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Executive Summary Over the next 30 years, most of the growth in the world's population is expected to occur in the cities and towns of poor countries. Cities are now home to nearly half of the world's total population and over three-quarters of the population of high-income countries. By 2020 the developing world as a whole is likely to have become more urban than rural. The changes under way are not only a mat- ter of percentages, but also of scale. At the beginning of the twentieth century, just 16 cities in the world the vast majority in advanced industrial economies- contained a million people or more. Today, almost 400 cities are of this size, and about three-quarters of them are in found in low- and middle-income countries. In the very near future, then, it will no longer be possible to conceive of de- veloping countries as being mainly rural. Both poverty and opportunity will take on an urban cast. This transformation will be a powerful force in shaping fam- ily, social, economic, and political life over the next century. And yet, in the research conducted to date on developing countries, demographers have devoted very little attention to the implications of urban contexts for marriage, fertility, health, schooling, and children's lives. As poor countries continue to urbanize, the distinctive features of urban life will have to be taken into consideration in demographic research and the policies it informs. As the demographic trends unfold, the nature of urban life in low-income countries will itself be changing. The world is in the midst of a period of fun- damental economic restructuring, driven by globalization and the revolution in information and communication technology. Many poor countries are industri- alizing rapidly, while advanced economies are shifting away from manufacturing toward finance, specialized services, and information processing. These changes are forcing countries and, indeed, individual cities to redefine their compara- tive advantages so as to be competitive in the global marketplace. As they link themselves to international markets, the cities that participate in global circuits are increasingly exposing their residents to the risks, as well as the benefits, that come from being more tightly integrated in world networks of finance, information, and production. The speed and scale of these changes present many challenges. Of particular concern are the risks to the physical environment and natural resources, to health

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2 CITIES TRANSFORMED conditions, to social cohesion, and to individual rights. For many observers, how- ever, the immediate concern is the massive increase expected in the numbers of the urban poor. In many countries in the developing world, at least one in four urban residents is estimated to be living in absolute poverty. The manifestations of poverty are clearly visible in all major cities: overcrowded neighborhoods; pol- lution; inadequate housing; and insufficient access to clean water, sanitation, and other social services. Compounding matters, each year cities attract considerable numbers of new migrants who, together with the increasing native population, can expand squatter settlements and shanty towns, exacerbate problems of con- gestion, and confound the ability of local authorities to provide infrastructure and basic amenities. At the same time, the benefits derived from urbanization must not be over- looked. Cities are the locations where diverse social and economic resources are concentrated. This concentration can bring substantial benefits in the form of positive social and economic externalities, which are expressed in technological change and economic growth. Historically, urban growth has been most rapid where economic growth rates have been highest. This is clearly the case today in Pacific Asia, where urbanization is accelerating and being accelerated by a newly globalized economy that is changing the face of the planet. As cities grow and evolve, the task of managing them becomes ever more complex, in part as a result of jurisdictional conflicts arising from the expansion of cities beyond existing administrative and political boundaries. The nature of man- agement and governance is also undergoing fundamental change. The policy and program environment in urban areas is being transformed as national governments decentralize service delivery and revenue raising to lower tiers of government. In the areas of health, family planning, and poverty alleviation, many national gov- ernments are beginning to allow local governments to operate the levers of policy and programs. But at present, few local governments are equipped with the tech- nical and managerial expertise they need to take on these new responsibilities. THE RESEARCH GAP Demographers are not now in a position to shed much light on the demographic aspects of the urban transformation, and they can provide little by way of guid- ance on urban-oriented programs and policies. Where urban/rural differences are recognized in demographic research, they still tend to be described in terms of simple urban/rural dichotomies. But urban growth is often accompanied by eco- nomic development, the restructuring and relocation of production, social and eco- nomic fragmentation, and spatial reorganization end urban/rural dichotomies are increasingly inadequate even to describe these changes. In countries where the level of urbanization is already high, further measurement of change in the urban percentage adds little by way of insight. What is needed is a new emphasis on the inter- and intraurban differentials, and these are topics to which demographers

