Life on the margins: the inequality of food and nutrition

Life on the margins:
the inequality of food and nutrition security
PowerPoint presentation by
Médecins Sans Frontières / Doctors Without Borders
Schools Team: Mary Doherty and Severa von Wentzel
January 2014
Left behind, left out
“A long but inequitable period of economic growth has lifted many developing
countries into middle-income status but left a minority of their populations mired
in poverty. Since countries involved include China and India, even a minority
amounts to a very large number of people”
- “Free Exchange, the geography of poverty”, The Economist, September 1st 2012
“Growth alone does not guarantee less poverty. Income distribution matters,
too. One estimate found that two thirds of the fall in poverty was the result of
growth; one-third came from greater equality. More equal countries cut
poverty further and faster than unequal ones”
“Briefing Poverty: Not always with us”, The Economist June 1 2013
Action for students: What does marginalisation mean? What does the
author mean by ‘mired in poverty’? What is meant by ‘inequitable growth’?
Clearly, growth on its own does not guarantee less poverty. Income distribution
matters too. What is meant by ‘income distribution’? In your answer, refer to
the GINI co-efficient or other income inequality metrics. What is the difference
between relative and absolute poverty?
Life on the margins
Overview slide
Why do so many people live on the edge of survival whilst there is enough food
globally? Growing inequality poses one of the biggest social, economic and
political challenges. Today’s disparities and their dangerous likely trajectory
reduce the pace of human development most markedly for education and
Why does some form of hunger and malnutrition exist in every country? Hunger
and obesity, which can both be forms of malnutrition*, are complex conditions
and a serious worldwide problem. The deadly cycle of poverty, malnutrition and
disease is also largely preventable.
Malnutrition is directly affected by physical factors such as low nutrition.
It is indirectly affected by social inequality, poverty, education, social status of women,
food systems, climate change and the resilience of vulnerable populations to
stressors such as drought, floods, price hikes and conflict.
•Malnutrition: An abnormal physiological condition caused by inadequate, unbalanced or excessive consumption of macronutrients and/or
Source: The Lancet “The complex challenge of hunger”
Left out, left behind
“The world is
doing a lot better
than it ever has in
the past, at least
on average. And
that's terrific
news. Not so
good news is that
a lot of people got
left behind and
haven't got there
yet.” – Angus
Landless rural
Anyone on a low income
People with
poor health
groups of
Urban dwellers with
no formal
Refugees and
displaced people
People with low
literacy rates
Women and
children and
Source: Edexcel Student Guide Unit 4, Option 3;;
Factors of people
on the margins
Action for students:
1. Note in your folder the factors experienced by those at the very bottom of
the income distribution. Those on the margins tend to have one and usually
more than one of the following factors:
Live in remote areas,
Have low literacy, few assets and are low-skilled
Poor health with little or no access to a medical, public health or
welfare system,
Stem from socially or economically excluded groups (e.g., ethnic minorities,
migrants, refugees) or parts of society (e.g., women in some cultures)
Be landless (non-landowning, dispossessed or nomadic)
Be victims of natural hazards, violence or war
2. Be aware that statistics may be presented in different ways – for example,
the absolute number of hungry people is increasing with the growing world
population while the percentage of people who are hungry in the world is
Vulnerability can be variable within a country, within communities
and even within households. It is not defined by income or wealth alone,
but the key factor in the food insecurity cycle is wealth. There is a range of
people more vulnerable to food insecurity.
Health, wealth and inequality
Well-being is not defined merely in terms of material living standards,
which is one of its parts. It is judged by looking at the whole, not one or
more of its parts. Above and beyond an average, inequality must be taken
into account to judge well-being.
The concept includes:
• Income and wealth
• Physical and psychological state (health and happiness). These are about
how people are when they are alive, not just living and dying.
• Education
• Ability to participate in society.
Action for students: Watch the Financial Times interview with Angus
Deaton on health, wealth and inequality. What has been the trend in the
last decades and how is progress measured?
