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date: 27 June 2022

Urbanization in the Global Southfree

Urbanization in the Global Southfree

  • Warren SmitWarren SmitResearch Manager, African Centre for Cities

Summary

The term “global South” (or just “South” or “south”) refers to the diverse range of countries in Asia, Africa, and Latin America that have a colonial past and are usually characterized by high levels of poverty and informality. The term global South has widely replaced other, similar, terms such as the Third World, developing countries, and low- and middle-income countries. Urbanization, in its narrow sense, refers to an increase in the proportion of the population living in urban areas; in its wider sense it refers to all the social, economic, biophysical, and institutional changes that result from and accompany urban growth, many of which have a profound impact on human health and well-being. The global South is the most rapidly urbanizing part of the world. Since about 2015, more than 75% of the world’s urban population lives in the global South. It is projected that by 2025, the urban population of the global South will be 3.75 billion (54.3% of the total population of the global South). Most of this urbanization is as a result of urban areas having higher natural population growth rates than rural areas, but migration to urban areas also plays a significant role. Although urbanization processes vary considerably across different countries in the global South (e.g., between different regions and between middle-income and low-income countries), there are a number of broad common trends: a rapid increase in the number of megacities (urban agglomerations with a population of more than 10 million), ongoing strong urban–rural linkages and increased blurring of “urban” and “rural,” increased urban sprawl and fragmentation, and growing intra-urban inequalities. There has been much debate about the nature of cities and urban life in the global South, giving rise to a body of literature on “southern urbanism,” characterized by case studies of everyday life. Urbanization processes in the global South have contributed to the growth and complexity of the burden of disease. Infectious diseases have continued at high levels due to poor environmental conditions in many parts of cities, particularly in informal settlements and other types of slums. Noncommunicable diseases are also growing rapidly in the global South, linked to changes in living conditions and lifestyle associated with urbanization. It is anticipated that the burden of disease in cities of the global South will continue to increase as urbanization continues, as a result of increased traffic injuries and respiratory disease resulting from increased numbers of motor vehicles; growing levels of violence due to growing levels of poverty and inequality in many cities; growing obesity as a result of changed lifestyles associated with urbanization; growing numbers of unsafe settlements in hazardous areas; and a high risk of infectious diseases. Climate change is likely to exacerbate these risks.

Subjects

  • Environmental Health

Introduction

It is widely recognized that urban environments and urbanization processes impact on health in a variety of ways. Urbanization in the global South is occurring particularly rapidly. As of 2015, about 75% of the world’s urban population lived in the global South, and the global South accounted for 94% of the increase in the world’s urban population between 2010 and 2015. Of the world’s 33 megacities, 27 are in the global South. Urbanization is therefore increasingly a phenomenon associated with the global South, and this unprecedented urbanization process is linked to fundamental changes in the health and well-being of urban residents in the global South, particularly with rapid increases in noncommunicable diseases but also with a continuing high risk of infectious diseases.

This article provides an overview of urbanization in the global South. First, the terms “urbanization” and “the global South” (also often just called the “South” or “south”) are defined. In its narrow sense, urbanization means the increase in the proportion of people living in urban areas, and there are a number of factors driving this increase in the global South. In its broader sense, urbanization refers to the ongoing social, environmental, political, and biophysical changes associated with an increasing proportion of people living in urban areas, all of which can fundamentally impact on health and well-being. Second, a brief overview is given of urbanization in the global South, which is the most rapidly urbanizing part of the world. Third, some key perspectives on urbanization in the global South and the changing nature of urban life in the global South are discussed. Although the global South is very heterogenous and it is impossible to generalize about it, a number of key trends can be seen. Finally, some of the ways that urbanization in the global South impacts on the health and well-being of urban residents are briefly discussed.

Urbanization in the Global South: Definitions

Before discussing urbanization in the global South, it is necessary to discuss the two concepts of the global South (or just the south, as some prefer) and urbanization. Both concepts are contested and can be defined in various ways.

The Global South

The term global South (or just South or south) is essentially a replacement for the older, out-of-date term, “Third World,” and has become a synonym for the term “developing countries.” The term Third World was coined in a 1952 article by Alfred Sauvy to refer to nonaligned countries in the emerging Cold War (Sauvy, 1952) to distinguish them from the capitalist West (the First World) and the communist East (the Second World). These nonaligned countries were in Africa, Asia, and Latin America, were generally poorer countries (compared to Europe, the United States, Canada, Australia, New Zealand, and Japan), and generally had a colonial history (in the case of Latin America, most countries had gained independence from colonial powers in the early 19th century, but in the case of Africa, the main period of decolonization was from the 1950s to the mid-1970s). The concept of the Third World was also linked to dependency theory, with Third World countries seen as the “periphery” dominated by the economic “core” (e.g., Frank, 1966).

