The world is urbanising. By 2050, about 70% of the world’s people are expected to live in urban areas. Poor urban residents including people living in informal settlements or slums, poor households within better-off areas, informal and daily-wage labourers and the unemployed will bear the brunt of uncontrolled urbanisation.
Changing behavioural, social and environmental determinants are fuelling non-communicable and communicable diseases. Coupled with limited access to quality services, health inequities continue to grow, with the urban poor, frequently experiencing worse health outcomes than their rural counterparts. Yet, the generation of operationally-relevant research evidence on urban health policy and systems has not increased at a commensurate rate.
Africa and Asia contribute to 90% of urban growth worldwide. Rapid urbanisation is recognised as a global challenge and reflected across multiple Sustainable Development Goals, particularly number 11 which relates to sustainable cities and communities. The growing numbers of urban poor bear the brunt of both communicable and non-communicable disease, exposure to environmental and man-made hazards and limited access to quality, affordable health care. Many are reliant on pluralistic health systems which are a mix of private and public providers.
Due to the informality of their living and working conditions, the urban poor are frequently overlooked in data, programmes and policies. This is particularly true for those facing exclusion due to their ethnicity, religion, caste or disability. These factors are exacerbated as they intersect with the gendered exclusion of women and girls. Research has provided few answers to these complex health system challenges.
There is an urgent need to build resilient health systems in these settings.