WHO Kobe

1 This chapter reviews trends and projectionsrelated to the rapid increase of people living incities around the world, as well as some of theconsequences of this ONE. THE DAWN OF AN URBAN WORLDHIDDEN CITIES: UNMASKING AND OVERCOMING HEALTH INEQUITIES IN URBAN SETTINGS3 William 1 THE RISE OF MODERN CITIESD emographics of urbanization and trends For the first time in history, the majority of theworld s population is living in urban areas, andthis proportion continues to grow. It was only afew years ago that the world s urban populationstarted to outnumber its rural population. Onehundred years ago, only 2 in 10 people in theworld were living in urban areas. By 2030, 6 out of every 10 people will be city dwellers, rising to 7 out of every 10 people by 2050. According topopulation growth projections, virtually all globalgrowth over the next 30 years will be in urbanareas.

2 The number of urban residents is growing by nearly 60 million every humans change, so do their living and workingenvironments. In contrast to agrarian rural settings,cities are characterized by their mass production,service industries and marketplaces. Their scale,density and diversity of social, cultural and ethnicgroups also set them apart from rural contexts. It is not only the visible aspects of living andworking environments that change, but also theirintangible qualities, such as their intellectualassets, creativity, vibrancy and shared urbanites have more choice and opportu-nity than their ancestors ever had EXPLAINEDU rbanization refers to the overall increase in theproportion of the population living in urban areas,as well as the process by which large numbers ofpeople have become permanently concentrated in relatively small areas, forming definitions of urban differ from onecountry to another, in all regions urbanization hasbeen characterized by demographic shifts fromrural areas to cities; growth of urban populations;and overall shifts in the economy from farmingtowards industry, technology and service.

3 GLOBAL TRENDS AND PROJECTIONSU rbanization became more rapid as globalizationspread industry and technology to all corners ofthe world. For example, whereas London tookroughly 130 years to grow from 1 to 8 millionpeople, Bangkok took 45 years, and Seoul tookonly 25 , urban growth was at itspeak during the 1950s, with a populationexpansion of more than 3% per the middle of the 21st century, the urban population will almost double, increasing fromroughly billion in 2009 to billion in contrast, rural populations will decline aroundthe world during this same time these dramatic increases in the total numberof city dwellers, the overall pace of urbanization is not accelerating. On a global scale, the urbanpopulation is expected to grow roughly peryear between 2025 and the world becomes more urban, people willcontinue to live in cities of all sizes, with apattern of city size distribution similar to thatwhich is evident , around half of all urban dwellers live in cities with between100 000 and 500 000 people, whereas fewer than10% of urban dwellers live in mega-cities (definedby UN-HABITAT as a city with a population of morethan 10 million).

4 1In many places, however, citieswill merge together to create urban settlements on a scale never seen before. These new configura-tions will take the form of mega-regions, urbancorridors and city-regions, creating a new urbanhierarchy and , mega-regions are amassing larger populations than mega-cities. Mega-regions arenatural economic units that result from thegrowth, convergence and spatial spread ofgeographically linked metropolitan areas and other are growing consider-ably faster than the overall population of thecountries in which they are popula-tion of China s Hong Kong-Shenzhen-Guangzhoumega-region, for example, comprises approximatelyCHAPTER 1. THE RISE OF MODERN CITIESHIDDEN CITIES: UNMASKING AND OVERCOMING HEALTH INEQUITIES IN URBAN SETTINGS4120 million people, and it is estimated thatJapan s Tokyo-Nagoya-Osaka-Kyoto-Kobe mega-regionwill have a population of 60 million by ,9In urban corridors, city centres of different sizesare connecting along transport routes.

5 In Africa,the Greater Ibadan-Lagos-Accra urban corridor,spanning roughly 600 kilometres across fourcountries, is the engine of the regional economy in West corridor developing betweenMumbai and Delhi in India will stretch about 1500 kilometres from Jawaharlal Nehru Port inNavi Mumbai to Dadri and Tughlakabad in ,11 Urban corridors are changing the functionality oflarge and small cities, and even towns, increasingthe growth of trade, real estate development andland value along their ribbon-like development areas. At still another level, city-regions are developingas the result of large cities extending beyond their administrative boundaries to engulf smallercities and towns, absorbing semi-urban and ruralsurrounding areas, and in some cases merging withother intermediate cities. Many city-regions havegrown enormously over the last 20 to 30 extended Bangkok Region in Thailand, forexample, is expected to expand another 200 kilo-metres from its current centre by 2020, growing farbeyond its current population of more than 17million.

