But children who grow up under these conditions suffer a dual burden, as they have yet to fully develop physically and mentally. What are the primary factors that drive poor health outcomes of children residing in slum conditions and what can be done to reduce these disparities? Fairly recently, global attention has turned toward the conditions in slum areas with the inclusion of Millennium Development Goal (MDG) 7 Target 7D: ‘‘By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers’’.

That seemingly lofty goal is followed by ‘‘slum improvements, though considerable, are failing to keep pace with the growing ranks of the urban poor.’’ That is a gross understatement. Even the MDG target falls far short of the need. The number of slum dwellers is growing at an alarming rate: a tripling of slum dwellers in less than 3 decades. In 1976, 1.5 billion people lived in urban areas, and one-third were slum dwellers. In 2002, 3 billion or 47% of the world’s population lived in cities and 1 billion or 16% lived in slums.

It is expected that this number will double by 2030. Most of the urbanization is occurring in the least developed countries and many municipalities do not have the infrastructure to deal with the rapid expansion and lack the financial and human resources to provide basic utilities. In all regions of the developing world, the growth of slums, also known as informal settlements, is appallingly apparent. In Africa alone, close to 70 million live in slums; 6 of every 10 urban dwellers . This will likely continue to expand, as currently, 38% of the 297 million Africans live in urban areas , with an additional 60 million migrating into urban areas every year . In India, as of 2007, approximately 170 million people lived in slums and one-third of them were children. The rapid pace of urbanization is global.

Families and individuals move from rural to urban areas for several key perceptions, many are misperceptions: (1) employment opportunities and higher incomes, (2) availability of more and better social services and health care, (3) improved water supply and infrastructure, (4) a greater variety of educational opportunities, and (5) the reality of increasingly fractionated family lands yet more mouths to feed, declining crop production, and/or decreasing income from sale of crops. Many rural urban migrants are poorer and less educated than their non migrant neighbors. As an example, in Nigeria, 62% of rural to urban migrants met the poor index compared with 13% of rural non migrants, and with 19% of those living in the city. Sixty-five percent of the mothers leaving the rural areas had no education, as compared with 28% of those who did not migrate and 44% of those living in the city. Seeking a new and better life in the urban areas, these poorest of the poor and less educated from rural communities immigrate to the city. Yet on arrival, work is often scarce and individuals and families find themselves joining the urban poor. Residing in slum areas, they may find less access to the resources and services they were seeking when they left the rural areas.