Urbanization and Healthcare Quality in Melbourne City, Australia

This report explores the impact of increasing urbanization on the quality of human health in Melbourne, Australia. It begins by outlining the aims and objectives of the proposal, which include sensitizing residents and the administration to the effects of urbanization. The background and rationale delve into the definition of urbanization, its associated health risks (such as air and water pollution, climate change), and mental health issues. The proposed action plan details the study design, population, sampling methods, data collection instruments, and procedures for creating awareness and training health workers. Anticipated outcomes include increased awareness, a better city environment, and a reduction in communicable diseases and crime. The report concludes with strategies for evaluating outcomes, a proposed timeline, and a budget justification.

Running head: Urbanization 1
Impact of Urbanization on Quality of Healthcare in Melbourne City, Australia
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Table of Contents
CHAPTER ONE: AIMS AND OBJECTIVES......................................................................................3
1.1 Introduction.................................................................................................................................3
1.2 Aim..............................................................................................................................................3
1.3 Objectives....................................................................................................................................3
CHAPTER TWO: BACKGROUND AND RATIONALE....................................................................3
2.1 Introduction.................................................................................................................................3
2.2 Health Risks from Urban Environment Pollution........................................................................4
2.2.1 Urban Air Pollution..............................................................................................................5
2.2.2 The Health Risks of Water Pollution....................................................................................5
2.2.3 Climate Change....................................................................................................................6
2.2.4 Mental Health and Behavior- violence among youths..........................................................7
CHAPTER THREE: THE PROPOSED ACTION PLAN.....................................................................8
3.1 Study Design...............................................................................................................................8
3.2 Study Population and setting.......................................................................................................8
3.3 Sampling......................................................................................................................................8
3.4 Data Collection Instrument..........................................................................................................8
3.4.1 Primary Data.........................................................................................................................9
3.4.2 Secondary Data.....................................................................................................................9
3.5 Data collection procedure..........................................................................................................10
3.6 Creation of awareness................................................................................................................10
3.7 Training of the Health workers..................................................................................................11
3.8 Process Measures.......................................................................................................................11
3.9 Data Analysis.............................................................................................................................11
CHAPTER FOUR: ANTICIPATED OUTCOMES AND SIGNIFICANCE OF PROPOSAL............12
4.1 Anticipate Outcomes.................................................................................................................12
4.1.1 Create awareness on the effects of urbanisation on the quality of human health.................12
4.1.2 Better city environment due to migration to the rural areas................................................12
4.1.3 Reduction in communicable diseases and crime in Melbourne city....................................12
4.2 Significance of the Proposal......................................................................................................13
4.3 Strategies to Evaluate Outcomes................................................................................................14
4.4 Proposed Timeline.....................................................................................................................15
4.5 Proposed Budget and Justification of Budget............................................................................15
References...........................................................................................................................................18

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CHAPTER ONE: AIMS AND OBJECTIVES
1.1 Introduction
Melbourne city Local Government Area covers the central city of Melbourne and sixteen
inner city suburbs as displayed in the map below. It is estimated that Melbourne has 129,980
city dwellers with the ratio of males to females being almost equal. Furthermore,
approximately 1.2 million individuals comprising of employees, students and tourists that
visit the city on a daily basis. The rate of population growth has been on the rise for the last
decade, and this rate is expected to increase further. It is estimated that the population of
Melbourne city is likely to grow at the rate of 5.8% annually representing a population of
about 152,000 by 2021 (Urban Health & Wellbeing Profile, 2016). Already the health effects
of the current rate of population growth in the city of Melbourne have been reported by
multiple studies. These include climate change, cardiovascular diseases, drug abuse among
others (Loughnan, Nicholls, & Tapper, 2012; Urban Health & Wellbeing Profile, 2016).
Therefore, the estimated increase in the population is likely to affect the quality of healthy
life in the city.
1.2 Aim
This proposal aims at sensitising the residents and administration of Melbourne city of the
impacts of the increasing urbanisation on the quality of human health.
1.3 Objectives
1. To explore the effect of urbanisation on human health of the residents of Melbourne city
2. To create awareness on the impacts of urbanisation on human health
CHAPTER TWO: BACKGROUND AND RATIONALE
2.1 Introduction
There exist different definitions of the term urban among the regional and international
bodies. A correct definition of urban is essential towards understanding the intricate
relationship between human health and city life (Kovats & Akhtar, 2008). Urbanisation or