Inequality by region
for health, education and income
Income inequality is
correlated with health /
social problems
Individual income /
circumstances, background
(culture, ethnicity and
history) and welfare state
institutions and social
policies can also be
correlated with well-being.
Note to students:
correlation does not equal
causation (producing an
effect). A correlation
(mutual relationship)
between variables does not
mean that one causes the
Source: 2013 Human Development Report; Joseph Rowntree Foundation
“Does income inequality cause health and social problems?”
The causes of
health inequalities
More inroads are being made into global inequality, if you take improvements
in health into account. The gap between life expectancy between countries
has shrunk since the second world war.
Inequality and poverty
globally and locally
One of the world’s great challenges today, poverty and inequality (income,
gender, etc.) affect the well-being of populations or parts of populations.
A triad that holds true for all populations, Poverty reduces Dietary
Quality/Adequacy and lowers Health.
The development gap describes the social and economic disparity between the
wealthy and the poor between and within countries
The global development discourse has moved from the Brandt Line and indicators
on income (e.g., GNI, GDP, PPP) to
– Social indicators, deprivation, adult literacy, access to fresh water.
– Qualitative indicators dealing with vulnerability, Inequality, empowerment
and human rights.
BUT the global measures of inequality and poverty are fraught with difficulties.
In terms of inequality, the development discourse refers to gender and
malnutrition mostly in LEDCs countries.
Adverse political and social policies, instability and conflict are at the root causes
countries of countries on the wrong top ten (e.g, DRC, North Korea).
Income groups
Inequality can emerge as a consequence of progress and affect
progress. Inequality also has its own effects.
Modern inequality was brought about by modern economic growth.
North-West Europe and North America started experiencing sustained
economic growth about 250 years ago and pulled away from the rest of
the world. This ‘Great Divergence’ set the stage for the persistent
gaps, the hugely inequalities of the present day. The starkest evidence:
around a billion people still have low life expectancy and live in abject
Overall, the trend is encouraging, but the list of countries falling behind
is getting longer.
Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.
Comparing living
How do we compare who is poor, to what extent and who is not? Does
being poor mean being hungry?
The rhetorical link between poverty and hunger remains firmly established even
though the only the poorest in poor countries actually spend most of their
money on food. Economic growth means that:
• People become better-off, and even while they are still poor by most
standards, they spend a smaller fraction of their budgets on food.
• Economic growth makes it increasingly difficult to think of poverty entirely
in terms of food.
How to compare living standards around the world and count the number of
poor people on the basis of those comparisons?
Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.;;;
Comparing income
between countries
Comparisons between countries that are broadly similar such as USA
and Canada or OECD countries can stand on relatively firm ground.
PPP comparisons made between broadly similar regions or countries
can be useful.
It is very difficult to compare real income between countries, particularly
where countries have markedly different relative prices and economic
Though these measures will be contested and debated, they can serve
as the basis for global and national policy to allocate funds to the poor.
They are adjusted from time to time.
Measures of income:
Purchasing power parity
In order to measure poverty, we need to measure income. Doing so
across countries is difficult. Using foreign exchange rate of the local
currency is basically meaningless.
PPP Purchasing power parity helps compare living standards
across the world. It is used instead of the official exchange rate to
calculate the poverty line.
Simply put, PPP can better account for how price levels vary across
settings. For example, a price level for a bundle of goods will cost only
40% of what it would cost in the USA, so the PPP rate will be lower than
the foreign exchange rate in India.
Teams of international researchers and statisticians collect and
average out data on the prices of comparable items in different
countries to determine price levels around the world. The measure is
far from perfect, because there are no market prices for a substantial
share of what people spend.
Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.
Measures of income:
poverty line
Poverty line – is about defining a minimal standard of living, especially
having enough to eat. Choosing a poverty line is fraught with difficulties and
is almost always controversial. When states recognise poverty, they may
also have to accept responsibility to offset its worst impacts by distributing
funds to the poor.
