Urbanization and Mental Health: A Look at the Developing World

Spencer Hurt. Originally published in the HIR Winter 2019 Issue.

From disease to famine, corruption to war, poverty to unsustainable living, developing nations and their peoples have long endured remarkable numbers of hardships. But as these countries become more environmentally conscious, gain access to modern day medicine, improve education, seek regional stability, and adopt more advanced economies, their current conditions and future mostly appear far less problematic and more optimistic. However, as these regions start to catch up with their developed counterparts, not all has been well, particularly for the youth.

Rapid urbanization has become responsible for the growth of various “fringe populations” that undergo poverty and unhealthy living conditions. Crime, substance abuse, and alcoholism are all more significant problems in cities rather than rural areas across the globe. Families are more unstable and likely to disintegrate in densely populated areas, while urban populations are the epicenters of cultural change and division. All of these trends associated with the development of countries throughout the world have a devastating impact on mental health. Unfortunately, children and teenagers are particularly vulnerable and susceptible to these ailments. Consequently, as their homes become more like those in the developed world, the youth of emerging nations are beginning to face a mental health crisis.

South Asia

South Asia is seeing more and more people move into urban population centers. Consider Malaysia: according to The World Bank, the nation is experiencing an unusually high urban growth rate of 3.8 percent due to people migrating in pursuit of jobs, better healthcare, and better infrastructure. Today, 74 percent of people in the country live in an urbanized location. However, Malaysia is not alone. The World Bank has also found that 250 million more people will be living in cities throughout South Asia by 2030. In fact, Cambodia and Lao People’s Democratic Republic, both smaller than Malaysia, along with Vietnam, have been experiencing even higher rates of urbanization.

It becomes clear that these trends will have an increasing impact on youth when you consider that countries like India have large younger populations; a study conducted by the IRIS Knowledge Foundation projected the nation will become the youngest in the world by 2020. Unfortunately, researchers from the Indian National Institute of Mental Health and Neuroscience found that urban children and teens in the country are more likely to face addiction to technology and substance abuse. Time after time, these risk factors have been associated with poor mental health. We are only going to see these problems become more prominent as the urban youth population expands.

The World Bank has also demonstrated that living in urban areas is not necessarily better for many Indians. In 2011, 65.6 million of them lived in urban slums, and 13.7 percent of the urban population fell under the poverty line. Many of these residents are, sadly, children and teenagers. These conditions can drive many to desperation and are often one of the root causes in cases of mental illness.

A change in social values also accompanies urbanization. The Indian youth are becoming more progressive, adopting new views on a range of topics from marriage and premarital sex to financial independence. This often clashes with traditional values held by many, especially older family members. Furthermore, with an increasing emphasis on education and academic achievement, many teenagers feel unhappy as a potential source of disappointment for their family. Consequently, many have to suffer through dissolving family support structures.

As the youth face punishment for their personal ideals, endure poor living conditions, rely heavily on technology, and often become susceptible to drugs, their mental health becomes worse while future prospects are pushed aside. In 2011, 12.5 percent of children aged between 0 and 16 years old suffered from some psychiatric disorder. Furthermore, with a rate of 36 per 100,000 youths in 2012, many resulted in the worst possible scenario: suicide. Tragically, every hour, a student in India takes his or her own life.

Much of the mental health problem that coincides with urbanization has been exacerbated throughout the region by little government spending on aid and resources. In 2011, India only spent 0.06 percent of its health budget on mental health, which is extraordinarily smaller than the approximately 4 percent or more spent in most developed countries. Unfortunately, developing nations have many concerns—including hygiene and sanitation—that are of more significant focus in the world of public health. Furthermore, developing countries have many other priorities that need to be balanced. For example, other development projects such as infrastructure require large flows of money.

Making the problem even worse, the Ministry of Health and Family Welfare in the Lok Sabha shared in 2015 that the country faces an 87 percent shortage of mental health professionals. In addition, the majority of patients are forced to pay substantial out-of-pocket costs due to the absence of, or ineffective, prepaid mechanisms. Mental health care simply is not accessible in countries like India.

In 2016, researchers from Manipal University’s Department of Public Health discovered that adolescents in South India often resort to family members or to no one when seeking care for their mental health. These numbers clearly reflect two things: the lack of resources in the state and the suffocating stigma against mental illness. Unfortunately, as family support structures become strained by increasingly progressive ideals, youth will have even less resources. These conditions will only exacerbate the unhealthy influences of urbanization on mental health throughout the country, contributing to and increasing the desperation among children and teenagers.

Central and Western Africa

In Nigeria, the presence of urbanization is increasingly present. Even though the country has traditionally been rural throughout its history, rapid evolution in its social and economic patterns has directed people towards the cities. This trend is found throughout most African nations, but one thing sets Nigeria apart: rather than experiencing populations shifts towards one urban center, several large cities of importance have seen growth. In 2017, the UN Population Division put the urban proportion of the country at just under 50 percent, a significant increase from only a third of the population two decades earlier.

