Around the globe, a massive exodus from rural areas to cities is taking place. Migrants stream into a burgeoning metropolis in search of opportunity, but most often wind up living in fetid slums where basic sanitation and even the most rudimentary healthcare are unavailable.

By most measures, the health of the urban poor is not better than their rural counterparts -- and can often be much worse.

Healthcare around the world is caught up in the "urban crucible," said Victor Barbiero, a visiting professor at George Washington University. "The problems we see in our own urban centers will be exacerbated in developing countries."

Little data exists about slum populations, and they are typically ignored by policymakers, Silimperi said. An informal sector of traditional healers, apothecaries and doctors paid under the table arises, but the services they provide can be low-quality or too expensive for families paying out of pocket.

But cities also provide healthcare opportunities, she said. The density of urban populations make the delivery of healthcare services more efficient and cheaper, and urban areas have infrastructure that rural areas often lack.

Quality healthcare services are often available in cities, she said, but the poor lack access to them.

A completely new model of delivering healthcare to the urban poor is needed, Silimperi said, but currently no such model exists.

India is a perfect example of a country straining under the weight of urbanization, said Siddharth Agarwal, executive director of the Urban Health Resource Centre, an Indian non-profit organization.

Nearly 330 million Indians now live in cities, he said, and the slum population is the fasting-growing segment of urban dwellers. By conservative estimates, some 2 million babies are born into urban poverty each year.

Life in Indian slums is precarious at best given the fact that most of the slums have sprung up on land where they are technically illegal, he said.

"Tomorrow there could be a bulldozer throwing them out of the area where they are living."

India has a health infrastructure in place, but it is proving increasingly inadequate. There is approximately one urban clinic for 230,000 urban residents in the country. Underpaid doctors and nurses are often apathetic or do not come to work at all, instead choosing to sell their services to private patients.

To deliver quality health services, non-governmental organizations have begun partnering with local communities. Community health workers go into slums to educate residents, and clinics are built to provide basic care.

Once a clinic is established, it becomes a model for other groups looking to build their own healthcare centers.

In cities like Indore, where one-third of the 1.8 million residents live in slums, such programs have demonstrated some success in improving the health of urban dwellers, Silimperi said. Concerned citizens "can work together and use their commitment to the problem and knowledge of the situation to improve urban health."

But the public-health veteran is also realistic about the daunting challenge ahead.

"To what extent we will make a difference in the lives of the urban poor," he said, "is something we'll still have to see."

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