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EXECUTIVE SUMMARY - have paid remarkably little attention. The neglect of intraurban research on de- veloping countries is all the more surprising in view of the close attention given to neighborhood effects and other intraurban issues in research on cities in the United States. THE PANEL'S CHARGE Recognizing the need for a major new inquiry in this area, the National Research Council formed the Panel on Urban Population Dynamics. The panel's mandate was to develop a better understanding of the dynamics of urban population growth, as well as its causes and consequences, as a step toward helping governments better manage the environmental and social service problems that accompany the rapid growth of urban areas in poor countries. The panel focused on improving knowledge in six areas: Urban population dynamics and city growth Social and economic differentiation within and across cities . Fertility and reproductive health in urban areas Mortality and morbidity in urban areas Labor force implications of a changing urban economy The challenge of urban governance In addressing its task, the panel both reviewed the existing literature and conducted new data analyses. In particular, the panel relied heavily on a new database that it created by linking the Demographic and Health Surveys (DHS) with information on city sizes taken from United Nations (UN) sources. URBAN POPULATION DYNAMICS AND CITY GROWTH Almost all of the world's population growth for the foreseeable future will occur in the cities and towns of Africa, Asia, and Latin America. Although rates of urbanization in these poor regions today are similar in several respects to those in the Western historical experience, marked differences are also evident. Urban natural increase is as great a contributor to high rates of urban growth as is rural- to-urban migration, and because of lower mortality, natural rates of increase are higher in the modern era than in the historical record. Furthermore, many res- idents of poor countries will live their lives in very large cities whose sizes are historically unprecedented. With increases in urban percentages and the growth of cities large and small comes a need for adequate population data that are comparable among and within

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4 CITIES TRANSFORMED cities, as well as between urban and rural areas. The demographic field is perhaps overly dependent on the United Nations Population Division for such city and urban population counts. The Population Division does an admirable job of pro- ducing urban population estimates and projections, but it lacks the resources in terms of personnel, funds, and data contributed by member countries to meet the demands placed upon it. The panel recommends that a critical review of the United Nations data and methodology be undertaken with the help of outside re- searchers to bring additional perspectives and intellectual resources to bear on this difficult work. In addition, the DHS data would be much more useful for urban research if spatial identifiers for all surveys were made available to researchers, and if measures of public services better reflected variations in service adequacy and reliability. SOCIOECONOMIC DIFFERENTIATION Diversity is a defining characteristic of urban life. Every city has relatively more affluent and relatively poorer neighborhoods, and large cities are often marked by the spatial segregation of rich and poor. Yet these important inter- and intraur- ban differences are lost from view in demographic analyses that concentrate on ruraVurban dichotomies. In exploring cross-city differences, the panel found that large urban areas enjoy a marked advantage in the provision of piped water, waste disposal, electricity, and schools. Smaller urban areas particularly those under 100,000 in population are significantly underserved. In examining the effects of intraurban poverty, the panel found that the urban poor are in a distinctly inferior position relative to other urban residents in terms of access to basic amenities. The urban poor are also particularly vulnerable to economic, social, and political crises and environmental hazards and disasters. Current systems of poverty measurement are inadequate for capturing all of the dimensions of urban poverty. The panel recommends improving data systems on access to services, income and assets, the multiple dimensions of poverty, and education, so that the data will be comparable among and within cities. Such data must also be disseminated widely to policy makers and program managers at the national and local levels. FERTILITY AND REPRODUCTIVE HEALTH The fertility levels of urban residents are shaped by urban constraints and opportu- nities. Typically, urban couples desire to have fewer children than their rural coun- terparts, so that the general level of demand for contraceptive services is higher in urban than in rural areas. This can be partially explained by higher levels of schooling among urban adults, and perhaps by the greater prevalence of women working outside the home.

