Skip to main content
SpringerLink
Log in

Will Urban and Rural Mortality Converge in Africa?

  • Chapter
  • First Online:
New Approaches to Death in Cities during the Health Transition

Part of the book series: International Studies in Population ((ISIP,volume 12))

Abstract

During colonization and the first decades of independence, mortality underwent a major transition in Africa, from very low levels of life expectancy to average levels for the period. At the same time, urbanization developed rapidly from very low levels to about 40 % in recent years. Because of data availability, mortality changes are better documented for infants and children but they also affected young adults. In almost all countries for the 1950–1985 period, mortality decline was faster in urban areas than in rural areas. This occurred for a variety of reasons, and mainly because the city concentrated health services, basic hygiene, wealth and modern education. However, since the mid-1980s, mortality changes were more contrasted, and a number of cases of “health regressions” were noted, characterized by stagnating or increasing under-five mortality. On average, over the past 25 years, urban mortality stagnated while rural mortality continued to decline for the continent as a whole, with large differences by country. The study builds on an earlier reconstruction of under-five mortality trends in urban and rural areas in 37 countries of sub-Saharan Africa. It focuses on cases where urban and rural mortality tended to converge in the recent years, after years of faster decline in cities and towns. Three countries where rural mortality became lower than urban mortality in recent years are further investigated: Sierra Leone, Tanzania and Zambia. Reasons for these cases of convergence are investigated, in particular health policies and disease control programs, emerging diseases (e.g. HIV/AIDS), macro-economic policies (e.g. structural adjustment policies), and the dynamics of socio-economic correlates (urban poverty and rural education).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 34.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 44.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ahmad, O. B., Lopez, A. D., & Inoue, M. (2000). The decline in child mortality: A reappraisal. Bulletin of the World Health Organization, 78(10), 1175–1191.

    Google Scholar 

  • Antoine, P., & Diouf, P. D. (1988). Urbanisation, scolarisation et mortalité des enfants. Annales de L’IFORD, 12(1), 9–24.

    Google Scholar 

  • APHRC. (2002). Population and health dynamics in Nairobi’s informal settlements (p. 256). Nairobi: African Population and Health Research Centre.

    Google Scholar 

  • Becker, S. R., Diop, F., & Thornton, J. N. (1993). Infant and child mortality in two counties of Liberia: Results of a survey in 1988 and trends since 1984. International Journal of Epidemiology, 22(Suppl 1), S56–S63.

    Article  Google Scholar 

  • Bocquier, P., Madise, N. J., & Zulu, E. M. (2011). Is there an urban advantage in child survival in sub-Saharan Africa? Evidence from 18 countries in the 1990s. Demography, 48(2), 531–558.

    Article  Google Scholar 

  • Brockerhoff, M. (1993). Child survival in big cities: Are the poor disadvantaged? (Population Council, Research Division Working Papers No 58, 53 p). New York: Population Council, Research Division.

    Google Scholar 

  • Campbell, T., & Campbell, A. (2007). Emerging disease burdens and the poor in cities of the developing world. Journal of Urban Health, 84(Suppl 1), 54–64.

    Article  Google Scholar 

  • Egunjobi, L. (1991). Tackling Africa’s slums. World Health, 14–15.

    Google Scholar 

  • Ewbank, D. C. (1993). Impact of health programmes on child mortality in Africa: Evidence from Zaire and Liberia. International Journal of Epidemiology, 22(Suppl 1), S64–S72.

    Article  Google Scholar 

  • Foege, W. H., & Henderson, D. A. (1986). Selective primary health care. XXV. Management priorities. Reviews of Infectious Diseases, 8, 467–475.

    Article  Google Scholar 

  • Fotso, J. C. (2006). Child health inequities in developing countries: Differences across urban and rural areas. International Journal for Equity in Health, 5, 9.

    Article  Google Scholar 

  • Garenne, M. (2006). Migration, urbanisation and child health: An African perspective. In M. Tienda, S. E. Findley, S. Tollman, & E. Preston-Whyte (Eds.), Africa on the move: African migration and urbanisation in comparative perspective (pp. 252–279). Johannesburg: Wits University Press.

    Google Scholar 

  • Garenne, M. (2011). The impact of HIV/AIDS on the health transition among under-five children in Africa. In G. Letamo (Ed.), Social and psychological aspects of HIV/AIDS and their ramifications (pp. 237–248). (Chapter 13). Rijeka: In-Tech Publishers.

