Urbanization and health in developing countries: a systematic review.

BACKGROUND Future population growth will take place predominantly in cities of the developing world. The impact of urbanization on health is discussed controversially. We review recent research on urban-rural and intra-urban health differences in developing countries and investigate whether a health advantage was found for urban areas. METHODS We systematically searched the databases JSTOR, PubMed, ScienceDirect and SSRN for studies that compare health status in urban and rural areas. The studies had to examine selected World Health Organization health indicators. RESULTS Eleven studies of the association between urbanization and the selected health indicators in developing countries met our selection criteria. Urbanization was associated with a lower risk of undernutrition but a higher risk of overweight in children. A lower total fertility rate and lower odds of giving birth were found for urban areas. The association between urbanization and life expectancy was positive but insignificant. Common risk factors for chronic diseases were more prevalent in urban areas. Urban-rural differences in mortality from communicable diseases depended on the disease studied. CONCLUSION Several health outcomes were correlated with urbanization in developing countries. Urbanization may improve some health problems developing countries face and worsen others. Therefore, urbanization itself should not be embraced as a solution to health problems but should be accompanied by an informed and reactive health policy.