Originally conceived as calorie-based poverty lines in many countries
around the world. The association with food also gives more political
support to anti-poverty programmes. Lines have tended to be updated for
inflation and changes in prices, so have usually been held constant in real
$ 1.25 / day – originally $1 / day, the World Bank Global Poverty Count
number of people in the world who live on less than a dollar a day, where
the international differences in prices are adjusted using purchasing power
parity exchange. It gained currency with the World Development Report
1990 and was incorporated into the Millennium Development Goals.
Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.
China and India,
the two countries
with the largest
populations in the
world, drove much
of the reduction in
global poverty
since 1980,
improving the lives
of over 1 billion
Source: Deaton, Angus, The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press, 2013.;;
Poverty line
Although the trend has gone down, poverty reduction measures have
tended to help people living close to the poverty line, not the very
poorest persons living on the margins.
Global inequality
Equal area cartogram*
* A cartogram depicts values by
areas while preserving the
aesthetics of relative geographic
position in striking images
depicting global inequalities.
GINI co-efficient
Action for students: What does the GINI coefficient measure? Explain
the global index measure. Explain the key for this map of income
distribution and give examples of most, medium and least equal countries.
North-South Division
and the “Rise of the South”
In the past the world was
divided into North and South,
also called the Brandt line
after an 1980s report on the
rich North and the poor South,
the UNDP now reports on the
“Rise of the South” with
significant advances in
countries like Brazil, China,
India, Indonesia, Mexico, South
Africa and Turkey. (See
Action for students:
What are the strengths and weaknesses of the Brandt line as an indicator?
Read Hans Rosling’s Debunking myths about the “third world”
Source: 2013 Human Development Report
Image success stories:
Southern success
Source: 2013 Human Development Report
Poverty line
in the UK
Action for students:
1. Find out what is meant by the poverty line. Why is it useful? Where is it
set? Who sets it? Is it relative in relation to different countries?
2. Is the experience of poverty the same in the UK and the developing world?
Note some of the similarities and differences relating back to the factors.
Start your research with the Trussell Trust.
North-South divide?
Action for students: Read
The Guardian article on
“Deprivation mapped: how
you show the poorest (and
richest) places in England”
including an animation on
the English indices of
deprivation. How and why
do you map micro-level
What are the limitations,
inaccuracies of scale (e.g.,
South Africa – Lesotho) on
Crown copyright and database rights 2012 Ordnance Survey 100020290
Living on the margins in the UK
Being left behind is not only confined to
countries with low income as indicated by the
graphs on growing income inequality and the
poorest tenth in the UK, for example.
Poorest closer
to home
3.8 million children estimated to
be living below the poverty line
3 million people
estimated to be
suffering from
malnutrition in
the UK
3.8 million
children in the
UK currently
living below the
poverty line.
Nutritious food
perceived as too
expensive and
out of reach
“The long economic slump and the rising price of food and energy have already made life
harder for the very poorest. At a church in Brixton, South London, desperate flock wait
for parcels of donated food....In the past, children collected food for the elderly, remarks the
vicar. Now they collect it for their classmates”
Image of report:
Image and graph from “Measuring Poverty: The end of the line”, The Economist November 17th 2012,
Source:; Report:
Austerity measures and
inequality in the UK
“The long-term social cost
of the economic crisis has
been underestimated. More
people are being evicted from their
homes. More people are trapped in
over indebtedness, as they face
increased living costs with reduced
income. Child poverty is growing
and young people are being
deprived from the possibility to
imagine a future. Vulnerable
people feel more and more
stigmatized in the public opinion,
as if they were responsible for their
situation and if social protection
was a luxury in times of
European Anti-Poverty Network, August
2013, as quoted in Oxfam’s ‘ A Cautionary
“I felt very ashamed having to go to a food bank
the first time. It was down to my son’s school liaison
officer coming round to my house, because I hadn’t sent
my son into school for a couple of days as I couldn’t
afford a packed lunch for him and I couldn’t afford to pay
for a school dinner. I couldn’t do what a mum should do
for them – look after them. I couldn’t even feed them.
That just makes you feel really low as a parent.”