From the 1990s, with the end of the Cold War, the term South/south (or global South) began to replace the term Third World (Comaroff & Comaroff, 2011; Tomlinson, 2003).The origins of the term lie with the Brandt Commission’s report on the “North–South divide” in 1980 (Independent Commission on International Development Issues, 1980). The international commission, chaired by Willy Brandt, highlighted that there was a large divide in the standard of living between the “developed” countries in the North and the “developing” countries in the South, and there should therefore be a large transfer of resources from developed to developing countries. The map illustrating this divide has a line, subsequently called the “Brandt line,” separating North and South. The Brandt Line included the United States, Canada, Europe, the USSR, and Japan in the North (and also looped down to include Australia and New Zealand in the “North”). Over time, this division has changed slightly, and since the 1990s, most definitions of the North exclude the former Soviet Republics in Central Asia and the Caucasus (in Western Asia). For example, the United Nations definition of developed countries are those in “all regions of Europe plus Northern America, Australia/New Zealand and Japan,” while developing countries are defined as those in “all regions of Africa, Asia (excluding Japan), and Latin America and the Caribbean as well as Melanesia, Micronesia and Polynesia” (UNDESA, 2019, p. viii). Some other definitions of the North also include other countries and territories (e.g., Wikimedia includes Israel, South Korea, Taiwan, Hong Kong, Macau, and Singapore in its definition of the North) (Wikimedia, 2020).

The South increasingly began to be called the global South to distinguish it from other geographical regions commonly called the South, such as the southern United States. Some scholars have gone beyond seeing the South as a geographical concept, seeing it rather as a relational concept (“the south”) that involves poverty and inequality, by which reading the poor and marginalized parts of global cities like London are southern. In the view of these scholars, the south can be “defined in transnational social terms” (Hurrell, 2013, p. 206) or as “a set of practices, attitudes, and relations” (Grovogui, 2011, p. 177). Some scholars prefer the term “south-east” or “global South-East” (e.g., Watson, 2013; Yiftachel, 2006) to emphasize that the notion of the south is opposed not only to the North but also to the West and its various connotations of liberal democracy and free market capitalism.

The concept of the global South (and its variations) has been much criticized. First, the term is geographically dubious—although most of the North is, in fact, in the northern part of the northern hemisphere, Australia and New Zealand are firmly in the southern hemisphere. There are also territories that are geographically in the global South but that are also part of countries in the North, such as Réunion in the Indian Ocean and Guadaloupe and Martinique in the Caribbean, which are integral parts of France. Second, some countries in the South have experienced rapid economic growth over the past few decades and are now classified as high-income countries (e.g., the United Arab Emirates and Singapore; see table 1 for other high-income countries in the global South). Conversely, some Eastern European countries are now classified as middle-income countries (i.e., Albania, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Moldova, Montenegro, North Macedonia, Romania, Russia, Serbia, and Ukraine) (UNDESA, 2019). In practice, the global South is often used as a synonym for low- and middle-income countries (and other euphemisms like developing countries and less developed countries), but this is becoming increasingly inaccurate. New terms are constantly being coined, such as the “majority world” as a synonym for the global South (Silver, 2015), but these terms have not yet been widely adopted, and global South is still widely used (and is less problematic than developing world or developing countries).

Table 1. The Global South by Geographical Region and Income Level

Income Level of Countries

Africa

Asia and Oceania (Excluding Japan, Australia, and New Zealand)

Latin America and Caribbean

High-income countries

Seychelles

Bahrain, Brunei Darussalam, Israel, Kuwait, Oman, Palau, Qatar, Saudi Arabia, Singapore, South Korea, Taiwan, United Arab Emirates

Antigua and Barbuda, Bahamas, Barbados, Chile, Saint Kitts and Nevis, Trinidad and Tobago, Uruguay

Upper middle-income countries

Algeria, Botswana, Equatorial Guinea, Gabon, Libya, Mauritius, Namibia, South Africa

Azerbaijan, China, Fiji, Iran, Iraq, Kazakhstan, Lebanon, Malaysia, Maldives, Marshall Islands, Nauru, Samoa, Thailand, Tonga, Turkey, Turkmenistan, Tuvalu

Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Grenada, Guyana, Jamaica, Mexico, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Venezuela

Lower middle-income countries

Angola, Cabo Verde, Cameroon, congo, Côte d’Ivoire, Djibouti, Egypt, Eswatini (Swaziland), Ghana, Lesotho, Mauritania, Morocco, Nigeria, Sao Tome and Principe, Sudan, Tunisia, Zambia

Armenia, Bangladesh, Bhutan, Cambodia, Georgia, India, Indonesia, Jordan, Kiribati, Kyrgyzstan, Laos, Micronesia, Mongolia, Myanmar, Palestine, Papua New Guinea, Philippines, Solomon Islands, Sri Lanka, Syria, Tajikistan, Timor-Leste, Uzbekistan, Vanuatu, Vietnam, Yemen

Bolivia, El Salvador, Guatemala, Honduras, Nicaragua

Low-income countries

Benin, Burkina Faso, Burundi, Central African Republic, Chad, Comoros, Democratic Republic of the Congo, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Rwanda, Senegal, Sierra Leone, Somalia, South Sudan, Tanzania, Uganda, Zimbabwe

Afghanistan, Nepal, North Korea

Haiti

Note: Adapted from UNDESA (2019).

In this article, the term global South and a largely geographical conception is preferred to terms such as the south or south-east and a more relational view of these concepts. In economic terms, there is still a clear global imbalance, as the global North, with one quarter of the world’s population, accounts for four fifths of the world’s income, whereas the global South, with three quarters of the world’s population, accounts for only one fifth of the world’s income (Mimiko, 2012). There are rich and poor people in both the North and the South, and there are richer and poorer countries in both (and the line between the two is increasingly blurred and fuzzy), but as Pieterse and Simone (2017) argue, the South is where the majority are poor and marginalized.

This usage of global South and global North does not imply that there is a simplistic duality involved: There are vast differences within each category and many similarities and links between North and South, but it is useful to have a term for countries that generally have higher levels of poverty and informality and weaker governments than is usually the case in the global North. As Schindler (2017) notes, even though there is no consensus with regard to its boundaries and there are places that defy classification as North or South, there are important underlying differences between North America, Europe, and Northeast Asia, on the one hand, and the regions beyond, on the other. As Miraftab and Kudva (2015, p. 4) note, the global South “offers a useful frame of reference to acknowledge the colonial past and a more recent shared development history.” Similarly, in the words of Mabin (2014, p. 23), cities in the global South are “marked both by a political economy of insufficient resources to provide on average a decent life for all; and by (post) colonial disabilities.” In addition, the concept of the global South has also become an important political project to resist neoliberal globalization (Ballestrin, 2020).

Urbanization

Urbanization, in its narrow sense, refers to an increase in the proportion of the population living in urban areas (e.g., Potts, 2009, 2012). The gradual increase in the proportion of people living in urban areas has been a feature of human history ever since the establishment of the first cities. However, defining what is and is not “urban” is not straightforward. Some countries, sometimes quite arbitrarily, define their urban population as those people living within certain administrative boundaries. Many definitions of urban include criteria such as settlement population size and density (Brockerhoff, 2000). Some other definitions focus on the functional characteristics of urban areas (e.g., the prevalence of nonagricultural economic activity [Brockerhoff, 2000]). Some scholars have developed complex, multicriteria scales for measuring how urban particular settlements are (Cyril et al., 2013; Jones-Smith & Popkin, 2010). Global compilations of data, such as the World Urbanization Prospects (UNDESA, 2019), use national definitions of urban, with all their inconsistences. In Angola, Argentina, and Ethiopia, for example, all settlements with 2,000 inhabitants or more are considered urban, while in Benin only localities with 10,000 inhabitants or more are classified as urban (Cohen, 2006). Some urban administrative boundaries include a large proportion of areas that are functionally rural, and vice versa. Urban population figures therefore need to be treated with caution.

The statistical dichotomy of urban and rural has been much critiqued. Brenner and Schmid (2014, p. 731), for example, regard the notion that the world has entered an urban age as “empirically untenable (a statistical artifact) and theoretically incoherent (a chaotic conception).” However, as they note, by far the dominant view is that, although cities and rural areas are interlinked and have blurred boundaries and the data sets on urban–rural populations are questionable, urban and rural are different, and the fact that an increasing proportion of people live in cities makes a difference.

