Rapid urban growth has several hazardous consequences on population health especially for low-income countries like Ethiopia, writes Sosena Kebede.
Addis Ababa is home to an estimated 3.6 million inhabitants (World Population Review 2007) and is the seat for some major international organizations including the African Union and the United Nations Economic Commission for Africa (UNECA). Over the past few decades the city has seen urbanization and population boom at an alarming rate. Urbanization is a global phenomenon with Asia and Africa leading the pack. Although still mostly rural, the World Bank estimated Ethiopia’s urban population growth rate at 4.7 percent in 2017, which places it among the highest in Africa and the world. More than a quarter of the urbanization in Ethiopia is concentrated in the capital city Addis Ababa.
Rapid urban growth has several hazardous consequences on population health especially for low-income countries like Ethiopia. These include shortage of water and sanitation, poorly constructed infrastructures, homelessness, crowding, pollution, food insecurity and cultural changes that promote the consumption of processed foods, sedentary lifestyles and social isolation all of which have deleterious effects on physical and mental health. Epidemiological researches indicate that the rise in chronic diseases in low-income countries such as diabetes, heart disease, lung problems, mental illness, substance use disorder and cancer in addition to infectious diseases is one of the unintended consequences of urbanization.
Let us look at the shortage of water and proper sanitation in Ethiopia in a little more detail. According to the World Health Organization (WHO), despite steady improvement over the years, only 33 percent of the country has access to safe water (including healthcare facilities) and up to 28 percent of the population still practices open defecation. The leading cause of death for Ethiopian children under the age of five is diarrhea. Although the exact number is not reported, it is estimated that thousands of patients admitted to Ethiopian hospitals develop hospital-associated infections and die from it yearly. Both of these are mainly due to the water, sanitation and hygienic practice challenges of the country.
Pit latrines and septic tanks are typically used for human waste disposal in Ethiopia and surface water contamination from overflow is common putting peoples’ health at risk. Individuals and industries use rivers to dump their wastes and toxic pollutants rendering the water unsafe for human use, poisoning the fish, and other animals and plants that are near it. These toxic pollutants also infiltrate the ground water and they contaminate soil for agriculture far away from their source. Urban waste that doesn’t end up in waters is seen piled up on illegal dump sites or on streets, creating perfect petri dishes for microbial festering. Some people resort to burning solid waste to avoid open dumping which contributes to air pollution which in turn compounds the pollution problem of the city from vehicle exhaust, construction dust, and factory chimney outputs.
There are several government and international works being done to improve access to safe water, and sanitation in Ethiopia and improvement has been recorded over the years but we still have a long way to go. Additional interventions worth considering include increasing public awareness of the gravity of the problem using multi-media, organizing volunteers for regular neighborhood cleanup, empowering the community to adopt hygienic practices as a culture, placing formally trained professionals in water, sanitation and hygiene at public facilities to train others and oversee progress, making hand sanitizers ubiquitous in health facilities and their use mandatory, providing micro-credits available to individuals and small groups to install sanitation facilities, advocating for strict regulation of water and sanitation standards and waste dumping practices of industries, and constructions with penalties for infractions.
A local public-private partnership (PPP) would be well suited to spearhead such a campaign. For instance, religious institutions have powerful human capacity and credibility to inspire their regular congregants to practice their faith in action. Regardless of how it is organized, such an entity would also have tremendous power to push for needed government investment in this sector, advocate for policy reforms, assist government implementation efforts, hold individuals and industries accountable and empower communities and neighborhoods to take back their health.
Ed.’s Note: Sosena Kebede MD, MPH is a physician and a public health practitioner who resides in Maryland, US. The views expressed in this article do not necessarily reflect the views of The Reporter. She can be reached at [email protected]