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Indicators of environmental health in the urban setting.

The North American population is approximately 80% urbanized and spends almost 90% of the time indoors. Accordingly, the built environment is the most important--one might almost say "natural"--human environment. Urban settlements incorporate within their boundaries natural ecosystems of plant and animal life (often highly adapted to the urban environment), and are in turn incorporated within wider bioregions and global ecosystems. But urban settlements are not just built and natural physical environments, they are social, economic, cultural and political environments; the whole constitutes an urban ecosystem. These ecosystems have profound implications for the physical, mental, social, emotional and spiritual well-being of their human inhabitants, as well as for human beings remote from these urban ecosystems. Therefore, this paper discusses urban ecosystems and human health and presents a framework for indicators of environmental health in the urban setting based on such an understanding. The concepts of environmental viability, ecological sustainability, urban livability, community conviviality, social equity, and economic adequacy are discussed in relation to human health and are used to organize proposed candidate indicators for urban ecosystems and public health.

Ecosystem↗

[Relationships between the diameters of Bacille Calmette-Guerin scars and asthma, atopy in urban and rural Beijing children].

OBJECTIVE: To compare the diameters of Bacille Calmette-Guerin (BCG) scars between asthmatic (allergic) students and normal students, and to compare the diameters of BCG scars in children in rural Beijing area with those in urban Beijing area, and to compare the prevalence of asthmatic (allergic) symptoms and atopy between rural and urban Beijing students. METHODS: Sampled by cluster-random Method, 819 urban school children and 1 044 rural school children aged 13 - 14 years were recruited for the Beijing arm of the phase III international study of asthma and allergies in childhood. The children answered the core questionnaires, and underwent skin prick test for 13 allergens, and were checked for BCG scars on their arms. RESULTS: (1) In both rural and urban Beijing students, the mean diameters of BCG scars in those with asthma (allergy) (asthma ever, wheeze ever, current wheeze within 12 months, hay fever ever, repeated rash ever, eczema ever, allergic rhinitis, atopy, high-sensitivity or were diagnosed asthma) were (7.0 +/- 2.1) mm-(8.8 +/- 2.8) mm, which were not significantly different from those of (7.2 +/- 2.7) mm-(8.2 +/- 2.2) mm in normal students (P > 0.05). (2) Compared to the urban students, the mean diameter of BCG scars in the rural students was (8.2 +/- 2.3) mm, significantly larger than that of (7.3 +/- 2.9) mm in the urban students (P < 0.01). The prevalence of asthma (allergy) (asthma ever, wheeze ever, current wheeze within 12 months, hay fever ever, repeated rash ever, eczema ever, allergic rhinitis, atopy, high-sensitivity or diagnosed asthma) were 0.6% - 11.4% in the rural Beijing students, significantly lower than that of 3.1% - 35.7% in urban Beijing schoolchildren (P < 0.01). CONCLUSIONS: The diameters of BCG scars were not significantly different between asthmatic (allergic) students and normal students. The diameters of BCG scars in the rural students were significantly larger than those in the urban students. The prevalence of asthma and allergy in the rural children were significantly lower than that in the urban students. The results suggest that there is difference in immunity between rural and urban children from early life, which may be caused by the different living environments.

Adolescent↗

Factors influencing family physicians to enter rural practice: does rural or urban background make a difference?