Lorna, school dinner lady and mother of three, Tower Hamlets, London
Action for students:
1. Read Oxfam’s Briefing Paper “A Cautionary
Tale”, September 2013: English paper and UK
case study
2. What reasons and experiences does the report
give for why austerity measures in the UK have
increased poverty and inequality?
3. Why are the poorest and women hardest hit?
Rural – urban
food and nutrition (in)security
There is a myth that food insecurity is a rural problem that will be resolved through
technical innovation among smallholders. Actually, rapid urban growth in developing
countries and informal settlement expansion have been correlated with a significant
rise in undernutrition in urban populations.
Rural and urban areas also tend to be perceived as separate spheres with a deep
divide between them.. Actually, it’s a two-way flow where rural-urban contexts and
households are highly interconnected. People, goods and money move in and out
along a spectrum. Financial remittances can play an important part in rural
development. Rural households buy some or most of their food with cash from family
members who have moved within the country or across borders to earn income
Migration and urbanisation can have ambiguous consequences for nutrition
security, as they can help poverty alleviation, but also obstruct it.
In town and village, increased production rather than more equal access to food is
often assumed to be the answer to food security; actually, access to food – notably,
lacking means to purchase food buy it - can be a greater issue. Urban households
are more dependent on food purchase.
Urban terms
“Megacities: A city with a population of 10 million or more residents – largest are Delhi,
Shanghai, Mexico City, New York and Tokyo with over 20 million.
Metropolitan area: A large concentration of population, usually an area with 100,000 or
more people. The area typically includes an important city with 50,000 or more inhabitants
and the administrative areas bordering the city that are socially and economically
integrated with it.
Urban: Countries differ in the way they classify population as "urban" or "rural." Typically, a
community or settlement with a population of 2,000 or more is considered urban. A listing of
country definitions is published annually in the United Nations Demographic Yearbook.
Urban agglomeration: Refers to the population contained within the contours of a
contiguous territory inhabited at urban density levels without regard to administrative
boundaries. It usually incorporates the population in a city or town plus that in the suburban areas lying outside of but being adjacent to the city boundaries.
Urbanization: Growth in the proportion of a population living in urban areas.”
Peri-urban are located in-between consolidated urban and rural regions and have also
been traditionally important in food supply. Outskirts of large cities (e.g. Beijing) are under
constant threat from urban sprawl. Peri-urban areas tend to be defined by mixed land use,
poorer urban infrastructure and lower demographic density.
Source: Definitions taken verbatim from
Place of residence
Recent studies indicate that socio-economic factors determine health status
(indicator: child mortality) more than residence per se, so differences at the
household level have a greater effect than at the community level.
Urban versus rural
Usually has a modern health care system, facilitating public health
interventions (vaccinations, control of epidemic diseases, mother-to-child
Usually more advantageous environmental conditions – better electricity and
water supply.
Road and rail links usually ensure more constant and abundant food supply
But population explosion not matched by increase in services in recent
decades and access to services is uneven (proximity ≠ access)
Traditional and cultural norms changed by more wide spread schooling,
greater access to information and ethnic melting pot
Source: Lalou, Richard and Thomas LeGrand Child mortality in the
urban and rural Sahel
Urbanisation and
urban rural change
Action for students:
What are displacement factors?
How can rural-urban links relate to
life on the margins?
1. Look at “Rural-Urban Links for Growth and Poverty Reduction”, Joachim von Braun,
World Bank slideshare,
2. Watch clip on megatrends: population growth, urbanisation are displacement factors
3. Article on urbanisation
4. On England’s big cities. Urban Living: The city roars back,
5. Construct a mind map or spider diagram on urbanisation and urban-rural migration,
compare your diagram with a partner and then another pair, add in additional detail which
you consider relevant from the diagrams of other students.
Huge urban growth is connected to urban-rural migration, and most urban
growth is projected to take place in less developed countries. Magnitudes of
migration varied greatly
• Negative net-migration is most likely in rural areas.
