Deadly Cities? Spatial Inequalities in Mortality in sub‐Saharan Africa

We investigate whether sub‐Saharan African countries are affected by an “urban mortality penalty” repeating the history of industrialized countries during the nineteenth century. We analyze Demographic and Health Surveys from several sub‐Saharan African countries for differences in child and adult mortality between rural and urban areas. For the first decade of the 2000s, our findings indicate that child mortality is higher in rural than in urban areas for all countries. On average, child mortality rates are 13.6 percent in rural areas and 10.8 percent in urban areas. In contrast, average urban adult mortality rates (14.1 percent) have exceeded rural adult mortality rates (12.4 percent). Child mortality rates are on average 65 percent higher in urban slums than in formal settlements. Child mortality rates in slum areas are, however, still lower than or equal to those in rural areas for most countries in our sample.     

Is There an Urban Advantage in Child Survival in Sub-Saharan Africa? Evidence From 18 Countries in the 1990s

Evidence of higher child mortality of rural-to-urban migrants compared with urban nonmigrants is growing. However, less attention has been paid to comparing the situation of the same families before and after they migrate with the situation of urban-to-rural migrants. We use DHS data from 18 African countries to compare child mortality rates of six groups based on their mothers’ migration status: rural nonmigrants; urban nonmigrants; rural-to-urban migrants before and after they migrate; and urban-to-rural migrants before and after they migrate. The results show that rural-to-urban migrants had, on average, lower child mortality before they migrated than rural nonmigrants, and that their mortality levels dropped further after they arrived in urban areas. We found no systematic evidence of higher child mortality for rural-to-urban migrants compared with urban nonmigrants. Urban-to-rural migrants had higher mortality in the urban areas, and their move to rural areas appeared advantageous because they experienced lower or similar child mortality after living in rural areas. After we control for known demographic and socioeconomic correlates of under-5 mortality, the urban advantage is greatly reduced and sometimes reversed. The results suggest that it may not be necessarily the place of residence that matters for child survival but, rather, access to services and economic opportunities.     

Slum Residence and Child Health in Developing Countries

Continued population growth and increasing urbanization have led to the formation of large informal urban settlements in many developing countries in recent decades. The high prevalence of poverty, overcrowding, and poor sanitation observed in these settlements—commonly referred to as “slums”—suggests that slum residence constitutes a major health risk for children. In this article, we use data from 191 Demographic and Health Surveys (DHS) across 73 developing countries to investigate this concern empirically. Our results indicate that children in slums have better health outcomes than children living in rural areas yet fare worse than children in better-off neighborhoods of the same urban settlements. A large fraction of the observed health differences appears to be explained by pronounced differences in maternal education, household wealth, and access to health services across residential areas. After we control for these characteristics, children growing up in the slums and better-off neighborhoods of towns show levels of morbidity and mortality that are not statistically different from those of children living in rural areas. Compared with rural children, children living in cities (irrespective of slum or formal residence) fare better with respect to mortality and stunting but not with respect to recent illness episodes.     

Quality of life declines in big and growing cities. Poverty in cities

The quality of life in developing countries during the first couple of decades after the Second World War was higher in cities than in small towns and villages. However, the relative advantage of city dwellers in developing countries has declined since the 1970s, with high-growth rate cities experiencing a more severe decline. Infant mortality levels in Latin America and sub-Saharan Africa in the 1990s are as high in large cities as in the smallest towns and villages. In most developing regions, big city residents are increasingly disadvantaged, such that researchers and policymakers can no longer assume that the quality of life in urban areas is better than in rural areas. The urban transformation of the developing world is similar to the 19th century urbanization of now-developed countries, but today many more people are crowding into far bigger cities. Using survey information from 43 countries representing 63% of the developing world's urban population outside of China and India, Martin Brockerhoff of the Population Council and Ellen Brennan of the UN Population Division found that rapid population growth and big size have overwhelmed the capacity of cities to provide essential goods and services.     

