Instead, the World Bank is funding a huge toilet-block building project, which aims to provide one toilet for every 50 people. The toilet blocks are administered by the community, but families pay a charge for using them — and such is the poverty that some still cannot afford it and defecate in the open.
Persuading city authorities to put in clean water and sanitation for unregistered residents is a delicate task, Verma says.
“Some of the slum housing is phenomenal: three or four floors made out of the flimsiest of materials, with an open toilet that’s shared, which is close to the drinking water and where they clean their clothes. Just a few meters away is a huge tower block. There is the juxtaposition of the incredibly poor with the incredibly rich in cities,” she says.
WEALTH AND HEALTH
However, arguing that infection could spread from slum to apartment block is dangerous: Authorities sometimes simply decide to clear the slum, rather than upgrade it.
Britain suffers the same health gap between rich and poor, Verma says.
The homeless and the vulnerable of British cities, as in Mumbai, suffer most frequently from tuberculosis.
However, cities also have health advantages over rural areas. They tend to be richer places and there is better access to healthcare even for those who are poor.
Children have a greater chance of being vaccinated.
A city-health commission set up by the Lancet medical journal and University College London reported in 2012 that citydwellers are healthier than rural residents.
However, the vast inequalities and their impact on people’s health will not just sort themselves out, the report emphasized. Cities need to be designed and expanded with the health of their citizens in mind.
This is, after all, in the interests of the entire planet.
SARS did not stay in Hong Kong, any more than it had originated there. It was first seen in China and traveled from one major city to another and another. Cities are now linked not by mule paths, but by fast aircraft used by millions of people. As far as viral infections go, it is almost as if people all live in the same city now.
At the time of the SARS outbreak, David Heymann was executive director of the WHO communicable diseases cluster that dealt with the crisis. Now head and senior fellow of the center on global health security at Chatham House and a professor at the London School of Hygiene and Tropical Medicine, he says cities are particularly vulnerable to infectious diseases not just because of their population density, but also because they have major airports.
SARS spread from China around the world because people traveled from one city to another.
Ironically, however, the real key to the spread of such infections is the people trying to save the lives of those who suddenly fall sick.
SARS in China and Ebola in Kikwit in the Democratic Republic of the Congo in 1995 were both spread by unfortunate hospital workers who were infected before they realized what they were dealing with.
The best protection for a city, Heymann says, has nothing to do with airport screening or special vehicles or technical equipment — the best protection is to ensure good hospital practices.
“If health workers get infected, they are a conduit out. What is important is what is done in the hospital,” he said.