• Positive net migration concentrates around urban areas (e.g., New Delhi)
• Africa and Latin America’s population has declined due to out-migration
across all decades.
• Asia has experienced fluctuations, but with overall out-migration.
• In Europe there was out-migration in 1970s and 1980s, which reversed in
the 1990s.
• North America has had an increase in migrants. The positive net migration
in North America and to some extent also in Europe may be for noneconomic reasons, a move to drier and sunnier areas with good amenities
like Arizona or the Mediterranean.
Image and source: Center for International Earth Sciences Network, “Migration in Risk-Prone Areas”
Urban and
rural populations
Action for students: Watch the TED Talk by Carolyn Steel on how advances in
transport and technology have emancipated cities from geography such that they
can grow to any size. Discuss why this has also distanced us from nature.
Urban and rural populations by population
group 1950 - 2050
Urbanisation trend:
terms and figures
The urban population
is growing by 193,107
new city-dwellers: 2
every second.
(UNHabitat). Urban
growth highest in
Africa and developing
Source UN Habitat;
Rapid urban expansion
The benefits of urban
expansion are uneven. Urban
settings are not as
homogenous in terms of
livelihoods and socio-economic
status as rural ones, and they
can vary significantly within
and between settings,
countries and continents.
Source: United Nations, World Urbanization Prospects: The 2007
World urban
Cities of different sizes play important role.
People also move from one city to another,
not just from country to town.
Agriculture has to compete for water and
land with sprawling urban areas and
Population by city size in millions in
1970, 1990, 2011 and 2025
Distribution of the world urban
population by major area 1950, 2011,
City size
Major area
Urban poor
Whilst very diverse across regions, countries and even within cities,
the urban poor tend to share deprivations day to day, including:
• Limited access to employment and income: urban poor are usually more
dependent on informal sector jobs that do not meet their consumption
needs. Women least likely to have secure jobs.
• Insecure and inadequate living conditions,
• Limited access to basic services and poor infrastructure,
• Vulnerability to risks (e.g., environmental hazards, natural disasters and
health risks particular to living in slums) which impact household health
• Barriers to mobility and transport
• Problems of inequality and exclusion, as the (World Bank 2007)
Source:; WB 2007. Bangladesh, Dhaka: improving living conditions for the urban poor. Report
No. 35824-BD World Bank; Sustainable Development Unit, South Asia Region.
Urban expansion
and links to human well-being
Migration to cities:
urban displacement
Displaced people = refugees (migrants who cross borders) and internally displaced
people (migrants within country)
Scale is growing: numbers estimated at 72 million, with growing numbers moving
into urban areas rather than camps
Urban displacement trend becoming more protracted
Causes complex, manifold and overlapping
Low and middle income countries send and receive disproportionate number of
urban displaced
Migration not always rural to urban, also between urban areas
Urban arrivals not homogenous group
New arrivals exacerbate local vulnerability, as they compete with already resident
urban poor for resources and livelihoods, which can lead to conflict
Response to challenges beyond the scope of any one actor or sector: urban
displaced people often beyond the reach of humanitarian and development
agencies and other formal assistance structures
Simone haysome, “Sanctuary in the city?
Urban displacement and vulnerability”
Internally Displaced People (IDP) collective centre in former hospital building,
Tbilisi, Georgia. An estimated 148 families live in this hospital complex which
suffers from widespread rat and insect infestation and falling masonry
Image and text:
Urban displacement
Principal drivers:
• Climate change and natural
• Armed conflict and violence
• Human rights abuses
• Dislocation due to
development policies and
• Land grabbing
Further info: “Adapting to Urban
Displacement”, Forced migration
• Ethnic, clan or family ties
• Better access to basic services
• Perception of better economic
• Greater proximity to
• Increased security, host
country not a fragile or failed
• Degree of anonymity
• Potential to access
humanitarian and development
Urban survivors:
chronic vulnerability
As of 2010 more than half of the world’s
population lives in cities compared to 20%
one hundred years ago.