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urban drift is the process of change from rural to urban regions increasing the population in
cities (Nnebue, Adinma, & Sidney-Nnebue, 2014). According to Kovats and Akhtar (2008),
urbanisation is the alteration in size, density, diversity of cities. It is the result of the
developments in social, political and economic that leads to the increased settlement and
growth of expanse cities, shifts in land utilisation and change from rural to the urban way of
administration and governance. There is a complex association between man’s health and the
environment of residence in addition to the population size, place of residence and manner of
life. For instance, through their utilisation of natural resources and generation of waste
products, all impact the environmental conditions. Consequently, the transformations in the
state of the environment can affect human health via effects such as poor hygiene and
housing among others.
Despite the negative impacts of urbanisation, there are benefits associated with city life.
Cities come with the enticement of employment, better education, and culture alongside
better national economies (Seto, Parnell, & Elmqvist, 2013). Consequently, individuals prefer
to migrate from upcountry to slum settlements or in overcrowded residential places in towns.
The growth of cities is a reflection of the shifts in the national and international economic and
political fortunes (Thirkell-White, 2008). Similarly, there is a paradigm shift in the health of
city populace. This means that while the city life progressively offers different opportunities,
it is also a source of health hazards of health risks (City & Assessment, 2010). The literature
section of this proposal aims at exploring the various aspects of the impact of urbanisation on
human health.
2.2 Health Risks from Urban Environment Pollution
Studies have shown that cities pose health risks in all aspects. The study by Gong et al.
(2012) reports that the air quality in cities is unhealthy alongside issues with water pollution.
Additionally, water and air pollution have been attributed to the high death and disability

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rates in the cities (Miri et al., 2016). The greenhouse emissions are on the rise due to the
increase in energy use. The global climate has currently worsened the environmental health in
the big cities, and the situation is expected to worsen due to the disastrous shifts in
temperature and rain caused by the extreme weather as is currently being experienced (Li,
Song, Lin, Dixon, Zhang, & Ye, 2016).
2.2.1 Urban Air Pollution
Air pollution in the cities is a global matter that poses several risks to man’s health and can be
verified from the increasing disease burden in the cities. According to the WHO (2014), over
80% of city dwellers are exposed to air pollution that is above the minimum exposure levels
with the low-income cities being at a higher risk of exposure. The WHO (2016) five-year
survey on 795 cities across the world showed an 8% increase in the urban air pollution level
notwithstanding the improvements in some countries. The systematic literature review by
Jahn, Schneider, Breitner, Eißner, Wendisch, & Krämer (2011) shows that over 800,000 lives
globally were lost due to urban air pollution. The most widespread urban air pollution to be
reported is the ambient particulate matter with an aerodynamic diameter less than 2.5 μm
(PM2.5). Even minimal exposure to (PM2.5) increases death and disability risk due to
respiratory and cardiovascular diseases (Yang, Lu, Weng, Jia, Ji, Xiao, & Zhu, 2010).
2.2.2 The Health Risks of Water Pollution
The drastic increase in urban population stretches the existing water resource in the city
leading to water shortages and uneven distribution (Vörösmarty et al., 2010). Zhang, Zhuang,
Ma, & Jiang (2014) carried out a study on water pollution and mortality rates in China and
found out that water shortages in the city forced some clusters of people to access their water
from sources that were polluted leading to adverse health effects such oesophageal cancer.
The study by Owa (2013) found out that over 80% of the global population is at risk of water
pollution. Domestic wastage causes over 75% of water pollution in cities according to

