Intended for healthcare professionals

Education And Debate

Will most people live in cities?

BMJ 2000; 321 doi: (Published 04 November 2000) Cite this as: BMJ 2000;321:1143
  1. David Satterthwaite, editor, Environment and Urbanization (
  1. International Institute for Environment and Development (IIED), London WC1H 0DD

    Based on a presentation from the Millennium Festival of Medicine

    Rapidly growing cities in Africa, Asia, and Latin America are often seen as presenting among the world's most intractable problems in terms of improving health. This is especially so their for low income citizens, whose tenements and squatter settlements are among the world's most life threatening living and working environments. Rapid urbanisation may even be considered to be “a problem.” But rapid urbanisation is usually associated with economic success. Furthermore, an increasing concentration of people in urban areas lowers unit costs for many forms of infrastructure and services that improve health. I have summarised key trends in urban change and some of the opportunities provided for improving health within an urbanising population. I have also highlighted how it is the quality of governance at city and municipal level that determines whether these opportunities are realised.1

    Summary points

    Most of the 300 cities with populations over 1 million are in Africa, Asia, and Latin America, and many have populations that have grown more than tenfold since 1950, but most urban dwellers live in cities with populations under 50 000

    The largest cities are concentrated in the largest economies, and many smaller cities have been able to attract an important proportion of new investment

    The concentration of people in cities provides opportunities for improving health and environmental quality; the resulting economies of proximity greatly reduce unit costs

    The absence of effective and representative government exacerbates urban environmental health problems

    An urbanising world

    More than two thirds of the world's urban population is now in Africa, Asia, and Latin America. Since 1950, the urban population of these regions has grown more than fivefold. Rapid urban growth has also brought a huge increase in the number of large cities, including many that have reached sizes that are historically …

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