Pakistan's affluence sparks health fears

By James Melik
Reporter, Business Daily, BBC World Service

Image caption,
Natural disasters have been responsible for an increase in water-borne diseases

Pakistan has the double burden of coping with infectious diseases always associated with poor countries, along with so-called diseases of affluence.

The former prime minister, Shaukat Aziz, says public health issues are evolving, like most things in the world.

Developing countries which are going through rapid urbanisation and growth face a change in demographics and that has an impact on human security and health.

"When you have large numbers of the population moving to cities from the countryside, the infrastructure gets strained and stretched," Mr Aziz says.

"That gives rise to disease, lack of sanitation, lack of water and a lack of housing."

Shift in emphasis

Mr Aziz says that is why his government focused on health care in large urban centres.

"If you look at the world today, four countries account for a large part of the global population in the emerging market," he says.

As the dynamics and demographics of a city change, health problems increase as well. That puts additional pressure on the water supply, sanitation and health care facilities.

"What you see is not just communicable diseases which affect the health of the people," he says.

"What you also see are diseases of lifestyle - of affluent societies."

Among the major issues in urban areas are heart diseases, diabetes and mental disorders.

"Stress is the biggest thing you get in a large urban centre," Mr Aziz says.

He believes that is understandable, because if people are in a remote rural area, their income may be low, but their stress level may also be low.

"When you come to a city, you are anxious to do better. You want to live in this huge place and make a good living and create a niche for yourself," he says.

"That gives you pressures you don't get in the village."

Housing problem

When developing cities experience a large influx of people, there is by definition an increase in slum dwellings, which exist because there are not enough homes.

With more people living in shanty towns, the rich-poor divide becomes more pronounced.

"People don't have access to toilets or running water - they have to queue up with a bucket to get water," Mr Aziz notes.

"So personal hygiene gets affected and your whole state of mind gets affected and in those conditions, people are also more vulnerable to communicable diseases."

Mobilising forces

According to Mr Aziz, for any country to make a impact in these areas, there have to be clear lines of authority and a clear sense of who will manage what.

"Unless you have clear divisions of responsibility, with more of that responsibility with the city government closer to the people, you will not get the results you need," he proclaims.

He points to Bogota, the capital of Colombia, as being an excellent example of a system which works.

"The mayor was empowered to deal with human security and health issues, so he could plan and line up the resources," he says.

"You also need civil society to be mobilised, you need philanthropists to come in," he adds.

He says matters cannot always be left to central government when it comes to cities with a population as big as 20 million.

"When I was prime minister, there were improvements," Mr Aziz says, "Measuring it was a problem, so we started household surveys to gather information, then we came up with policies to improve health care."

Mr Aziz also believes that it is necessary to lower general subsidies, but increase targeted subsidies.

"When you have a general subsidy, the richest person in society benefits as much as the poorest person," he says.

Tackling the problem

He is proud of his government's achievements in encouraging the private sector and non-profit organisations to become part of the delivery chain.

Only when there is an increase in income levels can there be a reduction in poverty levels.

Image caption,
Karachi has a population of more than 13 million and continues to grow rapidly

In rural areas, the best way to increase income is through agriculture, while urban jobs have to be created in industry and the service sector.

But that, in turn, attracts more people to the cities, exacerbating the lack of proper housing and prevalence of slums.

"The biggest challenge is always implementation," says Mr Aziz.

"I will be the first to say that it was not always perfect, because you are as weak as the weakest link in the chain. We made improvements and we made progress, but clearly there is much more to be done."

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