taking to such habits also puts migrants at higher risk than urban natives for diabetes, obesity, and some forms of cancer [II]. A general lack of knowledge about the dangers of such habits, combined with inaccessibility to primary healthcare or linguistic or cultural barriers between migrants and doctors, makes migrants stand out as a high-risk group for health threats of this sort.

Lack of access to medical care only exacerbates these health risks. While the European Union is making attempts to incorporate urban migrants into countries’ healthcare policies, the results have been varied [III]. Limited medical care can lead to late diagnosis or improper treatment. In terms of infrastructure it is also important to note that if healthcare were made accessible to migrants, it would also be necessary to significantly improve transportation infrastructure in many cities’ low-income neighborhoods in order to make medical facilities physically available to migrants in need.

Even if healthcare policy effectively incorporated migrants into the system, linguistic and cultural barriers may still stand in the way of proper treatment. Cultural miscommunications may lead to improper diagnosis or incorrect following of treatment regimes. Doctors should be trained in addressing the cultural differences between urban natives and rural-to-urban migrants and should be aware of which groups are at risk for which specific diseases. These barriers are high and will require much country-specific research, but they must be overcome if appropriate policies are to be adapted to protect rural-to-urban migrants from the threat of noncommunicable disease.

-Kate Burrows

I. Ebrahim, Shah, Sanjay Kinra, Liza Bowen, Elizabeth Andersen, Yoav Ben-Shlomo, Tanica Lyngdoh, Lakshmy Ramakrishnan, R.C. Ahuja, Prashant Joshi, S. Mohan Das, Murali Mohan, George Davey Smith, Dorairaj Prabhakaran, K. Srinath Reddy. (2010), The Effect of Rural-to-Urban Migration on Obesity and Diabetes in India: A Cross-Sectional Study. PLoS Medicine, 7(4):1-12.

II. Doll, Richard. (1991), Urban and rural factors in the aetiology of cancer. International Journal of Cancer, 47(6): 803-810.

III. Mladovsky, Philipa, (2007).Migrant health in the EU. Eurohealth, 13(1):9-11.

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