The definition of the term ‘urban’ in Bangladesh is a work on progress. The census definition of ‘urban’ includes four (4) distinct classes on the basis of population size: mega-city, metropolitan area, municipality and other urban areas. An increase in the number of urban centers has occurred mainly as a result of the reclassification of the areas.
The last census in Bangladesh was done in 2011. The preliminary counts show a population of 142,319 thousand which, after adjustment, can be as high as 152,111 thousand on a landmass of 147,570 square (sq) kilometers (km). Bangladesh is a country with the highest population-density, with 964 living per square kilometer as of 2011 census estimate. With the highest adjustment rate of 6.88% (as required in the 1974 census), the figure can be as high as 1,031 per square kilometer. According to Sample Vital Registration Survey 2009, three-fourths of the population (74.5%) live in rural area and the rest in urban area (25.5%).
During the current decade, the number of municipalities in the country jumped from 213 in 2001 to 309 in 2009. Generally, all the city corporations and municipalities are designated as urban areas. At present, there are 7 city corporations and 310 municipalities. Among the people living in urban areas, 35 % live in slums areas. Many more in urban live in public spaces lacking the most basic shelter. City corporations account for 61 % of urban population. Dhaka, the capital city, alone accounts for 40% of urban population of the country. Bangladesh Demographic and Health Survey 2007 reported a density of 2,756 per sq km in urban areas, when 843 per sq km was overall density in the country.
According to WHO Knowledge Network on Urban Settings (KNUS) Report 2008, around one billion people in present world live in deplorable conditions in slums or informal settlements, 90% of which belongs to the Least Developing Countries (LDCs). This number may double in coming decades unless appropriate policies for economic, social and health equity are made.
Rapid urbanization in Bangladesh has led to high population densities in urban centers in this country, with an increasing number of people living in slums and temporary dwellings. Urban population in Bangladesh has grown from 5% in 1971 to 27% in 2008. The urban population in Bangladesh is now estimated to be 25.5% of the total population, i.e. about 45 million people, with a current growth rate of 4% per annum. At this rate, half of the population of Bangladesh will live in urban areas in 25 years. It is estimated that of the roughly 45 million people living in urban areas, 35% live in slums areas. It is projected that an estimated 80 million people will be living in urban areas by 2020, 40-60% of whom will be in the slums. The major reason for this increase in urban poor population will be migration from the rural areas for economic reasons.
The rapid urbanization of Bangladesh is likely to have profound implications for her population health profile. Certain channels of health, particularly related to infectious disease, seem particularly susceptible to this possibility. The health indicators are worse for the urban poor than for the rural poor. In Bangladesh the urban areas provide a contrasting picture of availability of different facilities and services for secondary and tertiary level health care, while primary health care facilities and services for the urban population especially for the urban poor are depressingly inadequate. According to the Non Governmental Organization (NGO) directory 2003, total 384 NGOs work in Bangladesh conducting around 57 programs. Inspite of this, in urban areas, good health remains beyond the reach of many of the slum dwellers. Concurrently, uncontrolled urbanization is leading to creation of slums, overcrowding, poor housing, inadequate water supply and poor environmental sanitation, with detrimental effects on quality of life and outbreak of infectious diseases like the dengue outbreak over the last few years.
The health and rights of populations living in informal or slum settlements are key development issues of the twenty-first century. As of 2007, the majority of the world’s population lives in urban areas. In Bangladesh, urban slum settlements tend to be located in low-lying, flood-prone, poorly drained areas, having limited formal garbage disposal and minimal access to safe water and sanitation. These areas are severely crowded, with 4-5 people living in houses of just over 100 sq feet. These conditions of high density of population and poor sanitation exacerbate the spread of diseases. People living in these areas experience social, economic and political exclusion, which bars them from society’s basic resources.