    Google Scholar 

  • Garenne, M., & Gakusi, E. (2004). Reconstructing under-five mortality trends in Africa from demographic sample surveys (DHS Working Papers No 26). Calverton: IRD-Macro.

    Google Scholar 

  • Garenne, M., & Gakusi, E. (2006a). Health transitions in sub-Saharan Africa: Overview of mortality trends in children under-5-years-olds (1950–2000). Bulletin WHO, 84(6), 470–478.

    Google Scholar 

  • Garenne, M., & Gakusi, E. (2006b). Vulnerability and resilience: Determinants of under-five mortality changes in Zambia. World Development, 34(10), 1765–1787.

    Article  Google Scholar 

  • Garenne, M., & Hohmann, S. (2003). A wealth index to screen high risk families: Application to Morocco. Journal of Health, Population and Nutrition, 21(3), 235–242.

    Google Scholar 

  • Garenne, M., Darkaoui, N., Braikat, M., & Azelmat, M. (2007). Changing cause of death profile in Morocco: The impact of child-survival programs. Journal of Health, Population and Nutrition, 25(2), 212–220.

    Google Scholar 

  • Garenne, M., Tollman, S., Kahn, K., & The Agincourt Team. (2011). Trends in under-five mortality in countries with high HIV prevalence: When will they decline again? Paper prepared for the UAPS conference (session 23), Ougadougou, Burkina-Faso, 5–9 December 2011.

    Google Scholar 

  • Gilbert, A., & Gugler, J. (1992). Cities, poverty and development. Oxford: Oxford University Press.

    Google Scholar 

  • Gould, W. T. S. (1998). African mortality and the new urban penalty. Health and Place, 4(2), 171–181.

    Article  Google Scholar 

  • Gracey, M. (2002). Child health in an urbanized world. Acta Paediatrica, 91, 1–8.

    Article  Google Scholar 

  • Haines, M. (2001). The urban mortality transition in the United States, 1800–1940. Annales de Démographie Historique, 1, 33–64.

    Google Scholar 

  • Harpham, T., & Molyneux, C. (2001). Urban health in developing countries: A review. Progress in Development Studies, 1, I13–I37.

    Article  Google Scholar 

  • Harpham, T., & Stephens, C. (1991). Urban health in developing countries: From the shadows into the spotlight. Tropical Diseases Bulletin, 88(8), 1–35.

    Google Scholar 

  • Harpham, T., Lusty, T., & Vaughan, P. (1988). In the shadow of the city: Community health and the urban poor. Oxford: Oxford University Press.

    Google Scholar 

  • Herbst, A., Cooke, G., Bärnighausen, T., KanyKany, A., Tanser, F., & Newell, M. (2009). Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa. Bulletin of the World Health Organization, 87, 754–762.

    Article  Google Scholar 

  • Hill, A. (1991). Infant and child mortality: Levels, trends and data deficiencies. In R. Feachem & D. Jamison (Eds.), Disease and mortality in sub-Saharan Africa (pp. 37–76). New York: World Bank/Oxford University Press.

    Google Scholar 

  • Hill, K., & Yazbeck, A. (1994). Trends in under-five mortality, 1960–90: Estimates for 84 developing countries. Washington, DC: World Bank.

    Google Scholar 

  • Hohmann, S., & Garenne, M. (2011). Absolute versus relative measures of poverty. Application to DHS African surveys. Journal of US-China Public Administration, 8(7), 748–762.

    Google Scholar 

  • Kearns, G. (1988). The urban penalty and the population history of England. In A. Brändström & L. G. Telebrad (Eds.), Society, health and population during the demographic transition (pp. 231–236). Stockholm: Almqvist & Wiksell International.

    Google Scholar 

  • Kearns, G. (1993). Le handicap urbain et la baisse de la mortalité en Angleterre et au Pays de Galles 1851–1900. Annales de Démographie Historique, 1993, 75–105.

    Article  Google Scholar 

  • Leon, D. A. (2008). Cities, urbanization and health. International Journal of Epidemiology, 37(1), 4–8.

    Article  Google Scholar 

  • Montgomery, M. R. (2009). Urban poverty and health in developing countries. [Population Reference Bureau]. Population Bulletin, 64(2), 20 p.

    Google Scholar 

  • Montgomery, M. R., & Ezeh, A. C. (2005). The health of urban populations in developing countries. In S. Galea & D. Vlahov (Eds.), Handbook of urban health: Populations, methods and practice (pp. 201–222). New York: Springer.