There have been various attempts at coming up with more consistent ways to define the geographical limits of cities, such as “urban agglomerations,” based on the contiguous built-up area, or “metropolitan areas” or “functional urban areas,” based on the degree of economic and social interconnectedness of surrounding areas, as reflected, for instance, by commuting patterns (UNDESA, 2018). However, there is usually a blurred line between urban and rural—the concept of “peri-urban” emerged out of this recognition of the blurred boundaries between urban and rural (Iaquinta & Drescher, 2000).

Urbanization in the broader sense is much broader than just an increase in the proportion of the population living in urban areas, referring also to “the change in size, density, and heterogeneity of cities. Factors such as population mobility, segregation, and industrialization frequently accompany urbanization” (Vlahov & Galea, 2002, p. S4). The implications of urbanization include the following:

changes in lifestyles (changing diets, less physical activity, consumerism)

changes in governance (such as the rise of city-based social movements and opposition political parties)

changes in the burden of disease (toward a triple burden of infectious diseases, noncommunicable diseases, and injuries)

changes in resource usage and changes in land use cover (such as decreases in agricultural land and expansion of the built environment, with consequent negative impacts on ecosystems and the risk profile of urban residents)

Urbanization in the Global South

However one defines urban, it is clear that the proportion of people living in urban areas is increasing. The United Nations estimates that the proportion of the world’s population living in urban areas increased from about 20% in 1910 to 51.7% in 2010, and it is projected to increase to 68.4% by 2050 (UNDESA, 2019; UN-Habitat, 2013). The global South accounts for most of this, as it is urbanizing much more rapidly than the global North, and most new urban population growth is taking place in the global South. The urban population of the global South was estimated to be 3.002 billion people in 2015, which was 75.4% of the total global urban population of 3.981 million (UNDESA, 2019). The global urban population is expected to increase by about 793 million people from 2015 to 2025—about 745 million of this increase (93.9% of the total increase) will be in the global South (see table 2; UNDESA, 2019).

Table 2. Estimates and Projections of Urban Population in the Global South

Year

Urban Population in the Global South

Urban Population as a Percentage of the Total Population of the South

1995

1.72 billion

37.5

2005

2.30 billion

43.1

2015

3.00 billion

49.0

2025 (projected)

3.75 billion

54.3

Note: Adapted from UNDESA (2020).

It is, however, important to note that levels of urbanization and urban population growth rates can vary considerably from place to place. For example, in terms of geographic regions, Africa currently has the lowest levels of urbanization but has the highest urban population growth rate, whereas Latin America and the Caribbean are currently the most urbanized regions of the global South and have the lowest rate of urban population growth in the global South (see table 3).

Table 3. Urbanization Trends in the Global South by Region

Region

Proportion of People Living in Urban Areas (2015)

Annual Urban Population Growth Rate (2005–2015)

Africa

41.2%

3.70%

Asia

48.0%

2.43%

Latin America and Caribbean

79.9%

1.47%

Note: Adapted from UNDESA (2020).

Much of the regional differences in levels of urbanization and urban population growth can be explained by the income levels of countries. In general, higher-income countries have higher levels of urbanization and lower urban population growth rates, whereas lower-income countries generally have lower levels of urbanization and higher urban population growth rates. Table 4 shows the average urbanization levels and urban growth rates for countries of different income levels (as discussed in the section “The Global South,” low- and middle-income countries and the global South are not exactly the same, but there is a large overlap, and the table shows the broad trend for each income level). Within regions, the same trends are also apparent. For example, in Africa, Eastern Africa is the lowest urbanized subregion in Africa (25.6% urbanized in 2015) with the highest rate of urban growth in the region (4.39% per annum for 2005-2015), while Southern Africa is the most urbanized subregion in Africa (61.6% urbanized in 2015) with the lowest urban population rate of growth in the region (1.93% per annum for 2005–2015; UN-Habitat, 2016).

Table 4. Urbanization Trends in the Global South by National Income Level

Category of Countries

Proportion of People Living in Urban Areas (2015)

Annual Urban Population Growth Rate (2005–2015)

Low-income countries

30.9%

4.08%

Lower middle-income countries

39.2%

2.60%

Upper middle-income countries

64.1%

2.19%

Note: Adapted from UNDESA (2020).

