Is the migration of the masses to cities a good or bad thing for global public health? Arriving at one answer isn’t so simple, says Rebecca Martin, director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention in Atlanta.
The clustering of populations, often in areas without city services or access to adequate water and sanitation, can aid in the spread of disease. On the other hand, density brings opportunities for better education and easier intervention.
“You can reach many people at once, and we have to take advantage of that opportunity for prevention as well,” Dr. Martin said at the World Affairs Council of Atlanta’s annual global health summit this week, which explored the intersection of cities, technology and health.
One problem is that even as the world’s urban population is slated to grow from 55 percent to 70 percent by 2050, it is becoming clear that not all migration is created equal.
Millions are are now moving into informal settlements on the outskirts of major urban hubs, places they hope will be temporary bases from which to achieve their big-city dreams. They go by many names — slums, favelas, peri-urban areas — depending on the location.
“They’re not temporary, they’re becoming permanent, and their informality means that they may not be legal in terms of city jurisdictions and boundaries, such that access to services … is something that they need dearly,” Dr. Martin said.
That means cities and health ministries have to act in concert, sharing information and engaging civil society, companies and academia to stay ahead of outbreaks and respond quickly when the do occur.
“It’s not one group that can address how to stop infectious disease and how we can predict what will be coming to urban areas in certain settings,” she said.
They will have to deploy new technologies — from mobile devices, and messaging apps to artificial intelligence — to track risks, increase surveillance and communicate with the public.
Dr. Martin cited a few examples: using algorithms to track the movements of mosquitoes to predict (and potentially reduce) incidence of malaria, employing mobile health to track dengue in the Philippines and using WhatsApp to spread prevention information on Ebola in the Democratic Republic of the Congo.
That said, she believes technology is a tool rather than a panacea, noting that the sharing of information is just as important as the data itself.
Megacities may get the attention — 43 cities of 10 million-plus are expected to exist in the next three decades — but migration is also posing a health risk to cities with fewer than 1 million people, mostly in low and middle income countries in Africa and Asia.
And with people increasingly crossing porous borders seeking economic opportunity or fleeing from instability, it becomes all the more vital for national and urban governments to work together putting in place early warning systems and emergency plans. She contrasted responses to MERS outbreaks in South Korea and Thailand, with the latter containing it much more quickly, saving lives in the process.
“It really is the political commitment of the government to take the opportunity to strengthen their health systems and see health security as national security and be able to respond rapidly,” Dr. Martin said during a keynote address and conversation with council President Charles Shapiro.
The current Ebola outbreak in the eastern Democratic Republic of the Congo shows the potential perils of mobility. People are spreading the disease by moving between rural areas and large urban agglomerations to visit family and conduct business, sometimes crossing national borders. (The country’s president was recently in Atlanta, where he held meetings at the CDC and the Carter Center.)
The same pattern aided the spread of Ebola during the 2014 outbreak in West Africa, which had never seen Ebola in cities until it began to spread on their periphery. More than 13,000 people died from 2013-16 across Guinea, Liberia and Sierra Leone.
In the DRC now, more than 3,200 cases have been detected, with more than 2,200 people having died so far. Some 263,000 people, many of them health workers, have been provided an unlicensed Ebola vaccine manufactured by Merck and distributed under an emergency trial program approved by the government, Dr. Martin said.
She added that the developing world is not alone in facing these challenges. Some diseases like measles are making a comeback, partially caused by the anti-vaccination movement that rich Western countries are “exporting” abroad.
“Every country has some form where it has taken hold,” she said of the anti-vaxxer movement.
The Atlanta Global Health Summit was held for the eighth straight year in conjunction with the Center for Strategic and International Studies. The 2019 event at the Intercontinental Buckhead focused on urban health, with panel discussions on HIV/AIDS in Atlanta and other urban centers, inequality and non-communicable diseases and employing digital technology and artificial intelligence in urban settings.