18 - Urbanisation in the Third World: health policy implications

Summary

Introduction

Urbanisation, the rapid growth of the urban poor and the health problems of these populations in the Third World have received increasing attention during the past five years. The objective of this paper is to raise some of the issues that need to be considered in urban health policy development. The paper uses a particular conceptual framework to analyse health policy development, that is, the three-stage model of

1. problem identification;

2. policy formulation;

3. policy implementation.

It is argued that in terms of urban health policy the ‘problem’ has, to a large extent, already been identified and that it is difficult to justify more research in this area alone. Various trends can be identified in the way urban health policy is being formulated, and two examples are provided. A number of constraints in policy implementation are discussed, and future research needs are identified.

Problem identification

Two parallel movements, which have recognised the needs of the urban poor in developing countries, have emerged in two distinct sectors at different times during the late 1970s and the 1980s. The first was in the housing or urban development sector; the second was the health sector. The second movement reflected the first: policy developments in urban health for the poor in the late 1980s are closely linked with an earlier policy development in the housing sector, namely slum upgrading or slum improvement.