All around the world, rural migrants are flocking to cities in search of a better life. But it turns out that a move to the big city can bring out the worst in people.
According to public health researchers, the bad habits include a more sedentary lifestyle, the consumption of energy-dense but often nutrient-poor foods, and rampant use of alcohol and tobacco.
The result is a major increase in non-communicable diseases such as Type 2 diabetes, cardiovascular and perivascular disease, and chronic pulmonary disease, says Susan Foster, a professor at Boston University’s School of Public Health.
In a presentation titled “Promise and Peril: Urbanization and Public Health in Asian Cities,” at The Future is Now: Urban Asia in the 21st Century earlier this month, Foster detailed some of the ways that urban migration can go awry. The symposium was co-sponsored by Boston University’s Frederick S. Pardee Center for the Study of the Longer-Range Future, the Initiative on Cities, the Center for the Study of Asia, Global Programs India Initiatives, the Center for Global Health and Development, and in collaboration with the Lincoln Institute of Land Policy and BU’s Metropolitan College.
The majority of the costs of illnesses are borne by individuals and their families, which can be a significant burden for middle- and lower-income households, Foster said. At a basic level, the premature death of the family breadwinner is most obviously devastating.
The food problem— a version of which goes on in some neighborhoods of Western cities—has to do with the availability of what is essentially junk food, and its replacing rice and vegetables and other basic staples of rural environments.
But tobacco is wreaking havoc worst of all, as advertising, abundant availability, and the addictive power of nicotine conspire to make migrants frequently light up. In Bangladesh, Foster says, the poorest households are more than twice as likely to smoke, and consumers spend more on tobacco products than on clothing, housing, health, and education combined. Theoretically, kicking the habit could add 500 calories to the diet of a family of one to two children.
In China, where nearly 65 percent of urban dwellers smoke, the government actually encourages tobacco use. In workplaces and even some schools, there are quotas for the consumption of Chinese-made cigarettes. Incredibly, the story is told that inspectors look through ashtrays and waste bins, looking for butts that aren’t Chinese-made, and counting up the approximate cartons consumed; there are penalties, of course, for noncompliance. The payoff of this version of “buy local” is a flow of money to the Chinese tobacco companies. And the government collects tobacco taxes—which account for about eight percent of all government revenues.
To make any progress on urban smoking as a public issue, “We have to wean governments, as well as people, off the addiction to tobacco,” says Foster.
There are many benefits for humankind in the rapid urbanization happening in Asian cities and all around the world: Increased access to education, health services, electricity, water (even if often of dubious quality), income-earning opportunities, and the sense of being at the social center of things.
Planners and policymakers are rightly focused on providing basic services, decent and safe housing, and transportation infrastructure. But the city as den of iniquity—or web of hazardous choices— is another disturbing narrative, and the extent of the problem is surprising. Clearly, public health needs to be added to the list.
One could argue it has always been so—that unhealthy ways are part and parcel of the metropolis. With 6 billion people living in the world’s urban areas by 2050, however, the numbers of people affected by trends, good and bad, will continue to be outsized. Anything city dwellers do, they are going to do by the hundreds of millions. Such is the nature of the great urbanization project of the 21st century.