The Drivers of Urbanization in the Global South

The immediate (or proximal) causes of urbanization typically are a combination of the natural population increase of urban populations, migration to urban areas, and the reclassification of rural areas as urban as cities grow and absorb what were previously rural areas (UN-Habitat, 2013). In the global South, the increase of the urban population is typically made up as follows (UN-Habitat, 2013):

60% from natural population increase, as a result of low urban mortality rates and youthful and fertile urban age profiles

20% from migration from rural areas to urban areas

20% from the reclassification of rural areas as urban, as urban areas grow and rural areas gradually transform into urban areas

Despite popular discourse about urbanization mainly being driven by migration from rural areas, the mortality and fertility rates of urban residents are actually the key drivers of urbanization in the global South. Fox (2012) argues that urbanization should be understood as a process driven by population dynamics associated with technological and institutional change. For example, improved processes of food production, storage, and distribution and improved health care have greatly reduced mortality rates, particularly in urban areas.

Although migration accounts for a relatively small proportion of population growth in the global South, this is significant in that it is often adults of child-bearing age who migrate to cities. Migration in the global South is often very complex, with circulatory migration (cyclical migration between urban and rural homes), stepped migration (e.g., migrants first moving to a small town and then to a bigger city), and return migration (e.g., when migrants retire back to their rural home after spending most of their adult life living in an urban area).

The actual spatial expansion of urban areas and the transformation of what previously were rural areas into urban areas are increasingly important characteristics of the urbanization process as urban sprawl and urban fragmentation increase.

Key Characteristics of Urbanization in the Global South

Although the global South is very diverse and conditions in different places can vary considerably, there are a number of key characteristics of urbanization in the global South: the rapid increase in the number of megacities, strong urban–rural linkages, urban sprawl and fragmentation, growing urban inequalities, and changes in the understanding of “southern urbanism.”

Increase in the Number of Megacities

A notable characteristic of urbanization processes in the early 21st century has been the increase in the number of megacities (urban agglomerations with a population of more than 10 million), particularly in the global South. In 1970, there were only three megacities, all in the global North (New York in the United States and Tokyo and Osaka in Japan). By 2018, the number of megacities had increased more than 10 times to 33, of which 27 were in the global South (UNDESA, 2019). The number of megacities in the world is expected to increase to 43 by 2030, of which 35 will be in the global South (UNDESA, 2019). Table 5 shows the 10 largest urban agglomerations in the world, of which eight are in the global South (the other two urban agglomerations in the list are Toyo and Osaka, both in Japan).

Table 5. Ten Largest Urban Agglomerations in the World (2018)

Urban Agglomeration

Country

Population

1. Tokyo

Japan

37,468,000

2. Delhi

India

28,514,000

3. Shanghai

China

25,582,000

4. São Paulo

Brazil

21,650,000

5. Mexico City

Mexico

21,581,000

6. Cairo

Egypt

20,076,000

7. Mumbai

India

19,980,000

8. Beijing

China

19,618,000

9. Dhaka

Bangladesh

19,578,000

10. Osaka

Japan

19,281,000

Note: Adapted from UNDESA (2019).

Strong Urban–Rural Linkages

All urban areas have linkages with their surrounding rural hinterlands, but urban and rural are particularly porous concepts in the global South, with urban lifestyles permeating rural areas and vice versa, with many people having a simultaneous foothold in both urban and rural areas, and with fuzzy and shifting boundaries between urban and rural (e.g., Kombe, 2005). In the global South, therefore, “distinctions between rural and urban are becoming blurred as urbanization spreads” (UN-Habitat, 2008, p. 216), and the distinction between urban and rural needs to be regarded as a continuum rather than a dichotomy. A number of terms have been developed to attempt to capture this. For example, in South Africa, the term “semi-urban” is used for some settlements in rural areas that are a mix of urban and rural characteristics. Similarly, in Indonesia, zones called desakota zones (from the Indonesian words for village—desa—and town or city—kota) have emerged in the intersection between cities and rural areas that are neither urban nor rural in the traditional sense (Cohen, 2006). Urban scholars use the term city-regions to refer to functionally interlinked areas of urban and rural and the transition zones between them.

Urban Sprawl and Fragmentation

Over time, many cities in the global South are becoming less dense and compact and are “expanding in a discontinuous, scattered and low-density form that is not sustainable” (UN-Habitat, 2013, p. 32). Although many cities in the global South have dense cores, there has been low-density sprawl in peri-urban areas and fragmented growth in the form of “new towns.” In a survey of cities in the global South, it was found that densities declined in 75 out of the 88 sampled cities between 1990 and 2000, with average densities shrinking from 174 people per hectare in 1990 to 135 in 2000 (UN-Habitat, 2013). This trend has continued. For example, a study of 25 African cities found that their built-up area grew by an average of 5.13% per year between 2000 and 2014 compared to their average population growth rate of 4.04% per year during this period (Xu et al., 2019).