Differences in Child Health Across Rural,Urban, and Slum Areas: Evidence From India

The developing world is rapidly urbanizing, but an understanding of how child health differs across urban and rural areas is lacking. We examine the association between area of residence and child health in India, focusing on composition and selection effects. Simple height-for-age averages show that rural Indian children have the poorest health and urban children have the best, with slum children in between. With wealth or observed health environment held constant, the urban height-for-age advantage disappears, and slum children fare significantly worse than their rural counterparts. Hence, differences in composition across areas mask a substantial negative association between living in slums and height-for-age. This association is more negative for girls than boys. Furthermore, a large number of girls are “missing” in slums; we argue that this implies that the negative association between living in slums and health is even stronger than our estimate. The missing girls also help explain why slum girls appear to have a substantially lower mortality than rural girls, whereas slum boys have a higher mortality risk than rural boys. We estimate that slum conditions (such as overcrowding and open sewers), which the survey does not adequately capture, are associated with 20 % to 37 % of slum children’s stunting risk.     

Birth and death in cities in the developing world

City dwellers in Sub-Saharan Africa have increased roughly 600% in the last 35 years. Throughout the developing world, cities have expanded at a rate that has far outpaced rural population growth. Extensive data document lower fertility and mortality rates in cities than in rural regions. But slums, shantytowns, and squatters' settlements proliferate in many large cities. Martin Brockerhoff studies the reproductive and health consequences of urban growth, with an emphasis on maternal and child health. Brockerhoff reports that child mortality rates in large cities are highest among children born to mothers who recently migrated from rural areas or who live in low-quality housing. Children born in large cities have about a 30% higher risk of dying before they reach the age of 5 than those born in smaller cities. Despite this, children born to migrant mothers who have lived in a city for about a year have much better survival chances than children born in rural areas to nonmigrant mothers and children born to migrant mothers before or shortly after migration. Migration in developing countries as a whole has saved millions of children's lives. The apparent benefits experienced in the 1980s may not occur in the future, as cities continue to grow and municipal governments confront an overwhelming need for housing, jobs, and services. Another benefit is that fertility rates in African cities fell by about 1 birth per woman as a result of female migration from villages to towns in the 1980s and early 1990s. There will be an increasing need for donors and governments to concentrate family planning, reproductive health, child survival, and social services in cities, particularly in Sub-Saharan Africa, because there child mortality decline has been unexpectedly slow, overall fertility decline is not yet apparent in most countries, and levels of migration to cities are anticipated to remain high.     

Urban Growth in Developing Countries: A Review of Projections and Predictions

Comparison of the United Nations' earliest and most recent projections to the year 2000 suggests that urban and city growth in developing regions has occurred much more slowly than was anticipated as recently as 1980. A modified “urban population explosion” in developing countries since the 1970s conforms to explanatory models of urban growth developed by economists around 1980. Trends in productivity and terms of trade, in particular, have been highly favorable to agriculture as compared to manufacturing, presumably slowing migration to urban centers. Increases in national population growth rates have produced less than commensurate increases in rates of city growth, further supporting an economic and migration-related explanation for unexpectedly slow recent urban growth. Despite the efforts of the United Nations to maintain reliable statistics on urban and city populations, urban population projections should be interpreted with caution because of inadequacies of the data on which they are based. Moreover, current projections that virtually all world population growth in the future will occur in urban areas of developing countries may be misconstrued, if the forces that have retarded urban growth in recent years persist.     

Gender patterns in Vietnam’s child mortality

We analyze child mortality in Vietnam focusing on gender aspects. Contrary to several other countries in the region, mortality rates for boys are substantially larger than for girls. The mortality rate of boys appears to be more sensitive to parents’ education levels than the mortality rate of girls. A high education level of the father is particularly protective for boys. The rural–urban mortality difference in the raw data, which is particularly large for boys, can be fully explained by differences in observable characteristics of urban and rural households.     

Mortality in Quebec during the nineteenth century: from the state to the cities

The aim of this paper is to explore mortality in Quebec during the nineteenth century from a demographic perspective. During the nineteenth century, there was excess urban mortality in various countries; in order to identify such mortality differentials, we compared mortality indicators for the province of Quebec and then for the urban areas of Montreal and Quebec City. Using data from various studies, we produced life tables and compared life expectancies. We show that at different times during the nineteenth century, spatial variations in mortality levels across the province of Quebec and its urban areas were significant. According to the data we analyzed, mortality is undoubtedly higher in urban areas even though a convergence in trends took place towards the end of the century, resulting in an overall reduction in mortality. Also, exploring life expectancies within a cohort approach at times of fast-changing mortality patterns has proved to be instructive. Life expectancy estimates based on a cross-sectional approach were systematically lower than those resulting from a cohort-specific one. Trends diverged to a greater extent beginning with the 1870 cohort, reflecting the improvements made from that point on to World War II. Since current mortality levels are substantially determined by the cumulative effects of past behaviour specific to each generation, it is quite obvious that mortality analysis will reveal its true meaning only with the help of cohort life tables.     

