Is the rise of the 'city' hiding a looming mental health crisis?
One in four people are worried about losing their home against their will in the next five years revealed in a survey of nine countries. This level of insecurity inevitably has a major impact on people's lives, and their mental health and wellbeing, as these are inextricably linked (pdf). So yes, World Health Day is right to talk about depression today, but we need to talk about urbanisation as well.
With more than half of humanity now living in urban areas, and with the urban population in South Asia and sub-Saharan Africa, two of the world's poorest regions, set to double in the next two decades, the development community urgently needs ask whether the ‘urban juggernaut’ hides a silently looming mental health and wellbeing crisis.
The age of the ‘global city’
With just 600 cities accounting for the majority of global GDP, people are arguing that it is not nation states, but “global cities” driving the world economy. However, to enable this city-centric view, the world economy has become remarkably exclusionary, with devastating consequences even for those who think they are not vulnerable.'
The growing inequalities produced by the new global market for land, and the triumph of finance capital, have displaced a dramatically increased number of people, leading to a rise in homelessness due to foreclosures and underemployment, and causing the criminalisation or incarceration of people as a form of social control, as articulated by Saskia Sassen. Simply put: people are being expelled at historically remarkable levels, not only from their habitats, but also from the benefits of the global economic system.
Yet, in all of this, the poorest and most marginalised urban residents, who live in squatter settlements and in constant fear of their home and their bodies being subjected to the violence of eviction, find themselves both in the crosshairs of the legal instruments used to formalise urban space, as well as at the mercy of local gangs and non-state security providers who are often deployed to carry out evictions on the state's behalf.
What does this rapid urban development mean for slum dwellers and their wellbeing?
Based on the experiences of informal workers living in informal settlements in India and Bangladesh Dolf te Lintelo, Allister McGregor and I found that slum dwellers have very diverse needs and expectations, so wellbeing can mean different things to different people.
In fact, some of the priorities of the slum dwellers included what many may consider as part of everyday life, and in fact a given: having year round access to their homes and places of work; easily accessible medical facilities; having an enclosed toilet; the ability to observe religious practice; having protection from work-related hazards; ability to bring change in community and getting respect from others.
These priorities also differed substantively across the informal settlements (not just within), but there was a distinct difference between men and women, where men are more likely to have ‘better’ wellbeing than women. This divide could well reflect the fact that globally women are typically engaged in the most insecure, unstable and poorest paid jobs.
The impact of violence on wellbeing
There is no doubt that violence affects both mental health and wellbeing. But, when it comes to interpersonal violence, and insecurity, both men and women are impacted adversely. This has important consequences for how safety and security interventions in cities are understood and implemented. Our experience of engaging directly with slum dwellers also shows that people who have faced violence in the form of demolitions linked to evictions, have poor wellbeing, as compared with those who have not had their dwellings demolished.
The demolition of a person's home also destroys their social connections and sours their overall outlook on life. And we are not alone in pointing out that the brutality of evictions and the trauma of relocation render a horrific impact on physical wellbeing. Studies from the world over point to the negative affect of evictions on women's access to healthcare (pdf); that women who had experienced recent or ongoing domestic violence were far more likely to face eviction than other women (pdf); that evicted and relocated families are not sending their daughters to school fearing for their physical safety (pdf); and that young men struggle with new networks of crime, violence and informal justice in their relocated settings.
Looking to the future
A crisis looms if we do not heed the warning signs of the impacts of violence inherent in those urban development regimes that are complicit in evicting the most marginalised communities from our cities. The 2030 Agenda and the New Urban Agenda call for cities that are inclusive, safe and resilient. But invariably, the extent to which we can meaningfully reach these ends is limited by the dysfunctional nature of current trends in urban development.
We need better metrics for understanding success and failure in cities. Metrics that go beyond material success, and assess a person's subjective and relational wellbeing as well. Otherwise, the urban juggernaut will get carried away with a blinkered focus on economic growth, and leave behind an increasing number of distressed, disadvantaged and disconnected people.
Find out more about the 3-D concept of wellbeing in ‘Beyond Business as Usual: What Might 3-D Wellbeing Contribute to MDG Momentum?’