Urban poverty in Bangladesh is evident in all the towns and cities. It is estimated that 43% of urban households live below the poverty line among which 23% are considered extreme poor. Around 35% of the populations of six major cities live in slums which cover only 4% of their land area with limited or no access to services. In Bangladesh, the publicly financed primary health facility in urban areas is quite poor. There are just 9095 Mother and Child Welfare Centers (MCWC) and 3540 urban dispensaries focusing entirely on primary care. By contrast, rural areas have almost 6,000 primary health care service delivery points.
Continuing urbanization in the developing world has led to major problems in terms of hunger, poverty, inadequate shelter, social segregation, unemployment, pollution of water, soil, and atmosphere and so onward. In Dhaka, studies shown that suspended particulate matter (SPM) and ambient sulphur dioxide levels of air pollution are about 4 times and 5 times higher than the levels prescribed in Bangladesh Air Quality Standard. An ADB report shows that 3,850 premature deaths could be avoided had there been a reduction of SPM concentrations in Dhaka to the level of Bangladesh Air Quality Standard. It was found that in Dhaka 33% inhabitants experience hearing problems from noise pollution.
Traditional societies in developing countries that have experienced rapid and unplanned urbanization, are facing changed lifestyles characterized by unhealthy nutrition, reduced physical activity and tobacco consumption. These unhealthy lifestyles are associated with common modifiable risk factors for chronic diseases such as hypertension, diabetes mellitus, dyslipidaemia and obesity . It is expected that by 2020 in developing countries, non communicable diseases (NCDs) will account for 69% of all deaths, with cardiovascular diseases in the lead. Using the dichotomous United Nations definition of urbanization for more than 100 countries, Ezatti et al. found that both body mass index (BMI) and blood cholesterol levels rose rapidly in tandem with increases in national income and level of urbanization.
Lessons from countries situated in Africa and Latin America proves that partnerships and developing forum mechanisms works to ensure the harmonization of health and development activities. From the outset, these forums can be involved in arraigning policy dialogues, act as policy advocate, review and interpret formative research, and monitor and evaluate activities. In Bolivia, Madagascar and Ghana a forum was developed to work in partnership to make substantial rise in the rate of exclusive breastfeeding (EBF) and child nutrition. And in all those countries the goal of the forum was substantially achieved. Such as in Bolivia, Ghana, and Madagascar, in 2000 the rate of EBF was 39%, 53% and 41% respectively; which rose to 54%, 54% and 67% in 2007. And one of the potential reasons for the raise in breastfeeding rate was development of an inter-sectoral and multi dimensional forum.
Thus, in order to effectively address health concerns of urban population, civil society needs to take active part to promote, support and protect health justice to the poor–non-poor and slum–non-slum dwellers of the city. Having realized the imperative requirement of a strong support, fostering and backup as well as an aggregate effort for awareness building and overseeing the proper implications of existing health policy and interventions, Eminence has structured Bangladesh Urban Health Network (BUHN) at national level in collaboration with thirty national and international organizations. On January 18, 2010, consultation between RTM International and Eminence Associates for Social Development (www.eminence-bd.org) resulted in facilitating Bangladesh Urban Health Network (BUHN) for combined efforts in the urban health of the country. The network is an initiative to endorse improved urban health in Bangladesh through enhanced coordination and cooperation between GoB, donor and other development agencies, national and international NGOs. BUHN envisions to promote the exchange of information, influence policies, generate and exchange ideas, share best practice, advance scientific knowledge, promote knowledge transfer, stimulate joint activities among its members, harmonization of procedures and the use of common data and information. BUHN will be a sustainable (well funded), preeminent national network of civil society members for urban health knowledge generation and exchange in Bangladesh for research and exchange of knowledge, promote and apply more effective policy and strategies to achieve health equity in urban settings worldwide.
In addition, Eminence is presently conducting its core program Urban Health and Demographic Surveillance Project (UHDSP) in two wards of Mirpur in Dhaka city. For more information the project please click here.