Healthy Country, Unhealthy City: Population Growth, Migration, and Urban Sanitation in Lima and Manila

Abstract

This article explores the connection between the significant health improvements made in the developing world, particularly after World War II, and the goal of providing clean water and sanitation services to large urban centers in these countries. Using Manila and Lima as case studies, it argues that increases in life expectancy stemming from reduction in the incidence of infectious diseases led to significant rural population growth, spurring rapid migration to urban areas. This migration in turn created enormous public health challenges in cities. Migrants generally lived in unsanitary informal settlements. In some cases, particularly in the short term, moving to the city posed significant health risks to migrants. However, a combination of activism by migrants and increased managerial competence on the part of urban authorities is beginning to yield an urban health dividend, at least in most Latin American and Asian cities. Drawing on the theories of the demographic transition and the epidemiological transition, this analysis links urban health issues to larger-scale transformations in population and health trends.