Intra-urban Inequalities

The net results of rapid urbanization and the inability of the state to manage cities adequately are the rise of inequality, the increasing prevalence of elite gated developments, and growing informal settlements and other types of slums. UN-Habitat has noted that cities in the global South have particularly high levels of income and consumption inequality, as reflected in Gini coefficients (UN-Habitat, 2010). Urbanization has tended to increase inequality levels, and levels of inequality have actually been growing in many cities in the global South, particularly in Africa and Asia (UN-Habitat, 2013). As examples, inequality in urban Bangladesh grew by 20% between 1993 and 2002, and inequality in urban Vietnam grew by 17% in the same period (UN-Habitat, 2010).

As another tangible example of intra-urban inequalities, more than 20% of the world’s population lives in slums, overwhelmingly in the global South, and the number of people living in slums has been steadily increasing, from 807 million people in 2000 to 883 million in 2014 (UNDESA, 2019). The majority of the 883 million people living in slums in 2014 were in just three regions: Eastern and South-Eastern Asia (332 million), Central and Southern Asia (197 million), and sub-Saharan Africa (189 million) (UNDESA, 2019). UN-Habitat, in their widely used definition, define slums as groups of households “lacking one or more of the following conditions: access to improved water; access to improved sanitation facilities; sufficient living area (not more than three people sharing the same room); structural quality and durability of dwellings; and security of tenure” (UN-Habitat, 2008, p. 92). This is a broad definition that includes many different types of settlements differing greatly in shelter and infrastructure conditions and quality of life. Informal settlements are a particularly common type of slum in the global South; they are settlements in which residents do not have legal security of tenure and do not have dwellings that comply with planning and building regulations, and which therefore generally lack adequate services (Smit, 2016).

Informal settlements and other types of slums are particularly prevalent in sub-Saharan Africa, where more than 60% of the urban population lives in slums. Although the proportion of urban residents in sub-Saharan Africa who live in slums has been decreasing slightly, from 65% in 2000 to 61.7% in 2012, the absolute number of people living in slums in sub-Saharan Africa increased during this same period from an estimated 168 million to an estimated 213 million (UN-Habitat, 2013). The net result of the growth of slums in many parts of the global South is increasingly polarized cities, with the juxtaposition of slums and elite enclaves, which Yiftachel (2009) has referred to as “creeping urban apartheid.”

Southern Urbanism

There is an ongoing debate about the nature of urbanism in the global South (e.g., Mabin, 2014). Some scholars hold the view that there is no dichotomy between cities in the North and South (or urban and rural). For example, Brenner and Schmid (2014, 2015) adhere to the concept of “planetary urbanization,” which essentially argues that all the population concentrations of the world (and the areas between) have all become part of a worldwide urban fabric. Other scholars, however, are of the view that urbanism in the South is different from urbanism in the North. The stereotype of the global South city is “a ‘pathological’ space in need of salvation at the hands of Western experts” (Kanna, 2012, p. 360), but many scholars have tried to go beyond this in understanding cities in the global South on their own terms rather than as failed versions of cities in the North, linked to calls for “southern theory” (Connell, 2007) and “theory from the south” (Comaroff & Comaroff, 2011).

Ananya Roy (2009) was key in the growth of the idea of “Southern urbanism.” Over the past decade, a large number of works have examined cities in the global South and have attempted to theorize from the South (e.g., Edensor & Jayne, 2011; Miraftab & Kudva, 2015; Myers, 2011; Parnell & Oldfield, 2014; Simone, 2010). Many of these works share a “focus on detail, specificity, molecular urban practices, and the co-constitutive nature of plural subjectivities and harsh living conditions amidst widespread informality and precarious living conditions” (Pieterse, 2012, p. 42).

The obvious key characteristics of most cities in the global South are their higher levels of poverty and inequality, their higher levels of informality, and their relatively weaker government capacities, which often translates into lower levels of networked infrastructure but also vibrant social and economic life. Schindler (2017) suggests that the key characteristics of cities in the global South include a disconnect between capital and labor (reflected in the inability of the formal economy to absorb more than a small proportion of the labor pool) and governance regimes that focus on physical development rather than human and social development.

