Urban Health Challenges

The Healthy Cities Initiatives should be revived. Intersectoral action in urban health should also be strengthened.

The Philippines is one of the most rapidly urbanizing countries in the world. Our urban population reached 63.7 million in 2010, representing 65 percent of total population; it was only 47 percent of the population in 1990. Filipino urban dwellers are expected to reach 102 million in 2050.

The health of city folk who live and work closely together, many in congested, unsanitary, and sometimes crime-infested locations, presents a different challenge than that of rural residents. There are around 1.5 million informal settlers, and 600,000 of them (40 percent) are in Metro Manila. Urban inequity is growing between poor and nonpoor households, fragmenting the social fabric and creating social tensions. For instance, unemployment and underemployment among the poor is 29 percent, compared to 15 percent among the nonpoor.

Urban health is under the purview of the DOH Bureau of Local Health Development. In metropolitan areas (Metro Manila, Cebu, and Davao), there is no centralized health authority, and each local government within the metro area manages its own health program. This fragmentation makes it extremely difficult to deliver urban health services especially because many of those living in informal settlements are highly mobile. In terms of governance and coordination for urban health, the number of component cities (those included in the province that encloses them) is expected to rise to 600 by 2020, while the number of highly urban cities (currently 138) is also expected to grow.

WHO has used the Urban Health Equity Assessment and Response Tool in seven cities and it seems to be useful. WHO’s short course on Urban Health Equity is also being offered, but the trained LGU staff are too few. DOH also introduced Citywide Investment Plans for Health but they need updating. “Galing Pook” also awards innovative city health programs, but these are rarely scaled up.

What should be done? Cities need to conduct wealth classification of barangays so neediest areas and households can be identified. The Healthy Cities Initiatives should be revived. Intersectoral action in urban health should also be strengthened. A federal structure can unify fragmented urban areas that streamlines urban health financing and service delivery.

About the Author
Mr. Oscar F. Picazo is a retired specialist in health systems, health economics, and social policy. He has worked in 24 countries for the World Bank, the United States Agency for International Development (USAID), and as an independent consultant. He returned to the Philippines in 2009 and became a senior research consultant for the Philippine Institute of Development Studies.
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