    Chapter  Google Scholar 

  • Montgomery, M. R., Stren, R., Cohen, B., & Reed, H. E. (Eds.). (2004). Cities transformed: Demographic change and its implications in the developing world (pp. 108–154). London: Earthscan.

    Google Scholar 

  • Newell, M. L., Brahmbhatt, H., & Ghys, P. D. (2004). Child mortality and HIV infection in Africa: A review. AIDS, 18(suppl 2), S27–S34.

    Article  Google Scholar 

  • Patel, R. B., & Burke, T. F. (2009). Urbanization: An emerging humanitarian disaster. The New England Journal of Medicine, 361, 741–743.

    Article  Google Scholar 

  • Preston, S. H. (1985). Resources, knowledge, and child mortality: A comparison of the US in the late nineteenth century and developing countries today. In Proceedings of the IUSSP international population conference. Florence. June 5–12, 1985 , 4, 373–388.

    Google Scholar 

  • Preston, S. H., & Haines, M. (1991). Fatal years: Child mortality in the late nineteenth century America. Princeton: Princeton University Press.

    Book  Google Scholar 

  • Preston, S. H., & van de Walle, E. (1978). Urban French mortality in the nineteenth century. Population Studies, 32(2), 275–297.

    Article  Google Scholar 

  • Pryer, J. N., & Crook, N. (1988). Cities of hunger: Urban malnutrition in developing countries. Oxford: Oxfam.

    Google Scholar 

  • Reher, D. S. (2001). In search of the urban penalty: Exploring urban and rural mortality patterns in Spain during the demographic transition. International Journal of Population Geography, 7, 105–127.

    Article  Google Scholar 

  • Rosen, G. (1958). A history of public health. New York: MD Publications.

    Book  Google Scholar 

  • Stolnitz, G. (1955). A century of international mortality trends, pt. 1. Population Studies, 9(1), 24–55.

    Article  Google Scholar 

  • Stolnitz, G. J. (1965). Recent mortality trends in Latin America, Asia and Africa: Review and re-interpretation. Population Studies, 19(2), 117–138.

    Google Scholar 

  • Szreter, S., & Mooney, G. (1998). Urbanization, mortality and the standard of living debate: New estimates of the expectation of life at birth in the nineteenth-century British cities. Economic History Review, 51, 84–112.

    Article  Google Scholar 

  • Timaeus, I. M., & Lush, L. (1995). Intra-urban differentials in child health. Health Transition Review, 5(2), 163–190.

    Google Scholar 

  • Van de Poel, A., O’Donnell, O., & van Doorslaer, E. (2007). Are urban children really healthier? Evidence from 47 developing countries. Social Science & Medicine, 65, 1986–2003.

    Article  Google Scholar 

  • Van der Woude, A. D. (1982). Population developments in the northern Netherlands (1500–1800) and the validity of the “urban graveyard effect”. Annales de Démographie Historique, 1982, 55–75.

    Article  Google Scholar 

  • Van Poppel, F. (1989). Urban-rural regional differences in demographic behaviour: The Netherlands, 1850–1960. Journal of Urban History, 15, 363–398.

    Article  Google Scholar 

  • Walsh, J. A., & Warren, K. S. (1979). Selective primary health care: An interim strategy for disease control in developing countries. The New England Journal of Medicine, 301, 967–974.

    Article  Google Scholar 

  • Woods, R. (2003). Urban rural mortality differentials: An unresolved debate. Population and Development Review, 29, 29–46.

    Article  Google Scholar 

  • Woods, R. I., Patterson, P. A., & Woodward, J. H. (1988). Mortality decline in England and Wales, 1861–1921. Population Studies, 42(3), 343–366.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut de Recherche pour le Développement (IRD), Paris, France

    Michel Garenne

  2. Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France

    Michel Garenne

  3. School of Public Health, Witwatersrand University, Johannesburg, South Africa

    Michel Garenne

Authors
  1. Michel Garenne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel Garenne .

Editor information

Editors and Affiliations

  1. CCHS-CSIC, Spanish National Research Council CCHS-CSIC, Madrid, Spain

    Diego Ramiro Fariñas

  2. University of Geneva, CIGEV University of Geneva, Geneva, Switzerland

    Michel Oris

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Garenne, M. (2016). Will Urban and Rural Mortality Converge in Africa?. In: Ramiro Fariñas, D., Oris, M. (eds) New Approaches to Death in Cities during the Health Transition. International Studies in Population, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-319-43002-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43002-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43001-0

  • Online ISBN: 978-3-319-43002-7

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation