The Health, Economic and Environmental Impacts of Urbanization in the Philippines

Introduction

As described by the United Nations Population Fund (UNFPA) (2007), “The world is undergoing the largest wave of urban growth.” More than half of the world’s population now lives in urban areas. This global phenomenon is happening across different regions and development levels in the world. Richer countries in Europe and the Americas already large percentage of their population live in towns and cities, while developing countries in Africa and Asia, still a large percentage of their population lives in rural areas, however urbanizing faster than developed countries. The landscape of human settlement is changing due to these global trends, with significant effects on health, living conditions, the environment, and development across the world. The purpose of this paper is to discuss the health, economic and environmental impacts of urbanization in the Philippines.

What is Urbanization?

Urbanization is defined as “the process by which an increasing proportion of the population comes to live in urban areas” (Yassi et al, 2011, p. 293). Many theories of development view urbanization and industrialization as interdependent processes of modern economics. However, according to Gollin et al (2013, p. 2), these two concepts are not synonymous, and they argue that there is not a strong association between urbanization and industrialization specifically among developing countries today. They pointed out that there are many countries, which have not industrialized significantly but are highly urbanized. One widely accepted theory of urban origins is that cities emerged from places where agriculture was highly productive to feed enough people, which lead to population concentration. Because of the abundance of food people became free of agricultural demands and therefore began to engage into other types of economic activities (Boone & Fragkias, 2013, p. 14).

In today’s setting, urbanization is a result of migration of populations from rural areas to urban areas, or a natural population increase caused by a decrease in death rates while birth rates remain high (Cyril et al, 2013, pp. 1-2). The main cause of urban migration is because rural people perceive cities to have better job opportunities, better living conditions, better access to health care, education, social services, cultural events. Other causes of urban migration include wars, natural disaster, or sustained ecological changes such as land degradation and exhaustion of natural resources (The Cities Alliance, 2014). Urbanization has both positive and negative factors. Cities provide people good access to employment, education, health and social services. It is in the cities that generate income through internal commerce, foreign trade, modern technological development and industry. However, the rapid urban growth leads to increasing unemployment, environmental degradation, lack of urban services, creation of slums, strain on existing urban infrastructure due to overpopulation, as well as social problems such as socio-economic inequalities, prostitution, and crime (Cyril et al, 2013, p. 2).

Urbanization in the Philippines

The Philippines is one of the world’s fastest urbanizing countries. According to the Philippine Statistic Authority (2013), in 2010 the Philippines had a population of 92.3 million, with 41.9 million (45.3%) living in urban areas. The National Capital Region (NCR) is entirely urban. Region III, Region IV-A, Region XI, and Region XII all now have a level of urbanization higher than the level of urbanization for the whole country. Ooi and Phua (2007, p. 4) stated that the high levels of rural poverty due to droughts, low farm productivity, and lack of employment opportunities are pushing Filipinos into the cities. The concentration of economic development in some urban areas and rapid population growth throughout the country are the factors contributing to persistence and formation of slums, which severely tests the coping capacity of city governments and is a major obstacle in efforts to reduce poverty and improve living standards in the Philippines.

Health Impacts of Urbanization

The Philippines is among the countries where health is directly severely affected by urban living. UNICEF (2009) reported “Thousands lack food, potable water, sanitation, education, family planning, decent housing, information, and participation.” These are seen in the poorest neighborhoods resulting to health inequalities. Due to rapid increase of urban growth it has become harder for people to find employment, especially for those who are less educated. People become hyper-competitive willing to engage in cheap labor with long working hours compromising their health. Some engage in prostitution making themselves at great risk to sexually transmitted diseases and sexual abuse (Cyril et al, 2013, p. 2). The location of where people live (including living conditions) is a determinant of urban health. Many of the urban poor live in the worst areas of the cities, squatting underneath bridges or beside rivers, living in cheap, self-made houses that make themselves vulnerable to typhoons, floods, and landslides (Singh, 2012). Some are homeless and strive to survive without basic facilities such as toilets. Homeless people are at risk of social breakdown, isolation, loneliness, depression, and alcohol and drug dependency. Urban crime and violence are associated with alcohol and drug dependency, homelessness, and poverty (Srivastava, 2009, p. 2). Furthermore, diseases, poor nutrition, and lower life expectancy threaten people who are homeless or living in poor housing conditions. Philippine slums have significantly higher child mortality compared to rural child mortality, which is mainly due to poverty and high incidence of water-borne infections in the slums (Godfrey & Julien, 2005, pp. 139-140).