OBJECTIVE: To examine where rural physicians grew up, when during their training they became interested in rural medicine, factors influencing their decision to practise rural medicine, and differences in these measures according to rural or urban upbringing. DESIGN: Mailed survey. SETTING: Rural Canada. PARTICIPANTS: Rural family physicians who graduated between 1991 and 2000 from a Canadian medical school. MAIN OUTCOME MEASURES: Backgrounds of recently graduated rural physicians, when physicians first became interested in rural practice during training, and most influential factors in decisions to practise rural medicine. RESULTS: Response rate was 59% (382/651). About 33% of rural physicians grew up in communities of less than 10 000 people, 44% in cities of 10 000 to 499 999 people, and 23% in cities of more than 500 000 people. Physicians raised in rural areas were more likely than those raised in urban areas to have some interest in rural family practice at the start and end of medical school (90% vs 67% at the start, 98% vs 91% at the end, respectively, P < .0001). Physicians raised in urban areas were more likely to state that rural medical training was the most influential factor in their choice of rural practice (19% vs 9%, P = .015). Other factors cited as influential were the challenge of rural practice (24% for both urban and rural upbringing), rural lifestyle (14% for urban and 18% for rural upbringing) and, for physicians raised in rural areas, having grown up or spent time in a rural area (27% for rural and 4.1% for urban upbringing, P < .001). Financial incentives were least frequently cited as the most influential factor (7.5% for urban and 4.9% for rural upbringing, P = .35). CONCLUSION: Although other studies have suggested that physicians with a rural upbringing are more likely to practise rural medicine and policy makers might still wish to target students raised in rural areas as candidates for rural medicine, this study shows that physicians raised in urban areas remain the main source of human resources for rural communities. They account for two thirds of new physicians in rural areas. Education in rural medicine during medical training has a stronger influence on physicians raised in urban areas than on physicians raised in rural areas. Undergraduate and postgraduate training periods, therefore, offer an important opportunity for recruiting physicians raised in urban areas to rural practice.

Adult↗

Low urinary dopamine excretion associated to low sodium excretion in normotensive Piaroa Amazonian ethnia compared to urban subjects.

The objective of this work was to compare urinary dopamine, noradrenaline, adrenaline, sodium and potassium excretion in a group of normotensive Piaroa Amazonic ethnia who do not use salt in their regular food intake, against a group of urban normotensive citizens known to have a high salt intake in their regular meals. Twenty adult normotensive Piaroa subjects living in the Amazonas forest, 11 men and 9 women, 23-72 years old, and 33 normotensive urban citizens, 25-70 years old, 17 men and 17 women, were included in the study. After a 10 min. rest, an average of three supine systolic (SBP) and diastolic (DBP) blood pressure recordings was obtained. Piaroas subjects SBP and DBP were 111.3 +/- 2.9 mmHg and 62.7 +/- 1.9 mmHg respectively; urban subjects SBP and DBP were 111.8 +/- 2.2 mmHg and 70.3 +/- 1.6 mmHg respectively. Supine heart rate was lower in Piaroas (58.0 +/- 1.8 beats/min) than in urban subjects (76.5 +/- 1.9 beats/min), p < 0.05. Sodium urinary excretion was much lower in Piaroas (12.6 +/- 5.2 mmol/24 h) when compared to urban subjects (210.7 +/- 24.5 mmol/24 h), p < 0.01. No difference was found in daily urinary potassium excretion between Piaroas and urban subjects (50.4 +/- 7.2 mmol/24 h vs 45.1 +/- 7.4 mmol/24 h). Urinary dopamine excretion was lower in Piaroas (314.7 +/- 40.1 micrograms/24 h) in comparison to urban subjects (800.4 +/- 59.2 micrograms/24 h), p < 0.05. Daily urinary noradrenaline and adrenaline excretion were 67.9% and 85.4% respectively lower in Piaroas than in urban subjects. In conclusion, lower amounts of sodium daily intake are associated to lower kidney dopamine production in Piaroas as compared to urban subjects. Apparently indigenous tribes might require less kidney dopamine synthesis to excrete the very small amounts of salt they consume in their regular food intake. The opposite was found in urban subjects; more kidney dopamine synthesis would be required for larger amounts of urinary sodium excretion. In this population, essential hypertension has been associated to a failure of the natriuretic mechanism triggered by dopamine onkidney tubules.

Adult↗

One-year prospective study of cases of suspected acute myocardial infarction managed by urban and rural general practitioners.