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Kamble (2014). Additionally, wastes from industries such as pesticides, textile etc. are some
major sources of water pollution. As a result, the polluted water becomes a health risk to
respiratory disease, mental health issues, cancer, diarrhoea etc. Prüss‐Ustün et al. (2014)
showed that the incidences of viral diseases such as hepatitis were higher in urban dwellers
due to the intake of contaminated water. Additionally, Massoud, Tarhini, and Nasr (2009)
reports that most of the foods and vegetables are grown in the city are grown in contaminated
water, and over 10% of the city population depends on them. Tian et al. (2013) observed that
the algal blooms in the water bodies in cities contained toxic microcystins that poised
drinking water and caused liver cancers, body rashes and liver impairment.
2.2.3 Climate Change
Studies have acknowledged climate changes as the main cause of the aggravating
environmental risk and health risk in towns (Mishra, Ganguly, Nijssen, & Lettenmaier,
2015). Flooding is as a result of too much and frequent rainfall. However, the infrastructural
development in the cities such as roads and buildings have contributed to flooding because
they prevent soil infiltration. According to the WHO (2016), poor planning is the major cause
of increased runoff in the cities due to poor drainage systems. Several studies have exposed
the vulnerability of some specific cities to floods and the rise in sea level. A study by Douglas
et al. 2008 cited the inadequate preparation of flood emergencies in most of the African
countries in case of floods. Flooding affects human health in city populations in various
ways. Kjellstrom and Weaver (2009) conducted as a study on the effects of climate change on
human health and found out that in addition to the direct impact of flooding on human health,
it also led to the increase in mental health issues. Additionally, too much rainfall due to
climate change also favour insect breeding sites, expose various organisms which further
pollute water systems leading to epidemics in communicable illnesses (Bezirtzoglou, Dekas,
& Charvalos, 2011).

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2.2.4 Mental Health and Behavior- violence among youths
Rapid urbanisation has resulted in mental health issues because of poverty. Majority of those
who move from upcountry to cities bring with them individual values, cultures, and prospects
that are in most cases divergent from experience in town. As a result, there is a need for
adaptation to the new and challenging city environment (Trivedi, Sareen, & Dhyani, 2008).
Vacek, Coyle, and Vera (2010) showed that poverty is related to issues in peer associations,
depression and behavioural disorders. Studies have also investigated the negative effect of
crime in cities and mental health. Curry, Latkin, and Davey-Rothwell, (2008) assessed the
impact of neighbourhood issues such as vacant housing, the constant beholding of crime on
psychological distress and mental health. Lorenc et al. (2012) noted that fear of crime
significantly affected women and senior adults than men and youths. Chen (2010)
investigated the effect of constant contact with violence and routine struggles on mental
health on the young adults in the city. The author found out that fear of violence in the city
led to depression, anxiety, PSTD and hostility.
Urban mental health has also been associated with problem behaviours such as sexual,
gambling, and corruption behaviours. Hipwell, Keenan, Loeber, and Battista (2010)
highlights that adolescents in the city are likely to undergo earlier puberty than those in the
rural. As a result, there is an increase in the rates of teen pregnancy and other sexually
transmitted diseases. There is also the increase in drug abuse and prostitution in metropolitan
cities. Currently, the use of condoms is no longer promoted for family planning is was
initially but instead, it's being promoted for safe sex to avoid infection. Van Leeuwen,
Koenig, Graham, and Park (2014) assert that exposures to sex and sex-related content in
social media has not only done away with the traditional values of morality but has also led to
unstable families and divorce which further affects the mental health of both the couples and
children.

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CHAPTER THREE: THE PROPOSED ACTION PLAN
3.1 Study Design
This study will adopt a mixed research design in which a descriptive survey and correlation
research approaches will be used. The researcher will use the following methods
1. Quantitatively review and asses the total population of Melbourne city
2. Qualitative evaluation to prompt the view of the city residents and other stakeholders
3. Use of structured interviews and questionnaires on the selected officials and households
of Melbourne city respectively.
3.2 Study Population and setting
The target population will comprise all the city dwellers in the Local Government Area of
Melbourne comprising of 129,980 residents. This will consist of both the youths and adults at
an equal proportion. Most of the population lives in Melbourne with very few people living in
rural settings. The specific suburbs of Melbourne city will be examined.
3.3 Sampling
The sample study will only consist of Melbourne city dwellers randomly selected from the
four out of sixteen suburbs namely Melbourne, Carlton, East Melbourne, and South Bank.
The researcher will collect data from only these four towns in Melbourne for purposes of
efficiency in resource use and time. The researcher will purposively select twenty households
covering around 150 people to make up the study sample. The inclusion criteria will be all
those that will be living in the cities of focus at the time of the research. Additionally, the
youths aged above seventeen years and the adults not over 80 years will be included in the
study.
3.4 Data Collection Instrument
The researcher will design the research instrument under the guidelines of the study
objectives. The study will utilise both primary and secondary data. Primary data will be