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EXECUTIVE SUMMARY 5 But in considering theories of neighborhood effects, social learning, and dif- fusion, the panel found that urban socioeconomic diversity and the range of urban reference groups and role models are also likely to have an influence on fertility decisions. In particular, urban parents are apt to appreciate the advantages of hav- ing fewer but better-educated children. In some settings, urban environments are presenting women with novel behavioral options. The establishment of a garment manufacturing sector in Dhaka, for example, has created the opportunity for young unmarried adolescents to work outside the home in direct contact with men, a sit- uation almost unimaginable a generation ago. This experience is likely to have significant implications for women's attitudes toward marriage, childbearing, and children's education. The panel found considerable variation within urban settings in fertility; in factors relating to contraceptive use; and in other reproductive health indicators, such as place of delivery, birth attendance, and AIDS awareness. The urban poor and residents of smaller cities appear to be underserved in terms of access to re- productive health services as compared with their counterparts who are wealthier and living in larger cities. The panel's analysis revealed the need for policy pre- scription in four areas: improving services for the urban poor, enhancing services in smaller cities, creating appropriate services for adolescents, and augmenting HIV/AIDS prevention programs. Research is urgently needed to understand the implications of the decentralization of reproductive health services that is under way in many developing countries. MORTALITY AND MORBIDITY As is the case with fertility, many features of urban life have important implica- tions for urban morbidity and mortality. Social infrastructural investments have historically been greater in cities than in rural areas, so that on average, urban dwellers (particularly, as noted above, those in large cities) enjoy better infra- structure and easier access to health services, as least as measured by the physical distance to services. Other factors influencing urban health include the greater prominence of the private sector in health care, weaker informal safety nets, life- style changes that affect diet and exercise patterns, and increased exposure to envi- ronmental contamination. In some developing countries, noncommunicable (i.e., chronic and degenerative) diseases, accidents, and injuries are becoming more im- portant than infectious diseases as causes of death. Since the mid-1980s, the long-assumed urban advantage in health has been called into question. The international debt crisis hit many poor countries hard, and the implementation of structural adjustment programs led to a retrenchment of government subsidies and social expenditures that probably affected urban res- idents disproportionately. In addition, high rates of overall population growth, to- gether with significant rural-to-urban migration, have contributed to the rapid and unplanned expansion of low-income settlements on the outskirts of many large

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6 CITIES TRANSFORMED cities, which has occurred without a concomitant expansion of health services and facilities. The panel's analysis of urban/rural differences in infant and child mortality reveals the existence of a substantial urban health advantage, at least on average. The dominant pattern in the DHS data is one of declines in both urban and ru- ral mortality, with slightly greater declines taking place in urban areas. In the majority of the surveys analyzed, mortality risks facing the urban poor are found to be lower than those faced by rural children. In several surveys, however, the urban poor are found to face significantly higher risks than the general rural pop- ulation, and in Latin America, the residents of smaller cities are disadvantaged in comparison with residents of cities with more than 5 million population. The spatially concentrated urban poor such as those living in slums may face ad- ditional health penalties that erase the urban health advantage. Scattered data for sub-Saharan Africa clearly indicate deteriorating conditions in a number of places. The panel recommends that governments focus attention on inter- and intraurban differences when designing health services for cities (recognizing that this will require better data and research), and adapt existing services and programs to ad- dress emerging health threats, including injuries, chronic diseases, mental health issues, and in some areas communicable threats such as HIV/AIDS. THE URBAN ECONOMY AND LABOR FORCE The urban economy generates many of the resources needed by governments to improve services in health, education, and other areas. The scale of the urban economy enables specialization to take place and allows for a broad range of pro- ductive activity to develop, leading, for example, to diverse urban private sectors in health services. Through urban labor markets, the economic returns to school- ing are established, and for urban parents these returns may profoundly influence decisions about investments in children's schooling and family size. Urban labor and product markets also determine individual and family incomes and establish incentives for migration. Rapid growth in the supply of urban labor might appear to threaten the eco- nomic returns to schooling. Yet analysis of several case studies shows that where macroeconomic growth has been moderate or strong, the urban returns to school- ing have generally been maintained, and in some cases returns to university school- ing have increased. Evidently, the accumulation of physical capital and techno- logical progress can sustain educational returns even in the face of rapid shifts in supply. But where macroeconomic growth has been weak, as it has in much of sub-Saharan Africa, rapid increases in the supply of better-educated urban labor have resulted in marked declines in the returns to schooling. Surprisingly little attention has been paid to individual income dynamics within urban areas. The few longitudinal studies available do not clearly reveal higher rates of upward or downward mobility in cities as compared with rural areas; ~ . . . . . . . . .