There have also been significant policy and governance changes toward decentralization, corporatization, and privatization, linked to “neoliberal” ideas about the need to downsize the state and rely more on market-based processes. The implementation of structural adjustment programs in many countries helped introduce these shifts in the global South. These practices range “from the outright sale of public assets to the corporatisation of a public utility to the deepening commodification of essential services through full cost recovery” (McDonald & Smith, 2004, p. 1462). There is an ongoing debate to what extent this shift is a result of the importation of neoliberal ideas from the global North and to what extent it dominates urban policy and practice in the global South.

Many scholars are of the view that neoliberal policies, ideology, and practices became globally dominant in the 1980s and have continued to be so. Peck and Tickell (2002, p. 380), for example, were of the view that “neoliberalism seems to be everywhere” and that it had become “the dominant ideological rationalization for globalization and contemporary state ‘reform’.” Similarly, Saad-Filho and Johnston (2005, p. 1) were of the view that “we live in the age of neoliberalism. It strongly influences the lives of billions of people in every continent in such diverse areas as economics, politics, international relations, ideology, culture and so on.” Many scholar are of the view that experiments in neoliberal urbanism have particularly flourished “in the large and rapidly expanding metropolises of Asia, Latin America, and parts of Africa, where the Keynesian welfare state was never significantly installed . . . and the fetter of old forms, structures, and landscapes is much less strong” (Smith, 2002, p. 436). As a result, the rapidly growing cities of the global South “are now at the cutting edge of urban change” (Lees, 2012, p. 164). Murray (2004, p. 158) notes that neoliberal urbanism is particularly prominent in the growing cities of the global South which aspire to be “world class” cities.

Many scholars have an opposing view, believing that neoliberal ideas have had a limited impact in many parts of the global South. For instance, Ong (2006) notes that neoliberalism is an exception to the dominant systems of economic and political regulation in Asia, which include what is called the “Beijing Consensus” (Williamson, 2012). Even where neoliberalism has been adopted, it has often been done in a highly selective manner (Henisz et al., 2005). Ferguson (2012) notes that contrary to the narrative on the spread of neoliberalism in the global South, a number of countries in the global South (e.g., Brazil, South Africa, and India) have developed welfare systems to provide at least some sort of safety net for at least some of the poor. While some scholars (e.g., Smith, 2004) see practices such as corporatization and differentiation of service provisions as always harmful to the interests of the poor, other scholars, such as Jaglin (2008, p. 1905), see the differentiation of service provisions more positively as a strategy to “to preserve an institutional and financial public capacity of delivering subsidized services to the poor.” It is also not always clear whether superficially neoliberal practices in the global South are actually examples of neoliberalism, new home-grown strategies, or merely the evolution of exclusionary practices from previous times (Lees, 2012; Miraftab, 2012).

Some scholars have therefore challenged the usefulness of neoliberalism as an all-encompassing lens for understanding cities in the global South (e.g., Parnell & Robinson, 2012; Robinson & Parnell, 2011). This is not to say they deny that neoliberalism exists or is important in policymaking in the global South, but they emphasize that neoliberalism is always one strand among many, and that these other strands also need to be recognized (and that a process that superficially resembles a neoliberal strategy documented in the global North is not necessarily always a manifestation of neoliberalism).

Urban Health in the Global South

One of the ways that living in cities and towns impacts on people and society is through impacting on health and well-being (i.e., through the social determinants of health). The social determinants of health approach is based on the recognition that patterns of disease and mortality are to a large extent the result of “the conditions in which people are born, grow, live, work, and age. . . . Poor and unequal living conditions are, in their turn, the consequence of deeper structural conditions . . .” (Commission on Social Determinants of Health, 2008, p. 26). Health inequities in cities in the global South are underpinned by the fact that a large proportion of urban residents live in poor-quality living environments lacking clean water, adequate sanitation, or sufficient access to economic opportunities, recreational facilities, and healthcare services (Smit et al., 2011).

There has been particular recognition over the past two decades of the enormity of health challenges in cities of the global South (e.g., Agarwal et al., 2010; Commission on Social Determinants of Health, 2008; Harpham, 2009; WHO & UN-Habitat, 2010, 2016). Urbanization processes in the global South have contributed to the growth and complexity of the burden of disease. Initially, it had been expected that development and urbanization in the global South would result in a decline in infectious disease mortality and that, simultaneously, there would be an increase in noncommunicable diseases as a result of the adoption of unhealthier “modern” lifestyles (Omran, 1971). In reality, however, high levels of infectious diseases have come to coexist with high levels of noncommunicable diseases in the global South (Frenk et al., 1989).