Urban temporary out-migration under economic reforms: Who moves and for what reasons?

Studies of temporary migration in developing countries often focus on rural outmigration and are preoccupied with problems it may bring to cities. Using a unique data set from two surveys conducted in Zhejiang province, China, this paper examines the other side of the coin — temporary migration from urban places — and thereby provides an important complement to studies focusing on rural-urban migration. The analysis identifies three types of temporary migrations: on-business, economic, and family-related. Using multinomial logit model, the analysis suggests that the three types of temporary migration differ significantly from each other in both their causes and migrants' socioeconomic characteristics; so does urban-urban migration from urban-rural migration. The considerable urban-rural temporary migration attests to the fact that temporary migration is not a one-way process; its positive selectivity further indicates that a considerable human capital flows from urban to rural areas through urban-rural temporary migration, which provides rural areas much needed science and technology and becomes an important facilitating factor of rural socioeconomic development.This article is based on a paper, presented at the meetings of the American Sociological Association, Pittsburgh, August 1992.     

The inequality of maternal health care in urban sub-Saharan Africa in the 1990s

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa. The dis-advantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care.     

Population redistribution policy in Korea: A review

With its rapid industrial transformation over the last two decades, Korea has experienced a massive population shift from rural to urban areas. In particular, population concentration together with the concentration of economic and political power in the primate city of Seoul created spatial imbalances and a host of urban problems which are not uncommon to many developing nations. In response to these persisting imbalances and problems, the government of Korea has implemented various programs and measures since 1970. Korea's experiment with population redistribution, although it may not be easily replicated in other countries, provides a rare example with which we can examine some of the major issues involved in population distribution policies. The paper reviews Korean policies and programs for population redistribution, assesses their effects in redressing the three major spatial imbalances - between urban and rural, between regions, and between cities of different sizes - and draws lessons for policy formation in Korea as well as in other countries which are considering such a policy.     

Urban Form,Heart Disease,and Geography: A Case Study in Composite Index Formation and Bayesian Spatial Modeling

Recent studies indicate a relationship between measures of urban form as applied to urban and suburban areas, and obesity, a risk factor for heart disease. Measures of urban form for exurban and rural areas are considerably scarce; such measures could prove useful in measuring relationships between urban form and both mortality and morbidity in such areas. In modeling area-level mortality, geographic relationships between counties warrant consideration because geographically adjacent areas tend to have more in common than areas farther from each other. We modify county-level indices of urban form found in the literature so that they can be applied to exurban and rural counties. We then use these indices in a Bayesian spatial model that accounts for spatial autocorrelation to determine if there is a relationship between such measures and cardiovascular disease mortality for white males age 35 and older for the time period 1999–2001. Issues related to the formation and usefulness of the indices, and issues related to the spatial model, are discussed. Maps of observed and expected relative risk of mortality are presented. Jimmie Givens retired from his service.     

Population statistics] as of July 1, 1999

Reported in tabular form are population statistics published by the Institute for Population and Social Research, Mahidol University, in Thailand, as of July 1, 1999. The three objectives of the table were 1) to present the most recent estimates of relevant population numbers and vital rates twice a year, 2) to provide the most accurate demographic estimates possible through the use of standard techniques of demographic analysis, and 3) to disseminate the demographic data to Thailand, and international researchers and planners. The table shows statistics on the following elements: total population; population by sex; population in urban and rural areas; population by region; population by age group; crude birth and death rates; natural growth rate; infant mortality rate; life expectancies at birth and at 60 years and over; total fertility rate; contraceptive prevalence rate; and median age. A new basis for age estimates is also presented.     

