There is a growing interest in the role played by the community context or neighbourhood characteristics, or 'the place' in shaping health outcomes (1-3). Whereas, most population-based medical research has often focused on individual risk factors, such as life-style, diet, cholesterol, smoking, lack of exercise as the major contributory factors to disease, increasingly; this focus has been shifted to the community or neighbourhood context (1-4). Most research in medical sociology has found evidence to link social conditions as antecedents of disease outcome in the causal chain. Link et al. and Coken et al. emphasize that the focus should be on the social conditions which are the 'distal causes' of disease (4-5). The central message is that focusing on the individual risk factors deflects the beam from the real upstream factors that are antecedent to onset of disease. By ignoring the role of the community context in shaping health outcomes, individual-level indicators are less reliable in reflecting a holistic picture of human well-being. Results of most recent studies concerning the impact of concentrated poverty environments on health outcomes indicate that community characteristics have an impact on most members of a community, irrespective of the socioeconomic status of the individual (3,6-8). High levels of neighbourhood problems, such as pollution, poor weather, noise, unsafe areas, smells, fumes, and litter, contribute to stress that has negative health consequences.
Global overview of urbanization
Urbanization, poverty, and sustainable development have become very important topics at the global level. In 1999, 75% of Latin America was urbanized; in the Middle East and North Africa, urbanization was at 58%; in South Asia, it was 28%; and in sub-Saharan Africa, urbanization was 34%. Recently, the United Nations General Assembly elevated the United Nations Centre for Human Settlements (UNCHS) to the status of a full-fledged programme, now referred to as United Nations Settlement Programme because of the challenges involved in urbanization (9,10).
The rate of urban growth in developing countries has been estimated to be higher than that in more developed countries (11-14). There were 330 million urban poor in 1988 in the developing world, distributed as follows: Africa--56 million; Asia--137 million; Latin America and the Caribbean--77 million; and other regions--60 million. By 2005, the majority of the world population would be living in urban areas (9,10,12,15). According to UN projections, the world's total urban population will have risen to 4.54 billion in 2025, an increase of 1.69 billion people (16). According to the UN, urban dwellers are vulnerable to global forces, manifested by growing polarization and exclusion, a visibly increasing poverty, and a widening gap between the rich and the poor. As a result, squatter settlements, slums, and shantytowns have become commonplace in most developing countries (12).
Sub-Saharan Africa and urban poverty
According to the UNCHS, Africa (which has remained predominantly agrarian for the most part) would also face an explosive demographic shift from rural to urban areas in the next 10 years (13). In sub-Saharan Africa, rapid urbanization and industrialization became a major feature immediately after Independence in the late 1950s and early 1960s. Most cities had been newly established (or newly refurbished) as centres of trade and administration during the colonial era. Residents seeking a better life moved rapidly from the deteriorating agricultural sector because of droughts, overgrazing, and soil-erosion. As a result, the African continent experienced rapid urban sector growth and ultimately was recorded as a continent with the highest rate of urbanization worldwide (12,17).
For the most part, African societies have slowly transformed from agricultural to agro-industrial states. The population in urban settlements in Africa has increased substantially. …