Urbanisation, health and the Sustainable Development Goals

Health, gender and urbanisation are all included in the Global Goals, but are the links clear enough?

The urban share of poverty is increasing: according to the UN, by 2030 almost 60 per cent of the world’s population will live in urban areas. Over 90 per cent of this urban growth will happen in Africa, Asia, Latin America, and the Caribbean.

Rapid urbanisation creates challenges for access to basic infrastructure and services such as water, health care and education, which can escalate poverty and unemployment, crime, safety problems and poor health.

'With good governance, cities can do pretty well at delivering on education and health care and other services but they can also concentrate and incubate, and potentially exacerbate, health challenges,' says Catherine Hankins, Deputy Director of Science at the Amsterdam Institute for Global Health and Development.

The Sustainable Development Goals (also known as the Global Goals or the SDGs) intersect with many issues of urbanisation, gender and health. They were officially adopted by UN Member States in September 2015 with 17 universally applicable Goals and 169 targets.

Where gender, urbanisation and health meet

 A busy street full of traffic in Dhaka, Bangladesh.

As the world becomes more urban there could be increased opportunities for women. In some instances, access to health care and commodities might be better. Urban areas can offer women more diverse employment and education opportunities, more opportunities to socialise outside the home, more prospects to take up community or political leadership roles and more possibilities to redefine traditional gender roles.

But challenges still exist; women may be restricted in terms of their ability to move within urban spaces, either because of household commitments, or because they do not feel able to move freely and safely. 

'When you move in from rural areas to urban areas do you have social networks? Is there social cohesion?' says Hankins. 'If you do face gender problems like intimate partner violence do you have any safety net? Do you have people that you can talk to?'

Migration to, and residence in, low-income urban settlements is associated with particular health challenges for women and girls. Communicable diseases such as HIV, sexual and reproductive ill-health and, increasingly, non-communicable diseases related to poor diet, tobacco and sedentary lifestyles, are a concern. 

There can be multiple levels of gendered political exclusion on urban health policy making and formal and informal political decision making processes. This can be due to a number of reasons, including discriminatory practices, limits on education or income and care giving responsibilities. This inequality is compounded for women in poverty who often live in unrecognized areas, considered as ‘temporary’ and therefore not worthy of planning.

Global Goals

A woman walks beside a railway in Kibera slum, Nairobi, Kenya. There is a child in a sling on her back.

The Global Goals make frequent reference to urban health and gender.

For example, under Goal 3: 'ensure healthy lives and promote well-being for all at all ages', the targets explicitly talk about a wide range of health problems. Goal 5, 'achieve gender equality and empower all women and girls' includes a target (5.6) on access to sexual and reproductive health and rights (SRHR).

However, many SRHR advocates are concerned that there are not enough joining of this with other issues, as well as a lack of language on sexual rights. 

'Globally it’s quite a challenge that reproductive justice or sexual and reproductive health is viewed as controversial, politically complex and sensitive by some governments,' says, Marion Stevens, Coordinator of WISH Associates in South Africa and Research Associate, African Gender Institute – she highlights the US as an example. 

'Even though within South Africa we have a very progressive legal framework we’ve been essentially influenced by international agendas which are more conservative than our own context… So our health system’s work tends to focus on more agreeable topics like maternal health and leaves out contraception and abortion.’

It is Goal 11 – 'make cities and human settlements inclusive, safe, resilient and sustainable' – where urbanisation gets its main focus. Targets cover access to safe and affordable housing and transport (including road safety). Here women are mentioned as one of the groups in a potentially vulnerable position.

Other targets aim for better urban planning, a reduction in deaths and economic loss caused by disasters, better air quality, tackling climate change and increased resilience. The need for inclusive and accessible, green and public spaces is recognised and again women are specifically mentioned here. 

'We see SDG 11 as very significant as it brings a renewed emphasis on urban issues and, for the first time, puts cities front and centre on the international development agenda. This is definitely a shift in focus,' said Sharon Van Pelt, democracy and governance practice director at Chemonics, a Washington-based international development company in this Devex article. She said that Goal 11 and its targets 'encourage the development and implementation of more integrated development strategies and solutions within cities.'

Can the SDGs make a difference?

Some are concerned that the SDG agenda is not explicit enough about who is responsible for achieving the Goals and how the work will be supported.

'We are faced with the fact that it will fall to urban governments (municipal, city and metropolitan), to plan and manage much of the adaptation to climate change and much of the mitigation; and urban governments will be responsible for planning and managing the necessary integration with disaster risk reduction and poverty reduction, including the universal provision of basic services,' writes David Satterthwaite, of IIED's Human Settlements Group in this article. He argues that local governments should have a bigger role in defining and making commitments so they are more accountable to their populations.

Catherine Hankins is optimistic about the difference the Global Goals can make. 'I think it’s a natural progression,' she explains. 'We’re not just talking about development, we’re talking about sustainable development and that puts the footing on what is going to be not just achieving a goal by a certain date but actually taking into account the sustainability issues both socially, environmentally, financially everything.'

The development sector has a lot of work to do to catch up with the speed of the world’s urbanisation, argues IDS Research Fellow Linda Waldman. 'It’s something that we’re still grappling with,' she says.

'We still think of development as being a rural problem and of the issues as being rural but the problems are increasingly becoming urban. I think that not only are they urban but they’re pockets within urban, so they’re peri-urban areas, they’re informal residential areas, they’re areas that don’t have access to services.'

'You see this particularly in relation to things like disease outbreaks. There’s no point in telling people they have to act and behave hygienically if they don’t have running water and sanitation. The assumptions of what urban life is like, or should be like is very, very different to people’s lived experience.'

In 2016, the issue of urbanisation will be firmly on the international agenda in the lead-up to the United Nations Conference on Housing and Sustainable Urban Development (Habitat III) in Quito, Ecuador (17-20 October 2016). The event is an opportunity for UN member states to discuss an urban agenda, and a chance for those advocating on issues around urbanisation to make their voices heard. But to what extent will the links between urbanisation, health and gender be made?

IDS, along with international partners, is researching the health challenges faced by women and girls in low-income urban settlements in expanding cities in Kenya, India and South Africa and what interventions exist to address these health challenges. Find out more here on Interactions.