农村养老保险制度的环境建设分析

文章认为 ,中国农村养老保险制度建设的经济环境、人口环境和政治环境基本具备 ,但农村居民的收入水平、农村居民收入水平地区差异以及农村大量剩余劳动力的存在直接制约农村居民养老保险制度的建立 ,因而政府在农村养老保险制度建立过程中 ,应从提高农村居民收入水平、加大政府财政转移支付力度和加强农村组织资源建设几个方面优化农村养老保险制度的环境     

Interagency working group on demographic projections

The Interagency Working Group on Demographic Projections held its 8th session in Amman, Jordan during May 1977. Under discussion at the session was the progress of work in the field of demographic projection. A report of the current activity of preparing illustrative national population projections by sex and age based on assumptions obtained from intensive empirical observations was reviewed. Information was also provided concerning the computer program developed by ESCAP. Future ESCAP work in this area would include the preparation of projections for urban and rural populations of each country which take into account more than 1 assumption on mortality. 1 of the important recommendations made in the session was that future demographic projections should be presented by developed and developing regions and that the developing regions should include the subregion of "least developed countries."     

On population of urbanization]

Unlike cities in capitalistic societies our socialistic cities are publically owned, and the relationship between rural and urban areas is mutually supportive and beneficial. 2 types of calculations are required for successful urbanization: an estimate of the total labor required in the city and an estimate of total agricultural products required to support the cities. Disregard for these 2 factors and overpopulated cities will result in unemployment, decreased agricultural production, inflation, and a decreased living standard. A balance between cities and country is important, and therefore population urbanization should be well planned. Capitalistic urbanization of population is based on the principle of private ownership and competition--from unplanned concentration of population in big cities to malignant expansion to the final decline of inner cities. Their governments are forced to redistribute the urban population. The same problem of overpopulated cities in underdeveloped countries results from stagnant agricultural production. We should learn from their mistakes in developing our cities. There are 2 types of socialistic urbanization. Russia has lopsidedly emphasized urban development and ignored agricultural production. Romania, on the other hand, emphasized both labor force distribution and agricultural production. Their numerous small cities near rural areas decrease the difference between big cities and the country. In the past we failed to follow our direction of urbanization--control the size of big cities, reasonably develop mid-sized cities, and actively develop small cities--because of the great difference in living standards between urban and rural areas and the lack of urbanization plans. The concept of industrialization must be accompanied by the concept of population urbanization.     

Sex ratio at birth for urban and rural areas

Previous studies show that sex ratio at birth in China's urban areas is usually higher than that of rural areas. The higher proportion of 1st births in urban areas was once taken to explain the cause for the higher sex ratio. The data of the 1982 fertility sampling survey show that the sex ratio at birth during the period from 1964 to 1981 remains higher in the urban areas (108.0) than in the rural areas (107.8). Further studies are yet needed on the differentials in sex ratios at birth between urban and rural areas and on their causes. The sex ratio in 1981 of the 29 provinces, municipalities and autonomous regions in China's mainland was 108.5, somewhat higher than that of most countries in the world. 2 things account for the occurrence. 1 is that, biologically, certain particularities may exist in the sex ratio at birth of China's population, for the ratio varies with ethnic groups, nationalities and regions. The other is that, sociologically, female infants may be underreported in some areas and the phenomenon of infanticide left over by history still exists in some isolated cases. These surveys suggest that a certain specific characteristic does exist in the sex ratio at birth of China's urban areas, but they also contribute to the explanation of the higher sex ratio at birth of the total population of the country.     

Household and Context Determinants of Child Labor in 221 Districts of 18 Developing Countries

We develop a new theoretical framework that explains the engagement in child labor of children in developing countries. This framework distinguishes three levels (household, district and nation) and three groups of explanatory variables: Resources, Structure and Culture. Each of the three groups refers to another strand of the literature; economics, sociology and anthropology. The framework is tested by applying multilevel analysis on data for 239,120 children living in 221 districts of 18 developing countries. This approach allows us to simultaneously investigate effects of household and context factors. At the household level, we find that resources and structural characteristics influence child labor, whereas cultural characteristics have no effect. With regard to context factors, we find that children work more in rural areas, especially if there are more unskilled manual jobs, and in more traditional urban areas. In more developed regions, girls tend to work significantly less.