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EXECUTIVE SUMMARY 7 in both there is a great deal of flux. However, studies of migrants based on cross-sectional surveys that may overrepresent the more successful migrants- generally show that rural migrants undergo a period of adjustment to city life during which their earnings are low, but subsequently achieve earnings levels that rival and sometimes exceed those of urban natives. There has been much recent speculation about whether the globalization of economic relationships heightens urban inequalities. Case studies of Brazil, Taiwan, and China provide some evidence of rising inequality in urban incomes in the 1990s. Although the sources of the trends are not clearly identifiable, such em- pirical findings are consistent with the view that urban labor markets are increas- ingly heterogeneous and volatile, in part because of their exposure to world mar- kets. An examination of the urban impact of international economic shocks and crises shows that city dwellers can be disproportionately affected the evidence from Indonesia is especially clear on this point. The spatial effects are not always focused on cities, however, and urban residents also realize considerable benefit from their exposure to world markets. Further research on cities and their urban- regional economies, as well as the linkages between globalization and inequality, would help illuminate changing urban economic relationships and patterns. THE CHALLENGE OF URBAN GOVERNANCE The central challenge for the governments of poor countries to improve the so- cial and economic conditions of their citizens while preserving the natural envi- ronment for future generations is becoming an urban challenge. The concept of urban governance has itself undergone a major transformation over the last decade and a half. Governance reforms have been affected by the movement toward de- mocratization and political pluralism, an emphasis on decentralization, the rise of civil society, and the spread of powerful local social and environmental move- ments. Numerous legal and institutional reforms in many countries have given shape to institutional reform at the local and municipal levels. Solutions to urban problems are increasingly being sought at the local level as central governments cede responsibilities in basic service delivery, giving lo- cal authorities more opportunity to take charge of services that affect the daily lives of their residents. New institutional forms of local governance are emerg- ing in municipalities across the developing world. These new forms often involve larger roles for nongovernmental organizations and community groups, greater transparency and accountability, and the devolution of more legal and financial responsibility for urban affairs to the local, rather than the state or national level. Although no consensus has emerged on the direction in which urban gover- nance will develop, there is general agreement that as cities grow, some new form of governance response will be required. The panel identified five dimensions of the urban governance challenge facing all large urban areas: (1) capacity- the ability of local governments to provide adequate public services to their

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8 CITIES TRANSFORMED citizens; (2) financial the ability of local governments to raise and manage suffi- cient revenue; (3) diversity the ability of government to cope with the extraordi- nary internal variation within cities and to address the attendant issues of fragmen- tation and inequality; (4) security the ability of government to deal with issues related to rising urban violence and crime; and (5) authority which is related to the increasing complexity of managing the jurisdictional mosaic as large cities grow and spread out. LOOKING AHEAD: NEW TECHNOLOGY, DATA, AND RESEARCH If demographic research is to make a contribution, attention must be paid to the international infrastructure of research, as represented in the major international datasets. There is still considerable unexploited potential for urban research in existing databases and data collection mechanisms. At present, however, these data are often inaccessible or coded in such a way as to hinder cross-linkages to other datasets. At the national and local levels, effective planning and governance require reliable and up-to-date information, which is a basic requirement for effective urban governance. Remotely sensed and geocoded data hold some promise for measuring the spatial extent of cities and certain aspects of urban change, but these are costly and difficult technologies. Many cities lack adequate intracity data, especially at the level of neighborhoods. There is a need to shift the focus of research from producing national datasets on social and economic differentiation to producing local datasets that are capable of reflecting local realities (including poverty lines adjusted to reflect local circumstances) and that can support local policy, planning, and investment decisions. By 2030, more than 80 percent of the population of North America, Europe, Oceania, and Latin America and more than 50 percent of the population of Asia and Africa will be living in urban areas. In the long run, no doubt, this will be good news for global development. Over the next 30 years, however, the challenge will be to take full advantage of the potential benefits of urbanization in an inclu- sive way while reducing the risks of negative outcomes. Meeting this challenge will inevitably require better data and a deeper understanding of the changing demography of place not just between rural and urban areas, but also across the urban spectrum and within large urban agglomerations. To date, these issues have been given inadequate attention. Until demographers develop an understanding of all facets of the urbanization process, their work will continue to be of marginal relevance to those charged with the design of better urban policies.