Urban growth rates and slum growth rates
are nearly identical (UN Habitat)
One in 10 lives in a slum, which have grown
in numbers and size with urbanisation.
• Video life in megaslum Kiberia
• Article 7 myths of slums
Urban rural graph: production-2005-by-country
A train, known locally as 'The Lunatic
Express' passes through the centre of
Kibera. © Francesco Zizola/Noor
Slum populations
in developing countries 1990- 2010
“Although nowhere is immune from urban disasters and humanitarian crises, cities in the
developing world are far more vulnerable to the consequences than those in the
developed world. The risk of disaster [and humanitarian crises] is sharply increased by
rapid urbanisation, and poorly managed or uncontrolled urbanisation and inadequate
governance...” with less well-resourced small and medium-sized cities particularly
Source:; * Quote:
The Sahel: growth in
informal urban settlements
The Sahel is not only rural – a common misconception. The region with a population
of about 50 million people has experienced unprecedented urban population
explosion and most future growth is set to occur in cities.
Urban environments are more heterogeneous than rural ones.
Many of the newcomers are from most disadvantaged rural backgrounds, and thus
have fewest resources to help them cope in cities.
Economic decline or slowdown (stagnating or declining gross domestic product
annually),results in urban economies strained with limited ability of local and national
governments to provide minimally decent living conditions, basic social services and
livelihood opportunities.
Overcrowded and extremely unsanitary slums and shantytowns which leads to
epidemics and outbreaks of diseases – pockets of severe deprivation, poverty and
concentration of ill health.
Health care systems affecting health and mortality tend to be better for urban than
rural populations. However, overall the rural-urban gap in child health is narrowing
due to increase in urban malnutrition, and health and nutritional outcomes for poor
urban children can be worse in cities.
Source: Lifland, Amy. Starvation in the Sahel
Urban-Rural Differentials in Child Malnutrition Trends and Socioeconomic Correlates in Sub-Saharan Africa
Growing urban poverty:
Mali, Chad, Burkino Faso
Action for students:
How do growing poverty and a
breakdown of the country’s
social fabric relate to growing
urban settlements and
malnutrition in the Sahel?
• Bamako, Mali
• BBC Photo journal on Chad urban
migrant story
• Burkino Faso’s urban hunger
What do the slums look like in the
Sahel? More on Chad’s N’Djamena,
for example, pictured here:
Urban and
rural Sudan
Action for students:
1. Create a mini country profile and fact file on what is meant by life at the
margins to someone in Sudan’s western region of Darfur region versus
someone in a city such as Djibouti City.
MSF Starved for Attention “Frustration” Urban malnutrition in Djibouti
BBC country profile Djibouti
Food insecurity looms in Djibouti
BBC Sudan timeline
Darfur Image Derk Segar / IRIN
and Kenya urban case studies
Action for students:
1. Watch Urban survivor film series and related material: in:
Dhaka, Bangladesh.
Kibera, Nairobi, Kenya.
See also MSF account
2. Relate these case studies to quality and adequacy of food, food production, increased
vulnerability and life on the margins. Why can it be harder to reach vulnerable people
in urban settings? Why can be well-being be variable at the sub-state level?
Further info: Series also covers:
Karachi, Pakistan;
Johannesburg, South Africa. See also report
Port au Prince, Haiti
Kamrangirchar slum
Houses in the Boubazar slum near Kamrangirchar and
children playing (inset)
Action for students: read this slide and the next
one, and extract the key information
fact sheet. Find out where the Kamrangirchar
Peninsula is, the name of the river and make a
sketch map showing the locations.
In the Kamrangirchar
slum of Dhaka - on
the banks of one of
the most polluted
rivers in the world MSF runs a primary
healthcare centre that
provides care to
children under five
and pregnant and
lactating women.
Nearby, MSF also
runs a therapeutic
feeding centre.
Through a largely
programme, these
children are being fed
with Plumpy Nut, a
thick nutrient-rich
peanut paste which
helps children regain
normal body weight.