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collected using questionnaires and interviews whereas secondary data will be obtained from
the critical review of the literature.
3.4.1 Primary Data
Primary data will be collected using structured questionnaires designed by the researcher
specifically for the study. The questionnaires will be developed based on the study objectives.
Interview of the specific stakeholders and experts on the topic of research will also be
conducted to provide more insight into the subject under study. Questionnaires will be
administered to the participants by the researcher and other three trained assistant researchers.
Face-to-face interviews will also be used to gather data with the help of an interview
schedule. An interview schedule is a list of questions that are asked by an interviewer during
the interview. The interviews will be used to gather data from the government administration
(Phellas, Bloch, & Seale, 2011). The interview schedule will enable the researcher to acquire
information that is needful for meeting the aim of the study (Creswell, & Clark, 2017). An
introductory letter will be sent to the city administrations of interest before the
commencement of the study. Gill, Stewart, Treasure, and Chadwick (2008) notes that the
interview schedule is significant for exhaustive research.
3.4.2 Secondary Data
Several sources were used to obtain secondary data. The researcher used search engines like
Google Scholar, NCBI, PubMed, and research gate to search for articles published between
2008 January to 2018 January. Furthermore, other sources such as World Health
Organization publications were used to explore the effect of urbanisation on human health.
The keywords used in the search were urbanisation, city life, human health, infectious
diseases, environmental pollution, and mental health. The studies that examined urbanisation
and its effect on human health were included in the review. Data extracted from the articles
included study population, the impact of urbanisation on human health, and the study

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settings. A total of 50 studies were searched, and after screening and quality check, 28 were
included in the analysis under literature review. Thematic analysis was then used to report the
outcomes of the review as illustrated under the literature review section of this study.
3.5 Data collection procedure
The researcher will alongside other three trained researchers administer the questionnaires to
the respondents for filling and then returned for the analysis of data. Face to face interviews
will also be conducted with mental health experts, psychologists among others on the
research topic. Secondary data were obtained from several sources including published
journals, articles and books relevant to urbanisation and human health. 150 individuals
selected from 20 households in Melbourne, Carlton, East Melbourne, and South Bank will be
approached in their houses and requested to fill in the questionnaires based on their life
experiences and perception on the issues or challenges faced in urban life. Each participant
will be assigned a unique identification number.
3.6 Creation of awareness
Awareness of the contribution of city life to the poor quality human health will also be
conducted by selected community workers after undergoing training. The training and
awareness creation will be done in collaboration with the department of health of the LAG of
Melbourne. The meetings will take place at the town halls of the selected suburbs. The
awareness campaign is expected to last for three months. The objective of the awareness on
the effects of urban life on human health will be aimed at sensitising the residents of
Melbourne on the advantages of residing outside town or in the rural areas over dwelling in
the city. Promotional campaigns for the awareness program will be conducted by both the
researchers and the trained health workers. Door to door, Internet and social platforms will be
used to reach many people and to save on costs. All residents in the city in addition to those
initially included in the research will be viable for attending the awareness program.

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3.7 Training of the Health workers
The Melbourne department of health and population is the one with baseline data on the
urbanisation rate, its effect and implemented strategies so far. The researchers will offer
training to the selected health workers who will be selected from different hospitals in the
suburbs. The training is to consist of knowledge about the increasing urbanisation,
challenges, options, and associated risks. They will be trained on how to conduct the
awareness campaign and sessions.
3.8 Process Measures
At the commencement of the awareness programme, an awareness questionnaire will be
administered to the participants to gauge their level of knowledge regarding urbanisation and
its impact on health. The effectiveness of the awareness programme will again be measured
by administering the awareness questionnaire at the end of the three months after which the
results of each respondent will be compared.
3.9 Data Analysis
SPSS version 20 will be used to carry out descriptive data analysis to present the negative
impacts of urbanisation on the quality of human health. Data will be extracted from the
questionnaires and checked for completeness, cleaned, validated and analysed in the SPSS
programme. The outcomes will then be interpreted and presented in the form of tables and
charts for easy analysis by the reader.
CHAPTER FOUR: ANTICIPATED OUTCOMES AND SIGNIFICANCE OF
PROPOSAL
4.1 Anticipate Outcomes
4.1.1 Create awareness on the effects of urbanisation on the quality of human health.
Since the objective of the study will be to sensitise the city dwellers on the impact
urbanisation has on their health. It is expected that some of them will resolve to move out of
the city thus decongest the city population. As a result, the city population will reduce to