Introduction

Numerous reports that present data on child growth and health outcomes around the world highlight urban-rural differences. Many of the classic growth studies reported in Tanner & Eveleth (1976) show that, in general, children in urban areas tend to be healthier, taller and heavier than children in surrounding rural areas. Similarly, data from the FAO's 1985 Fifth World Survey (presented in Fig. 1 of Keller, 1988) show consistent urban-rural differences in the prevalence of stunting and wasting among 0–5 year old children (see Fig. 6.1). The better health status of urban children is often attributed to a regular supply of goods, health and sanitation services, education, and medical facilities, associated with the urban environment.

If we look at large urban centres of the developing world over the past two decades, however, a different picture begins to emerge (Popkin & Bisgrove, 1988). Urban centres are not necessarily uniformly healthy environments. Population growth in urban centres is proceeding at a very rapid rate: by the year 2000, it is projected that 43% of people in developing countries will live in cities (United Nations, 1980). Concomitant with rapid population growth, due to both migration and natural increase, is a dramatic shift in demographic and socioeconomic composition of urban areas. Approximately one third of the world's poor now live in cities (Churchill, 1980), mostly in makeshift squatter settlements that share problems of poverty, overcrowding, poor environmental conditions and psychological stress.