Infectious diseases remain at a high level in most cities of the global South. There are two broad types of infectious disease: those associated with poor environmental conditions (e.g., diarrhea, respiratory illnesses, and malaria) and those associated with person-to-person transmission (e.g., tuberculosis, HIV/AIDS, and COVID-19). Both types of infectious diseases have continued at high levels due to poor environmental conditions and overcrowding in many parts of cities, particularly in informal settlements and other types of slums (Sverdlik, 2011). Informal settlements are the parts of cities where problems of insecurity of tenure, poor shelter, overcrowding, lack of services, and hazardous locations all intersect to create particularly large and complex burdens of disease (Sverdlik, 2011; Unger & Riley, 2007). Residents of informal settlements “suffer disproportionately from ill-health throughout their life-course. These households are more likely to experience disease, injury and premature death, and ill-health may combine with poverty to entrench disadvantages over time” (Sverdlik, 2011, p. 123). For example, during 2020, a particularly high incidence of COVID-19 occurred in informal settlements in South African cities, and informal settlements are also characterized by high levels of other infectious diseases as a result of overcrowding and lack of adequate water and sanitation (Smit, 2020).

Noncommunicable diseases, such as diabetes mellitus and ischemic heart disease, are growing rapidly in the global South (Swinburn et al., 2019). These are linked to changes in living conditions and lifestyle associated with urbanization and the transition of some households to more affluent lifestyles, which typically result in unhealthier eating patterns and reduced levels of physical activity (Swinburn et al., 2019). Changing global social and economic conditions, such as the rapid rise of supermarkets in the global South since the 1990s (Reardon et al., 2003), have resulted in both increased levels of food insecurity for the urban poor in the global South and a shift toward unhealthier diets, resulting in a double burden of malnutrition and obesity for the urban poor (Doak et al., 2004; Popkin, 1999). Food is particularly a problem in slum areas, which are characterized “by high food insecurity and low dietary diversity” (Battersby & Crush, 2014, p. 143). Urban environments that are not conducive to physical activity and food security particularly impact on the health of poor people, which means that the burden of noncommunicable diseases “disproportionately affects poor people living in urban settings” (Mayosi et al., 2009, p. 934).

Indoor and outdoor air pollution, closely related to urbanization, is a major environmental risk to health and is estimated to cause approximately 2 million premature deaths worldwide per year, with most of the burden of disease being in the global South (WHO, 2010). Injury rates (e.g., from violence, traffic accidents, fires, and floods) are also high in cities of the global South along with high levels of psychosocial stress and depression (Commission on Social Determinants of Health, 2008).

It is anticipated that the burden of disease in cities of the global South will continue to increase as urbanization continues, as a result of increased traffic injuries and respiratory disease resulting from increased numbers of motor vehicles; growing levels of violence due to growing levels of poverty and inequality in many cities; growing obesity as a result of changed lifestyles associated with urbanization; growing numbers of unsafe settlements in hazardous areas; and high risks of infectious diseases (Campbell & Campbell, 2007). Climate change is also projected to increase the burden of disease in cities (Friel et al., 2011; Harlan & Ruddell, 2011).

Further Reading

  • Harpham, T. (2009). Urban health in developing countries: What do we know and where do we go? Health & Place, 15(1), 107–116.
  • Miraftab, F., & Kudva, N. (Eds.). (2015). Cities of the global South reader. Routledge.
  • Mitlin, D., & Satterthwaite, D. (2013). Urban poverty in the global South: Scale and nature. Routledge.
  • Parnell, S., & Oldfield, S. (Eds.). (2014). The Routledge handbook on cities of the global South. Routledge.
  • Parnell, S., & Robinson, J. (2012). (Re)theorizing cities from the global South: Looking beyond neoliberalism. Urban Geography, 33(4), 593–617.
  • Prashad, V. (2012). The poorer nations: A possible history of the global South. Verso.
  • Smit, W., Hancock, T., Kumaresen, J., Santos-Burgoa, C., Sánchez-Kobashi Meneses, R., & Friel, S. (2011). Toward a research and action agenda on urban planning/design and health equity in cities in low and middle-income countries. Journal of Urban Health, 88(5), 875–885.

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