BACKGROUND: The role of the general practitioner in the management of patients with suspected acute myocardial infarction is important and specific. It has been recommended that eligible patients should receive thrombolysis within 90 minutes of alerting medical or ambulance services. The administration of prehospital thrombolysis by general practitioners is controversial. Most research into the management of acute myocardial infarction has been hospital based and has not explored differences between urban and rural general practice. AIM: In 1993-94 a one-year prospective survey was undertaken of samples of urban and rural general practitioners to examine their management of cases of suspected acute myocardial infarction and to determine whether differences in management existed between the two settings. METHOD: General practitioners were recruited through the continuing medical education faculty network of the Irish College of General Practitioners. Participating general practitioners completed a report form for cases of suspected acute myocardial infarction. Six-week follow-up forms were also completed. RESULTS: A total of 113 general practitioners (54 urban and 59 rural) participated in the study. A total of 57 general practitioners contributed 195 cases, 49 from urban and 146 from rural areas. The mean number of cases of suspected acute myocardial infarction per participant for urban and rural doctors was 0.9 and 2.5, respectively. Median delay time from onset of symptoms to contacting the general practitioner was 90 minutes for both urban and rural patients. Median general practitioner response times for urban and rural doctors were 10 and 15 minutes, respectively. Median estimated journey times from location of the patient to hospital for urban and rural patients were 10 and 40 minutes, respectively (P<0.001). Rural doctors were more likely, in comparison with their urban counterparts, to administer aspirin (given to 40% of patients versus 16%, P<0.01) but less likely to administer intravenous morphine (26% versus 41%, P<0.05). Twenty one patients (11%) died at the scene; follow-up forms were received for 94% of the remaining patients. Of these 163 patients, 99% were admitted to hospital; 49% were discharged with a diagnosis of acute myocardial infarction and a further 25% had final diagnoses consistent with acute coronary heart disease. CONCLUSION: This study suggests that the management of patients with suspected acute myocardial infarction differs in urban and rural settings. Delay times suggest that in order to meet current guidelines, prehospital thrombolysis must become a reality in rural areas.

Adult↗

Regional and rural-urban differences in obesity in Canada. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To describe regional and rural-urban differences in weight and weight loss patterns in Canadian adults. DESIGN: Population-based, cross-sectional surveys. SETTING: Nine Canadian provinces (excluding Nova Scotia) from 1986 to 1992. PARTICIPANTS: A probability sample of 27,120 men and women aged 18 to 74 years was selected using the health insurance registration files in each province. Anthropometry was performed on 18,043 participants (67%). OUTCOME MEASURES: Region of Canada (Atlantic, central, western); rural or urban residence (rural if participant resided in a community whose population was < 10,000, urban if population > or = 10,000); body mass index (BMI, kg/m2); percentage of participants trying to lose weight; reasons for trying to lose weight; level of leisure-time physical activity. RESULTS: Overall, mean BMI values in rural men (26.1 kg/m2) and women (25.3 kg/m2) were not significantly different from urban counterparts (25.7 kg/m2 and 24.8 kg/m2, respectively). Similarly, obesity (BMI > or = 27 kg/m2) was as prevalent in rural men (37%) and women (30%) as in urban participants (34% and 28%, respectively). However, a difference was observed in western Canada where 41% of rural and 34% of urban men were obese (odds ratio [OR], adjusted for age and education = 1.29; 95% confidence interval [CI] 1.06, 1.57), as were 35% of rural and 25% of urban women (OR, adjusted for age and education = 1.47; 95% CI 1.17, 1.84). Among men in western Canada, the rural-urban differences were greatest in the 25-64 year age group, whereas in women the differences were present at all ages. Overall, in Canada, urban men (26%) are more likely than rural men (23%) to be trying to lose weight; the reverse was true for women (39% and 42%, respectively). CONCLUSION: Considerable regional and rural-urban differences are seen in the patterns of weight and weight loss in Canada. A fuller understanding of the underlying behavioural determinants of these differences is needed. On the basis of such an understanding, effective programs to promote healthy weights for individuals and communities in these areas might be developed.

Adult↗

Urbanization and the risk for chronic diseases of lifestyle in the black population of the Cape Peninsula, South Africa.

