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February 25, 2013

Urban decay

Top Story

February 25, 2013

For the last two decades, the rural population of Pakistan has been steadily migrating to the cities. Modern farming methods and larger fields translate into fewer jobs and a move to the urban areas. The cities have tended to grow laterally rather than vertically and in a country with a failing power sector the last thing that will be invested in is high-rise cheap urban housing – nobody wants to be stranded without elevators in a 20-story block of flats. While the cities have spread outwards very quickly, utilities and services have rarely expanded to meet the growing population that is spread over an ever-increasing city-footprint. There has been little, if any, planning for this kind of mass urbanisation. Karachi, in particular, is suffering as a result, although other large cities will surely experience the same in the near future. Around 45 percent of the population of Karachi is living in unplanned slums, which are virtually devoid of civic amenities like education and health-care services. The Aga Khan University recently held a conference on public health and health systems. Over 100 papers were presented and none of them contained good news. Of particular concern was Pakistan’s public health sector.
Fixing the system requires an integrated and holistic approach taking in a range of disciplines and crossing boundaries that tend to be impermeable in our ramshackle policy structures. Most public health care is directed towards the curative rather than the preventative. Thus sanitation comes low on the list of priorities – but large numbers of people are chronically sick and seeking treatment at curative facilities because they suffer water-borne infections caused by insanitary living conditions. A cycle of ill health is thus established. There is a lack of research that would properly inform policymakers who currently tend to ignore systems research, relying instead on biomedical and biotechnical domains. People need to be more aware of their

responsibility for their own health, but where are the health education programmes? Decanting rural populations into urban environments is bad for everybody. By the year 2020 the number of people living in slums in Karachi is expected to rise to 55 or 60 percent. The children of Pakistan are already stunted in their growth – 18 percent overall and 25 percent in Sindh. Malnutrition and food insecurity are now endemic in all urban areas; and there is a possibility that an entire generation will suffer cognitive impairment as a result of poor nutrition and unhealthy lifestyles. This is not a rumour or idle gossip, this is happening now. Our urban planners and policymakers need to wake up before systems decay any further.

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