Similar to India, Nigeria has also been seeing massive population growth. This boom has the country projected to become the third most populous country in the world by 2050, surpassing the United States. In other words, the population’s overall age is getting younger and younger, expanding the groups most vulnerable to the consequences of rapid urbanization.

Interestingly, many of the problems that typically arrive with urbanization have already been afflicting Nigeria for quite some time; cocaine and heroin are often trafficked, with numbers of drug-related arrests on the rise ever since the 1980s. However, Lagos, Kano, and Abuja, three major cities, are the epicenters of Nigeria’s drug crisis. Unfortunately, people in or nearby these centers of population are particularly vulnerable to substance abuse. Researchers from Obafemi Awolowo University discovered that among Nigerian university students, drug and alcohol abuse was predominant among those who have a mental illness, an increasing number of youth surrounded by drugs in the city cannot be suitable for overall health.

Just as problematic is the bleak economic outlook for many young people in Nigeria. Rising unemployment rates have accompanied the high rates of urbanization; because job prospects often motivate urban migration outside of rural Nigeria, there is usually a shortage of employment in the cities. This disproportionately affects young people, as many experience the detrimental effects of joblessness. The lack of economic prosperity is just another factor that degrades the mental health of many young populations. The risk of not obtaining a job may be a leading cause for many suicides that have occurred after a person fails to score well on an exam or find a job.

With the World Health Organization pegging Nigeria’s suicide rate at 9.5 per 100,000 people in 2016, mental health clearly is an issue. However, the country has attempted to take action, promoting drug-free lifestyles among youth and working to increase economic prosperity. In spite of this, it is fair to say they have not been terribly successful. As of now, urbanization and its associated crime, substance abuse, and lack of economic well-being are winning.

Furthermore, there are many difficulties when it comes to treating mental illness in Nigeria. Formerly a country where HIV, strokes and heart attacks, malaria, and many other diseases were leading causes of death, Nigeria’s government has had little time to develop a focus on mental health and devise a method to treat it properly. This, in conjunction with a lack of money to fund initiatives, are proving problematic for the Nigerian people.

South America

With drought and adverse weather, combined with factors like deforestation, life in urbanized areas has become more reliable than in rural Brazil. This may be accountable for the fact that, according to the United Nations Population Division, the urban population will have grown from 36.5 percent in 1950 to 90.5 percent in 2030, surpassing developed countries like the United States, which is anticipated to have an urban population of 84.5 percent.

Researchers from the London School of Hygiene and Tropical Medicine and the Institute of Psychiatry found that among many school children who have mental illness, most also suffered from living in dangerous regions and unstable or unusual family conditions. Unfortunately, many cities such as Rio de Janeiro host poverty-ridden favela (Brazilian Portuguese for slum), where crime and financial problems put stress on families and the overall health of their children. In 2010, 22.03 percent of Rio de Janeiro’s population lived in favelas. Numbers are similarly high in other cities, such as Sao Paulo. Urbanization favors growth in these low-income parts of Brazil. Compared to the rest of the city, which grew 3.4 percent over ten years, favelas increased 27.65 percent in Rio de Janeiro.

Favelas bring more harm to children than just poverty. Often times, they miss out on education after quitting due to financial stress. In other cases, they become involved in the rampant drug trade, seeing it as one of the few ways to become financially comfortable. Unfortunately, the government does very little to intervene in these extensive problems and leaves work to charities and organizations that are spread thin or fall victim to corruption. This translates to very little care for low-income youths that face the consequences of mental illness.

Considering that the World Health Organization found in 2017 that Brazil is one of the leading countries for depressive and anxiety disorders, mental health has been a long-overlooked problem that will only continue to worsen in the low-poverty areas that are nurtured by urbanization.

A Global Problem

With the majority of developing countries, the consequences of rapid development are indeed of global concern. Moreover, take into consideration that many rural regions of already-developed nations are facing similar interests, the breadth of this issue is expanding on a global scale. Urbanization will soon be influencing the lifestyles of most people, with the United Nations reporting in 2016 that by 2030, two-thirds of the world’s population will be living in cities.

Regardless of the country, urbanization mostly has the same implications, ranging from crime to poverty to destabilized families. However, developing nations are far more ill-equipped to address these problems and stop them from impeding on the mental and physical wellbeing of people, especially children. While it may be a strain on countries that are working to invest in things such as infrastructure or are concerned with health crises such as infectious diseases, they need to take action to protect the youth who are so vulnerable to mental illness. Achieving these goals requires better economic policy, providing coverage for mental health care providers, and increasing mental health literacy among school children. Hopefully, these could be steps towards resolving the issues in cities that worsen health conditions and thereby prevent children from getting the help they need, and addressing the stigma against those who lack mental wellbeing.