BACKGROUND: Men and women have experienced differing patterns of urbanization. Men spent more time in the city as migrant labourers, which could be attributed to the influx control legislation during the apartheid years. OBJECTIVE: To investigate urban exposure among black people of the Cape Peninsula, South Africa, in relation to unhealthy lifestyles and the risk factors for chronic diseases of lifestyle. METHODS: Blood pressure, height, weight and serum cholesterol were measured in a random sample of 986 persons, aged 15-64 years. Sociodemographic details, urban exposure, dietary intake patterns and personal habits were elicited by questionnaire. An urbanization index (percentage of life spent in a city), the dietary Keys score and body mass index were calculated. Linear regression modelling for cholesterol and hypertension, and multiple correspondence analysis for risk factors and demographic characteristics were performed. RESULTS: The degree of urbanization had no effect on total serum cholesterol concentrations, which were very low compared with other groups in South Africa. Hypertension was independently related to age, obesity and the degree of urbanization. Smoking patterns were influenced by the degree of urbanization in women only. Correspondence analysis identified groups with clusters of risk factors: formal housing-westernized diet-highly urbanized; male-normal weight-increased exercise-alcohol-smoking; female-obesity-non-smoking; and hypertension-ageing. CONCLUSIONS: Those who spent larger proportions of their lives in an urban setting tended to have unhealthier lifestyles and higher risk for chronic diseases lifestyle compared with their less urbanized counterparts. Groups to whom intervention should be targeted were also identified.

Adolescent↗

Modeling urban growth effects on surface runoff with the integration of remote sensing and GIS.

A methodology is developed to relate urban growth studies to distributed hydrological modeling using an integrated approach of remote sensing and GIS. This linkage is possible because both studies share land-use and land-cover data. Landsat Thematic Mapper data are utilized to detect urban land-cover changes. GIS analyses are then conducted to examine the changing spatial patterns of urban growth. The integration of remote sensing and GIS is applied to automate the estimation of surface runoff based on the Soil Conservation Service model. Impacts of urban growth on surface runoff and the rainfall-runoff relationship are examined by linking the two modeling results with spatial analysis techniques. This methodology is applied to the Zhujiang Delta of southern China, where dramatic urban growth has occurred over the past two decades, and the rampant urban growth has created severe problems in water resources management. The results revealed a notably uneven spatial pattern of urban growth and an increase of 8.10 mm in annual runoff depth during the 1989-1997 period. An area that experienced more urban growth had a greater potential for increasing annual surface runoff. Highly urbanized areas were more prone to flooding. Urbanization lowered potential maximum storage, and thus increased runoff coefficient values.

Automation↗

Biomonitoring of lead in atmospheric environment of an urban center of the Ganga Plain, India.

Monitoring of atmospheric lead from the Dalbergia sissoo tree was undertaken at Lucknow urban centre of the Ganga Plain, India. A total of 26 leaf samples were collected in spring, monsoon and winter seasons from 16 sampling sites and was analysed by Atomic Absorption Spectrophotometry method. Lead concentrations were low in spring season, increased in monsoon to winter seasons and range from 2.1 to 28.2 microg/g (dry wt.). This accumulative response of lead in the tree leaves is directly linked with the exposure time of automobile emission that is considered to be the predominant source for it. Highway localities show higher lead concentrations by a factor of 2 as compared to urban localities. Highest concentration was recorded at Sitapur Road (National Highway No. 24) in winter season. A linear quantitative relationship between urban air-lead levels and lead-in-the Dalbergia sissoo leaves is used to infer the qualitative assessment of present day atmospheric lead pollution. Reported results suggest a drastic reduction in mean lead concentration in Lucknow urban air from 1.32 microg/m3 in 1994 to 0.19 microg/m3 in 2002. Similarly, mean lead concentration in the tree leaves during winter season also dropped from 17.9 microg/g in 1994 to 8.1 microg/g in 2004. Despite of increasing urban population, urban area, vehicle population and traffic density, the introduction of unleaded-petrol (vehicular fuel) keeps lead level in the urban environment of Lucknow much lower than the past. Like Lucknow, other urban centres of the Ganga Plain are also on way to the exponential increase in pressure of urbanization. An appropriate urban public transport planning is required to provide healthy atmospheric environment for millions of people especially future young generation.