6 In Brazil, Metropolitan S o Paulo alreadycovers 8000 square kilometres, with a populationof extent of South Africa s CapeTown city-region, when including the distancesfrom which commuters travel to and from the cityevery day, reaches up to 100 , or urban sprawl, is also becomingprevalent around the world. Its hallmark character-istics include a population that is widely dispersedin low-density development; separated residentialand commercial areas; a network of roads markedby long blocks and poor access; and a lack of well-defined, thriving activity centres, such asdowntown areas. Other features usually associatedwith sprawl include overdependence on motorizedtransport coupled with a lack of transport alterna-tives, and pedestrian-unfriendly spaces. In mostcases, sprawl leads to increased public infrastruc-ture costs.

7 Sprawling metropolitan areas consumemuch more energy than compact cities and requirea greater output of materials such as metal,concrete and asphalt because homes, offices andutilities are farther GROWTH IS NOT UNIFORMU rbanization trends vary across different parts ofthe world. Some cities and regions are experi-encing rapid growth, whereas other cities andregions are in population decline. Currently, Africaand Asia are the least urbanized regions, with 40%and 42% of their populations, respectively, livingin urban areas. Yet by 2050, their urban popula-tions will increase to 62% in Africa and 65% , in Europe more than half of allcities are expected to experience populationdeclines over the next 20 all urban population growth in the next 30years will occur in cities of developing 1995 and 2005, the urban population ofdeveloping countries grew by an average of people per week, or around 165 000 peopleevery the middle of the 21st century, it is estimated that the urban population of thesecountries will more than double, increasing billion in 2009 to almost billion in , on average the rate of urban popula-tion growth is slowing in developing countries,from an annual rate of roughly 4% from 1950 to1975, to a projected per year from 2025 to contrast.

8 The total urban population in thedeveloped world is expected to remain largelyunchanged over the next two decades, increasingfrom 920 million people in 2009 to slightly morethan 1 billion by both legal and illegal will account for more than twothirds of urban growth in high-income immigration, the urban population inthese countries would probably decline or remainthe same in the coming decades. Urban growth in developing countries is far fromuniform, and this dissimilarity will only increase inthe future. While high growth rates are expected inCHAPTER 1. THE RISE OF MODERN CITIESHIDDEN CITIES: UNMASKING AND OVERCOMING HEALTH INEQUITIES IN URBAN SETTINGS5around half of urban areas in the next 20 years,another 16% will experience slow growth rates,and 11% will see their populations regress and,very likely, their economies as such as Phnom Penh, Cambodia; Tijuana,Mexico; Marrakesh, Morocco; and Lagos, Nigeria,are expected to continue to grow at annual rates ofaround 4%, effectively doubling their populationswithin the next 17 years.

9 Some cities in China,such as Shenzhen and Xiamen, will experienceannual growth rates of more than 10%, doublingtheir populations roughly every seven , other cities in developing countries are expected to experience population include La Paz, Plurinational State ofBolivia; Belo Horizonte, Brazil; Dengzhou, China;Madurai, India; Bandung; Indonesia; San LuisPotosi, Mexico; Rabat, Morocco; and Manila,Philippines. In these cities, departing residentswill leave behind unoccupied houses, vacantcommercial sites, idle infrastructure and neigh-bourhoods in physical ,17 City and regional planning will require newmethods and techniques that respond to urbandevelopment, expansion and growth management,but also to population decline or planning for growth needs to be combinedwith smart planning for contraction for moresustainable and balanced urban and regionaldevelopment.

10 The benefits of urbanizationFor both rich and poor, in developed and developingcountries, cities offer unique opportunities forresidents to increase income, to mobilize forpolitical action, and to benefit from education aswell as health and social services. The density ofurban settings lends itself to more efficient andenvironmentally sensitive housing, transportsystems and other physical infrastructure. Urbanization is also linked to economic develop-ment. Most urbanized countries have higherincomes, more stable economies and strongerinstitutions, and are better equipped to withstandthe shocks and volatility of the global , most countries with a high per capitaincome are among the most urbanized, whereasmost countries with a low per capita income areamong the least urbanized. In both developed anddeveloping countries, cities generate significantportions of gross domestic product and nationalwealth, and create development opportunities,jobs and investment.