The urban poor are more susceptible to non-communicable diseases because they are materially deprived, have lesser choices to pursue a healthier lifestyle and are more engaged in undertaking risky behaviors. Therefore they are vulnerable to disease, have limited access to good and quality care, and lesser chances in preventing complications. Non-communicable disease prevention for the urban poor will require changes in lifestyle related behaviors such as smoking, physical activity, and diet. Efforts need to be combined with investments in education, food policies, and urban physical infrastructure (Ala et al, 2008, pp. 2-3).

The Department of Health of the Philippines developed the Urban Health System Development (UHSD) Program to address the challenges of rapid urbanization caused by the interplay of different social determinants of health. UHSD incorporated the Healthy Cities Initiative (HCI) to continuously improving health and its social determinants and creating and improving physical and social environments. Reaching Every Depressed Barangay (RED)/Reaching the Urban Poor (RUP) is another strategy that reaches out to the urban poor and disadvantaged groups to increase access to health services. Another program initiated by UHSD is the Environmentally Sustainable and Healthy Urban Transport (ESHUT) responsible for developing projects that improve the policy, design and practice of an urban transport system that will help to improve health and safety of the people. Another development component of the UHSD is the Urban Health Equity Assessment and Response Tool (Urban HEART) used to identify and response to health equity concerns (DOH, 2011).

According to the National Nutrition Council (NNC) (2011), many Filipinos go hungry because they lack or do not have food to eat, and money to buy food to eat. In response to this problem the government developed the Hunger-Mitigation Program (HMP) that has two major components: the Food for School Program, which involves giving of 1 kg of iron-fortified rice daily for 120 days to poor families who suffer from hunger through children from school; and Tindahan Natin, which ensures that basic commodities such as rice and noodles are available for poor families at lower prices.

Economic Impacts of Urbanization

Urbanization is associated with social and economic development. Rapid urban growth burdens the capacity of local and national governments to provide even the most basic of services such as water, electricity and sewerage (UNFPA, 1999). In the Philippines farming is associated with poverty that is why one problem the Philippines is facing now is that the younger generations are no longer interested in farming or any agricultural activities. Most rural families desiring that their children will pursue employment in commercial centers in the cities. Firstly, this urban neglect has resulted to the depletion of agricultural workers. In response to this problem the government is now offering scholarship programs that combine classroom lectures and field training in farming to young people with the right skills and motivation who have dropped out of school (IRIN, 2014). Secondly, as the influx of urban migration continues the cities has become overpopulated causing shortage in job vacancies. For example the Calabarzon region, the second most densely populated region in the country, mainly because it is the nearest region to metro Manila where the industrial and economic opportunities exit. It is one of the country’s top regions for economic investment and growth. However, its unemployment rate is 9.4%, the second highest in the country next to NCR (Colson & Lusterio-Berja, 2008, p. 1). According to the National Statistics Office (NSO) out of five persons in metro Manila one is engaged in an informal economic activity as an owner/operator or as a worker, and approximately 70% with income less than the official poverty threshold. The International Labour Organization (ILO) Philippines promotes opportunities for men and women to have decent and productive work, in conditions of social justice and labour rights (ILO, 2002, pp. 3 & 6). Promoting Youth Employment in the Philippines (PYEP) is one initiative by ILO that facilitates job opportunities for Filipino youth. It aims to improve the national youth employment policy and action agenda; strengthen capability of institutional partners to provide models of providing youth employment support services; and enhance the knowledge base on youth employment through improved documentation and adoption of best practices in the delivery of youth employment support services (Habito, 2009, p. 6).

In Metro Manila, there are no linkages between economic development, urban growth and the provision of housing. The urban poor cannot afford the increasing costs of housing in rapidly growing cities unless city governments provide affordable housing (Ooi & Phua, 2007, p. 11). The government has come up with the Conditional Cash Transfer (CCT) program that gives money to poor families with the condition that they meet their civic duties by ensuring that they receive basic healthcare and send their children to school. It is the female head of the family that receives the money, as men have a risk of spending money in vices. CCT has aided over 2 million families since 2008, with nearly half of the poor Filipino families already receiving CCTs. Its budget is about $450 million with the help of international organizations including the World Bank (Poverties, 2013). In response to natural calamities, the National Food Authority distributes assistance to affected areas in providing relief goods. Also, the private sectors, NGOs, and international donors are actively involved in the planning, financing, and implementation of a lot of these initiatives (World Bank, 2007).