Air Pollutants↗

Pollution loads in urban runoff and sanitary wastewater.

While more attention has been paid in recent years to urban point source pollution control through the establishment of wastewater treatment plants in many developing countries, no considerable planning nor any serious measures have been taken to control urban non-point source pollution (urban stormwater runoff). The present study is a screening analysis to investigate the pollution loads in urban runoff compared to point source loads as a first prerequisite for planning and management of receiving water quality. To compare pollutant loads from point and non-point urban sources, the pollutant load is expressed as the weight of pollutant per hectare area per year (kg/ha.year). Unit loads were estimated in stormwater runoff, raw sanitary wastewater and secondary treatment effluents in Isfahan, Iran. Results indicate that the annual pollution load in urban runoff is lower than the annual pollution load in sanitary wastewater in areas with low precipitation but it is higher in areas with high precipitation. Two options, namely, advanced treatment (in lieu of secondary treatment) of sanitary wastewater and urban runoff quality control systems (such as detention ponds) were investigated as controlling systems for pollution discharges into receiving waters. The results revealed that for Isfahan, as a low precipitation urban area, advanced treatment is a more suitable option, but for high precipitation urban areas, urban surface runoff quality control installations were more effective for suspended solids and oxygen-demanding matter controls, and that advanced treatment is the more effective option for nutrient control.

Cities↗

Soil carbon pools and fluxes in urban ecosystems.

The transformation of landscapes from non-urban to urban land use has the potential to greatly modify soil carbon (C) pools and fluxes. For urban ecosystems, very little data exists to assess whether urbanization leads to an increase or decrease in soil C pools. We analyzed three data sets to assess the potential for urbanization to affect soil organic C. These included surface (0-10 cm) soil C data from unmanaged forests along an urban-rural gradient, data from "made" soils (1 m depth) from five different cities, and surface (0-15 cm) soil data of several land-use types in the city of Baltimore. Along the urban-rural land-use gradient, we found that soil organic matter concentration in the surface 10 cm varied significantly (P=0.001). In an analysis of variance, the urban forest stands had significantly (P=0.02) higher organic C densities (kg m(-2) to 1 m depth) than the suburban and rural stands. Our analysis of pedon data from five cities showed that the highest soil organic C densities occurred in loamy fill (28.5 kg m(-2)) with the lowest occurring in clean fill and old dredge materials (1.4 and 6.9 kg m(-2), respectively). Soil organic C densities for residential areas (15.5 +/- 1.2 kg m(-2)) were consistent across cities. A comparison of land-use types showed that low density residential and institutional land-uses had 44 and 38% higher organic C densities than the commercial land-use type, respectively. Our analysis shows that as adjacent land-use becomes more urbanized, forest soil C pools can be affected even in stands not directly disturbed by urban land development. Data from several "made" soils suggests that physical disturbances and inputs of various materials by humans can greatly alter the amount C stored in these soils.

Carbon↗

Soil nitrogen cycle processes in urban riparian zones.

Riparian zones have been found to function as "sinks" for nitrate (NO3-), the most common groundwater pollutant in the U. S., in many areas. The vast majority of riparian research, however, has focused on agricultural watersheds. There has been little analysis of riparian zones in urban watersheds, despite the fact that urban areas are important sources of NO3- to nitrogen (N)-sensitive coastal waters in many locations. In this study, we measured stream incision, water table depths, and pools, production (mineralization, nitrification), and consumption (denitrification) of NO3- in urban soils. Samples were taken from soil profiles (0-100 cm) of three forested urban and suburban zones and one forested reference riparian zone in the Baltimore, Maryland metropolitan area. Our objectives were to determine (1) if stream incision associated with urbanization results in lower riparian water tables, and (2) if pools, production, and consumption of NO3- vary systematically with stream incision and riparian water table levels. Two of the three urban and suburban streams were more incised and all three had lower water tables in their riparian zones than the forested reference stream. Urban and suburban riparian zones had higher NO3- pools and nitrification rates than the forested reference riparian zone, which was likely due to more aerobic soil profiles, lower levels of available soil carbon, and greater N enrichment in the urban and suburban sites. At all sites, denitrification potential decreased markedly with depth in the soil profile. Lower water tables in the urban and suburban riparian zones thus inhibit interaction of groundwater-borne NO3- with near surface soils that have the highest denitrification potential. These results suggest that urban hydrologic factors can increase the production and reduce the consumption of NO3- in riparian zones, reducing their ability to function as sinks for NO3- in the landscape.

Cities↗

Rural and semi-urban differences in salt intake, and its dietary sources, in Ashanti, West Africa.

OBJECTIVES: To provide a socioeconomic profile of rural and semi-urban settings in Ashanti, West Africa and to investigate the relationship between urbanization and sources of salt in the diet. SETTING: 12 villages (6 rural, 6 semi-urban) participating in a cluster randomized controlled trial of a health promotion in the Ashanti region of Ghana. PARTICIPANTS: 1013 adult men (N = 385) and women (N = 628), aged 40-75. METHOD: Between June 2001 and June 2002, participants completed a detailed questionnaire on demography, occupation and education, housing, radio and television use, personal and family medical history, drug therapy, smoking, alcohol consumption, and diet. RESULTS: 532 subjects lived in semi-urban and 481 in rural communities. Ninety-two percent of the participants were of the Ashanti tribe and 94% spoke Twi. The semi-urban villages were closer to Kumasi, the second largest city in Ghana, had larger population (1727 vs 1100 people) and household sizes (14.6 vs 8.8 persons per household; P < .001), had fewer farmers (53% vs 81%; P < .001) and more traders (22% vs 7%; P < .001), and had more homes with electricity (81% vs 17%; P < .001) and piped water (28% vs 0.2%; P < .05). Semi-urban villagers had higher systolic blood pressure than rural villagers (129 vs 121 mm Hg difference 8 mm Hg [95% CI 5-11]; P < .001). Salt is almost invariably added to food in cooking (98%), and salted foods such as fish and meat are eaten in both communities. Salt is often added at the table (52%), more often in rural villages than in semi-urban settings (59% vs 45%; P < .01), although the total salt consumed as measured by urinary sodium was similar (99 vs 103 mmol/day). Potassium levels were higher in rural villages (58 vs 40 mmol/day difference 18 mmol/day [95% CI 11-26]; P < .001). CONCLUSIONS: In this mainly farming community were clear differences in housing, population structure, and blood pressure between rural and semi-urban communities. While no significant differences were in the amount of salt consumed, the sources of salt differed between rural and semi-urban settings. Finally, rural villagers ate more potassium than semi-urban participants.

Adult↗

The urban environment and health in a world of increasing globalization: issues for developing countries.

Urban living is the keystone of modern human ecology. Cities have multiplied and expanded rapidly worldwide over the past two centuries. Cities are sources of creativity and technology, and they are the engines for economic growth. However, they are also sources of poverty, inequality, and health hazards from the environment. Urban populations have long been incubators and gateways for infectious diseases. The early industrializing period of unplanned growth and laissez-faire economic activity in cities in industrialized countries has been superseded by the rise of collective management of the urban environment. This occurred in response to environmental blight, increasing literacy, the development of democratic government, and the collective accrual of wealth. In many low-income countries, this process is being slowed by the pressures and priorities of economic globalization. Beyond the traditional risks of diarrhoeal disease and respiratory infections in the urban poor and the adaptation of various vector-borne infections to urbanization, the urban environment poses various physicochemical hazards. These include exposure to lead, air pollution, traffic hazards, and the "urban heat island" amplification of heatwaves. As the number of urban consumers and their material expectations rise and as the use of fossil fuels increases, cities contribute to the large-scale pressures on the biosphere including climate change. We must develop policies that ameliorate the existing, and usually unequally distributed, urban environmental health hazards and larger-scale environmental problems.

Developing Countries↗

Urbanization in sub-saharan Africa and implication for malaria control.