MSF doctor reporting
from Kamrangirchar
Terrible living conditions often with three generations of one family crammed
together in one room. Tensions between liberal and conservative strands of
Islam with the stricter mainly being based in the slums.
Patients often child brides with malnourished and premature babies – a
vicious cycle of malnutrition and stunting.
Overpopulation and pollution mean that infectious and chronic diseases
spread easily and quickly.
Many factories based in the slums with a lot of child workers and poor
conditions (sanitation and hygiene) – diarrhoea particularly problematic and
spreads especially quickly during the wet season. People’s homes become
flooded during this time.
Very high prevalence of domestic and sexual violence with many of the
women living in the slums experiencing some form of domestic or sexual
Policies and investment are needed to address local environmental factors, to promote well-being
at the household, community and country-level, which have been shown to be impacted by
availability of electricity, health and sanitation services and at least minimally decent living
conditions.(UN Documents, Our Common Future -
An MSF nurse measures the height and weight of a child to determine the level of
malnutrition. MSF hopes to bring its expertise and experience in treating malnutrition so that
more children and their mothers can continue to live and grow up healthily.
Photo: Julie Remy
Photos above Alfons Rodriguez
The MUAC (middle upper arm circumference)
bracelet is used in conjunction with the height to
prescreen children for malnutrition directly in the
Kibera, KENYA
A rooftop view of Kibera
during the day. Kibera is
one of the biggest slums
in Nairobi, and the
second largest urban
slum in Africa.
Photo: Charlie Dailey
Geographically divided into 12 ethnically heterogeneous villages of similarly poor
conditions, this sprawling slum it is one of the most densely populated districts of
Nairobi, home to an estimated 220,000 to 250,000 people. The land is owed by the
Kenyan Government, but private housing is owned by individuals who rent them out to
inhabitants. These buildings are made of mud and corrugated iron sheeting that make
up small, narrow rooms to house whole families. Some shelters are even used in
shifts, people working during the day outside the slum sub-let their rooms for others
who work at night. Poor sanitation, open sewers, overcrowded accommodation
and a lack of access to free healthcare all contribute to the spread of diseases.
MSF clinic
Kibera South
Inaugurated in 2013, the
centre offers comprehensive
primary healthcare and
maternity services integrated
with the management of
chronic diseases
Photo: Andre
Photos above:
Walking to the MSF centre
Kibera, Nairobi, Kenya
Photo: Charlie Davy
Photo: Charlie Davy
Photo: Charlie Davy
Photo: Andre Francois
Rural households
Rural households are most
affected by poverty and
They account for 75% of the
world’s hungry
Agriculture is the main
source of income in more
than 60% of rural households
Thirty per cent of these
households live in extreme
Source: http;//; International Assessment of Agricultural Knowledge, Science and Technology for
Development (2009). Agriculture at a Crossroads: A Global Report. IAASTD. Washington;
Rural change
As economies grow, so does the
importance of non-agricultural
income in the rural economy as a
• Developmental transition
• More people buying food rather
than growing it
Cloke’s 1971 Index of Rurality
helps to understand the changing
features on the rural-urban
continuum. It is composed of:
Occupancy rates
Female population (15-44)
Population density
Agricultural employment
Elderly population
Remoteness (distance to 50,000)
Incidence of extreme
rural poverty
percent of people living on US$1.25/day)
Source IFAD;;
20% of the
lives on less
than $1.25 /
Rural vulnerabilities
Action for students:
1. Discuss with other students and taking an evidenced based view, draw
conclusions to agree or disagree whether “The Urban Rural divide: Is it a Myth
or Reality”
2. Debate the issues in “Managing Risk and Vulnerability in the Rural Space”,
Joachim von Braun, World Bank slideshare
Discuss and map the physical and socioeconomic impact of climate change
and globalisation (integration of the world) on farmers in “Climate Change,
Rural Vulnerabilities and Migration”
Source: http;//; International Assessment of Agricultural Knowledge, Science and
Technology for Development (2009). Agriculture at a Crossroads: A Global Report. IAASTD. Washington.

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