Environmental Impacts of Urbanization

Many urban areas are now considered to be as the unhealthiest places for people to live. The most visible environmental impacts of urbanization include improper waste disposal, deforestation, land degradation (e.g. soil erosion), and brown haze of smog hovering over the cities. Less visible environmental impacts are the increased level of carbon dioxide in the atmosphere, water and land pollution, and industrial and hazardous wastes (UNFPA, 1999). As rapid urbanization continues to expand forming slums and squatter settlements, these areas become vulnerable to hazards such as floods, typhoons, fires, and earthquakes. The impoverished are at risk and exposed because no infrastructures, institutions, and processes have been set in place. These environmental hazards can lead to economic and human losses. Therefore effective risk reduction investments need to be incorporated in urban planning and must be top priorities. Increased in knowledge and expertise is vital to enable the government and communities to build more resilient urban environments (Singh, 2012). The Development of Poor Urban Communities Sector Project (DPUCSP) was started in 2005 to help out poor urban communities and their local governments in establishing housing development strategies that prioritized sites for community-based upgrading and negotiated relocation, that is sustained by operation plans for funding. These shelter upgrading and community infrastructure development plans will find mechanisms for building the assets of the urban poor at the community level, and at the same time provide a channel for effective policy development (UNHABITAT, 2014).

Due to this rapid urban migration and industrial growth, environmental issues such as pollution, waste management, conservation, and natural resource management have become a major concern. This means that more investments is needed in developing and maintaining infrastructure and services so that residents of the regions will continue to experience relatively good living standards (Colson & Lusterio-Berja, 2008, p. 1). Due to the pollution and rising insufficiency of renewable resources threatens not only the environment but also human health and welfare. The impact of population growth in urban areas can push communities into unsustainable practices, such as improper waste disposal (UNFPA, 1999).

Because of the rapid urban growth and the inadequacy of infrastructure and services it is difficult for any means of infrastructure to respond effectively to the needs of urban life. For example, there is sudden heavy rain and the whole densely populated city gets flooded, but supposedly, the flood should have been prevented because of working sewer and drainage systems. This indicates that as the urban population continues to increase, the amount of solid waste generated per day also increases. NCR generate about a quarter of the country’s total waste. The Philippine government has developed a number of strategies to protect the environment from the hazards caused by improper waste disposal. Local Government Units (LGUs) have been effective in managing solid waste, requiring cities and municipalities to provide efficient collection, transportation and disposal of wastes under PD No. 856, Code of Sanitation and PD 1152, Philippine Environmental Code (Kojima & Machida, 2011, pp.69-71). Air pollution is another unwanted element that is linked to urbanization. Industries and motor vehicles produce large quantities of carbon dioxide and other waste gases into the atmosphere. More vehicles mean more pollution. These toxic gases coming from the vehicles can cause acid rain that is damages the ecosystem and its organisms. The Asian Development Bank (ADB) funded the Metro Manila Air Quality Improvement Sector Development Program in promoting effective environmental management system to address the pollution problem in large urban cities like Metro Manila (ADB, 2012). The Department of Environment and Natural Resources (DENR), Transportation and Communication (DOTC), Trade and Industry (DTI), Energy (DEO), and LGUs implemented the Clean Air Act for the purpose of pollution prevention; for example, requiring a smoke emission tests before renewal of registration. The DOE has also been efficient in promoting the use of cleaner alternative fuels in government vehicles and public transportation, reducing significantly the harmful content in fuel (e.g. benzene in unleaded gasoline) (Caparas, 2014).

Conclusion

The proliferation of slum and squatter settlements exposes social inequalities. The rapid increase in population growth plunges the urban poor further into cycle of disease, poverty and social isolation due to high out-of pocket expenditure and slow national development, the country’s burden of poverty becomes bigger and causing a greater gap in health inequalities. At the same time impact of rapid population growth in urban areas can push communities into unsustainable practices, such as improper waste disposal. Unplanned urban expansion tests governments and municipalities, overwhelming their management and financial capacities. Economic growth needs to be aligned with the planned development of health services, environmental infrastructure, and housing. The health, economic and environmental impacts of urbanization is not determined by how large the population is, but by the behavior of the population. The decisions individuals and society make now will largely determine the future.

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