Malaria not only remains a leading cause of morbidity and mortality, but it also impedes socioeconomic development, particularly in sub-Saharan Africa. Rapid and unprecedented urbanization, going hand-in-hand with often declining economies, might have profound implications for the epidemiology and control of malaria, as the relative disease burden increases among urban dwellers. Reviewing the literature and using a modeling approach, we find that entomologic inoculation rates in cities range from 0 to 54 per year, depending on the degree of urbanization, the spatial location within a city, and overall living conditions. Using the latest United Nations figures on urbanization prospects, nighttime light remotely sensed images, and the "Mapping Malaria Risk in Africa" results on climate suitability for stable malaria transmission, we estimate that 200 million people (24.6% of the total African population) currently live in urban settings where they are at risk of contracting the disease. Importantly, the estimated total surface area covered by these urban settings is only approximately 1.1-1.6% of the total African surface. Considering different plausible scenarios, we estimate an annual incidence of 24.8-103.2 million cases of clinical malaria attacks among urban dwellers in Africa. These figures translate to 6-28% of the estimated global annual disease incidence. Against this background, basic health care delivery systems providing early diagnosis and early treatment and preventive actions through mother and child health programs and the promotion of insecticide-treated bed nets for the rapidly growing numbers of the urban poor must be improved alongside well-tailored and integrated malaria control strategies. We propose environmental management and larviciding within well-specified productive sites as a main feature for such an integrated control approach. Mitigation of the current burden of malaria in urban African settings, in turn, is a necessity for stimulating environmentally and socially sustainable development.

Africa South of the Sahara↗

Biosocial factors and hypertension in urban and rural Zulus.

A study of 1,000 urban and 1,000 rural Zulus was carried out to determine the biosocial factors associated with hypertension. The prevalence of hypertension was 25% in the urban Zulu (males 23%, females 27%) and 10.5% in the rural Zulu (males 10%, females 10.75%). The mean arterial pressure was higher in the urban Zulu than in the rural Zulu at all ages and for both sexes (greater in females than in males). In both the urban and the rural Zulu the following factors were found to be significantly associated with hypertension: age, sex, obesity, marital status, urbanization and number of dependents. In the urban Zulu other parameters absent in the rural Zulu were associated with hypertension: insomnia due to anxiety, cigarette smoking, alcohol intake, conditions of work, educational status, income, number of children not working, lack of recreation or sport activity, and overcrowding. Likewise, in the rural Zulu other parameters absent in the urban Zulu were associated with hypertension: having a family member with hypertension and the educational status of the children. There was a relationship between hypertension and social variables which were observed to be stressful. Unlike the rural Zulu, the urban Zulu is exposed to a different lifestyle, acculturation, detribalization and various political ideologies. This could explain the difference in the prevalence of hypertension in urban and rural Zulus.

Adolescent↗

Modelling urban-rural population growth in China.

"The population of China is still growing despite a dramatic decline in fertility in the past two decades. There are marked urban-rural differentials in fertility and, as a result, the pace of urbanization has significant effects on population growth. In this research an attempt is made to model urban-rural population growth in China. A demoeconomic model of urban and rural sectors is calibrated to account for the long-term trend of urbanization in China.... An accounts-based urban-rural population model, in which rural to urban migration and transition are driven by the foregoing demoeconomic model, is established.... These models are used to make urban-rural population projections for the period 1988-2087 under various fertility rate assumptions."

Asia↗

Morphology of India's urbanization.

"This paper is aimed at presenting the salient features of the morphology of India's urbanization paying due attention to interstate variations. We will find a lot of variations among the states in terms of their basic indices of urbanization. There are six sections in this paper. Section II deals with how to define an urban area. Section III presents a picture of the patterns of population transformation in India with due consideration to changes in the birth and death rates over time. Section IV examines the main features of the morphology of India's urbanization, discussing the level of urbanization, primacy patterns, interstate differences in urbanization, and the components of urban growth. Section V deals with the structure and pattern of migration in order to explain the background to India's slow urbanization."

Asia↗