Urbanization, the process of rural areas developing into cities and towns, has been especially prominent in our society in the last century. Today, over 55% of the world’s population lives in urban areas, which is set to rise to 68% by 2050 (World Health Organization). This land transformation is driven by various economic factors, including residential, commercial, industrial, and transportation interests. Urbanization increases employment opportunities, modernization, access to education, better healthcare, and other social services, creating an overall better quality of life. Blooming cities and towns become a society of culture that facilitates financial and educational growth. Although urbanization has its benefits, it creates challenges regarding social inequality, the environment, and health outcomes. Thus, addressing the economic forces behind urbanization, its health consequences, and the policies that can help mitigate the health problems it creates is crucial for reducing health disparities.

Urbanization stems from industrialization, since the transformation of an agricultural economy into a manufacturing one wouldn’t be possible without the creation of mass-production factories and assembly lines. The transition spurred economic growth, leading urban areas to gain a reputation for housing greater economic, political, and social opportunities than rural areas. Commercialization also plays a crucial role in the emergence of urbanization. Business and trade and the distribution of goods and services naturally give rise to the growth of towns and cities, as such areas offer better commercial opportunities and returns. As more people migrate and more businesses bloom in urban areas, this stimulates a cycle with even more commercial transactions. Of course, the services offered by the towns and cities also naturally draw people who want to benefit from them, as people from rural areas are incentivized to move to cities to acquire social and economic services as well as benefits, including better education, health care, housing, business opportunities, and social services.

Rapid and uncontrollable urbanization, however, can be a double-edged sword, especially in developing countries. Specifically, it can lead to increased economic instability and inequality, as higher costs of living and increased competition for jobs in the city can trap people in poverty. The same services and opportunities people are striving for by moving to cities are unevenly distributed, preventing groups and neighborhoods from accessing proper healthcare, better education, piped water, and adequate housing. The uncontrollable growth of urbanization and the slow social policy changes have resulted in inadequate public services for those in need and a failure to guarantee a minimum quality of life for residents. In fact, the most recent global estimates suggest almost 1-in-3 people in urban areas live in slum households (Our World in Data), the most notable extreme of a concentration of urban poverty and economic and social disadvantage.

While healthcare benefits and social services are more accessible in urban areas, rapid and uncontrollable urbanization facilitates health implications and inequalities. Cities often face higher levels of dust and carbon dioxide pollution due to industrialization and traffic. This leads to chronic respiratory diseases, which is a major contributor to poor health in urban areas. It’s estimated that around 91% of people in urban areas breathe polluted air (World Health Organization). High population density and overcrowding also foster conditions in which communicable diseases can flourish. Zoonotic transmission of infectious diseases such as tuberculosis, dengue, cholera, and malaria thrive in urban areas with poor sanitation and overpopulated environments. Poor urban waste management also fuels the transmission of Zika and Ebola viruses. More prominently in recent years, the COVID-19 pandemic reflects the burden higher populated cities bear during health emergencies, which includes higher rates of exposure to the virus, less space for protection, an increased risk of contagion due to lack of clean sanitation services, reduced access to quality health services, and a lack of hospital capacity during emergency outbreaks. Higher morbidity and mortality rates among the socioeconomically disadvantaged in urban areas demonstrate the challenge of urbanization and its repercussions on human health. In fact, COVID-19 cases and deaths in deprived areas are double those of more advantaged areas (World Health Organization).

In addition to increased risk and exposure to respiratory and infectious diseases due to rapid urbanization, diseases such as cardiovascular diseases, cancer, and diabetes are exacerbated by unhealthy living and working conditions, inadequate green space, a lack of active living space, and pollution (air, noise, water and soil contamination, etc.). It has also been demonstrated that urbanization results in adverse effects on the nutritional health of socioeconomically disadvantaged communities. Such groups have limited financial resources available, which coupled with the increased cost of healthy food and higher cost of living in urban areas, can lead to health implications. Many people with a lower socioeconomic status resort to unhealthy and poorly nutritious diets, which are on average $1.50 cheaper per day than healthy foods (Harvard Health). Urban centers in developed areas also have more supermarkets and fast-food chains, offering easier access to high quantities of processed foods, high-calorie snacks, sweets, and sugary beverages (Harvard School of Public Health). Furthermore, cities have more densely populated neighborhoods, fewer outdoor recreational spaces, and an increased prevalence of sedentary occupations. Unhealthy habits, combined with poor dietary patterns, can lead to overweight and obesity. In fact, in 2003, the World Health Organization (WHO) estimated that more than 300 million adults suffered from obesity, with the majority of these being in developed and highly urbanized regions. On the other end of the spectrum, for the poorest urban households, food is often the main expenditure. In Nepal and Cambodia, for example, the poorest households and those living in smaller towns may spend nearly all their earnings on food yet still have limited or no access to nutritious food (International Institute for Environment and Development). Environmental contamination and unhygienic conditions are also prominent in developing urban areas, which can also lead to undernutrition from outbreaks of bacterial illnesses, including botulism, salmonella, and shigellosis (News Medical Life Sciences).

Mitigating these health issues requires sustainable urban development, pollution control measures, equitable healthcare access, improvement of urban food environments, and educational campaigns. Sustainable urban planning that prioritizes green spaces, efficient public transportation, and pedestrian-friendly environments can promote physical activity and reduce pollution. The Sustainable Development Goals (SDGs), created by the United Nations, are intended to promote well-being and achieve a better and more sustainable future for all. The acknowledgment of health as a significant component of urban planning and cooperation between different stakeholders and institutions is crucial to delivering sustainable urban development and mitigating urban health problems. Ensuring equitable access to healthcare services in urban areas is also crucial. Affordable and accessible healthcare facilities can help address health issues promptly and efficiently. Moreover, environmental initiatives such as strict regulations on air and water pollution and the promotion of the use of clean energy sources and public transportation can reduce pollution-related health problems. Additionally, mental health programs and support services in urban areas can help residents cope with the stressors of urban life. These programs can include counseling, crisis hotlines, and community initiatives to foster social connections. Finally, promoting health education and awareness campaigns in urban areas can inform residents about healthy lifestyle choices, the importance of physical activity, and the risks of sedentary behavior.

By striking a balance between economic growth and public health, cities can become thriving centers of opportunity while prioritizing the well-being of their residents.