Poor children, especially those living "in the streets," are exposed daily to a host of factors that contribute to ill health in urban settings in both industrialized and developing countries, according to new research by a UNICEF official.
Writing in a special issue of the journal, Health Education & Behavior, Ximena de la Barra, senior urban advisor with UNICEF, describes a declining urban health environment that affects millions of children: lack of basic nutrition, inadequate sanitation and water supplies, uncollected garbage, overcrowding, food contamination, pollution, exposure to infectious diseases, violence, both physical and sexual abuse, social and psychological instability, and insecurity and fear.
Childhope, Inc. estimated in 1991 that there were 100 million street children in the world - those who have left home for one reason or another - including 40 million in Latin America, 25-30 million in Asia, 10 million in Africa, and the remaining 20-25 million dispersed among industrialized countries.
"Poverty, which used to be a mainly rural phenomenon," de la Barra writes, "is now concentrated in urban areas. Capital investment in urban infrastructure has not only not kept up with the pace of urbanization, but it has decreased." This, she says, has contributed to a "downward spiral...the poorer you are, the poorer you become" because access to basic needs costs more.
"At the bottom of the scale in urban disparity are children and youth living in the street. The existence of street children is a tragic expression of the failure of present society in its path toward development."
Cities, she notes, "are home to the extremes of wealth in both industrialized and developing worlds." Sao Paulo, Brazil, de la Barra reports, has the developing world's highest economic disparity and "equally high health disparities," where children under 5 in the most deprived zones have four times the respiratory and infectious disease mortality of those in the most privileged parts of the city.
De la Berra's analysis of programs to address problems faced by street
children revealed that the most successful involve the children in the
planning process, use child-to-child outreach as a main component, interact
with the children in the streets - on their own "turf," and coordinate
through a network of agencies, government bodies and community supporters.
Among successful programs she identifies:
- La Florida Municipality in Chile, which educates parents on how to
avoid family violence while reintegrating street children back into their
- Proyecto Compartir, in Tegucigalpa, Honduras, which offers job training,
counseling and community organizing to youths and their families in squatter
settlements before they end up in the streets.
- Catholic Action for Street Children, in Accra, Ghana, which runs a refuge center for street children that encourages and helps them with educational and vocational programs.
The special issue of Health Education & Behavior is the first of two focusing on community-based health education for urban populations.