Editorial: The full spectrum of risk in urban centres: changing perceptions, changing priorities

In many urban centres in the global South, there is little or no information on either the scale or the causes of premature death, serious injury, illness or impoverishment. In sub-Saharan Africa, this is the case for most urban centres. Even where there may be some information, it is seldom available for every district in the city. We get some sense of the scale of these issues from household surveys (such as the Demographic and Health Surveys), which show very high infant, child and maternal mortality rates “for urban areas” in many African and Asian nations.(1) But for practical action this kind of information is needed for every ward or district – on what the problems are, where they are and who is most impacted. Civil servants, politicians and civil society groups working at neighbourhood, ward, district and city levels may have some sense, based on their experience, of what the concerns are within their jurisdictions. But without data to present to higher-ups, it can be difficult to get proper action in response. The availability of data is worst of all for informal settlements – despite the fact that they often house more than half of a city’s population. In Nairobi, the African Population and Health Research Center (APHRC) has shown that aggregate figures for infant and under-5 mortality rates for the city hide the much higher rates in informal settlements.(2) But this kind of information is needed everywhere, and there is in general scant documentation of the serious risks faced by the billion or so urban dwellers who live in informal settlements.