Ecuador: Easing the burden of urbanization through improvements in health care



Rural-urban migration has become a large problem in many South American countries due to issues such as unemployment, unclean water, disease, and health care deficiencies in rural communities. In Ecuador, these issues, added with other economic and financial problems have made rural poverty practically a social norm. For example, a crisis in 1999 resulted in a 7.3% contraction of GDP, an annual year-on-year inflation of 52.2%, and a 65% devaluation of the national currency[1]. Due to crisis like this one, an increasing amount of Ecuador’s population has fallen below the poverty line and migrated to larger cities such as Guayaquil and Quito. Raul and Homero Harari in their article Children’s Environment and Health in Latin America: The Ecuadorian Case note that, “The poor, who comprise 61% of the total population do not have their basic needs met, and included among them are the 31% who are in extreme poverty, that is, have an income of less than one dollar per day to cover all of their needs[2].” Among the natives that live in rural areas, the numbers are even more astounding; according to studies done by the International Fund for Agricultural Development (IFAD) and the World Bank, “87% of indigenous Ecuadorians are poor and the percentage increases to 96% in the rural plateau regions[3].”

Poverty itself, along with issues like food security and employment, are major factors leading to rural-urban migration in Ecuador. However, in this article I will be discussing more specifically the push and pull factors relating to health care and how theses factors contribute to widespread urbanization. I will then discuss how improvements to the current health care system in Ecuador could potentially ease the burdens of urbanization.

Health care deficiencies, push and pull factors, and unhealthy urbanization.
Push factor: Poor health and infant mortality are among the most dangerous conditions of rural poverty. According to the UN Population Division, Ecuador has an infant mortality rate of 21.1 and an under-five mortality rate of 25.7 for every 1,000 live births[4]. Relatively high rates are also shared by Ecuador’s neighbors: Peru with an under-five mortality rate of 28.8 and Colombia with a rate of 26.0.
Diseases like diarrhea and pneumonia are the most common causes of infant mortality. Though cures and treatments are available, the majority of Ecuador’s rural communities do not have access to what we might think of as “common medical technology” such as immunizations or sanitary maternal care. This is mainly due to a lack of doctors, hospitals, and medical funding. In their article Propuesto para el desarrollo de la salud en el ámbito rural about rural health conditions in the United States, Dr. Yuri Carvajal B., et al, observed that, “the people of the rural world receive less preventative measures. Even though 20% of U.S. citizens live in rural areas, only 9% of doctors carry out their work there. Many of the hospitals that assist these areas have closed or are currently experiencing financial difficulties[5].” Though these statistics are based on studies in the United States, they are certainly not unique to it. These same issues are even more prevalent in Ecuador and other Latin American states and create push factors which encourage residents to consider risking dangerous migrations to urban and suburban areas in search of basic medical necessities.
Pull factor: Medical technology is a definite urban appeal to rural families, especially since the most available health care is focused in the larger cities. There are more doctors and healthcare workers. There is newer technology. There are newer medicines and more hospitals. Wikipedia comments that studies have shown, “a direct correlation between an increase in the number of healthcare workers with an increase in child and maternal survival.[6]” Amid the younger population—especially males—a common solution to poor conditions is to leave their families and often parts of their culture behind and migrate to where the medical benefits are better. For example, in response to the financial crisis of 1999, as many as 500,000 Ecuadorians migrated in search of better employment and health.
However, rural-urban migration does not always ensure better health. In fact, rapid urbanization more often leads to high unemployment and a dramatic growth in slums where health conditions are often worse than those of rural communities. Wikipedia comments that, “[slums] are commonly seen as ‘breeding grounds’ for social problems such as crime, drug addiction, alcoholism, high rates of mental illness, and suicide. In many poor countries they exhibit high rates of disease due to unsanitary conditions, malnutrition, and lack of basic health care[7].” According to research done by Thomas Klak and Michael Holtzclaw, 35.5% of housing in Quito, Ecuador’s capital city, is described as “inadequate[8].” Inadequate housing and slums create a difficult situation for urban planners because many slum dwellers cannot afford to move back to rural areas where the possibilities of employment and opportunity are scarce.
Another problem with these urban pull factors is the quality of the care itself. As the poor, urban population sharply increases, the supply has a difficult time meeting the demands and the quality of the care offered by institutions and workers decreases. Given these circumstances, it is easy to see why rural-urban migration is a large problem for citizens, policy makers, and medical establishments in Ecuador. Even though there are more physicians and better medical technology in urban areas, the solution for improved health care is not urbanization. The solution lies in equalizing available care and technology to both rural and urban communities. This will help to eliminate the push factors discussed above and stabilize the rural, suburban, and urban populations.

Solutions to poor health care and their effect on urbanization.
In my opinion, the most efficient way that Ecuador can improve health within its borders is to work to achieve the UN-established Millennium Development Goals 4, 5, and 6. To do this, changes is local government policy and international aid are of necessity. For example, indigenous tribes and communities would need more open access to rural land ownership. However, my purpose in this essay is not to discuss changes in policy or funding, but rather to discuss how changes in health care—assuming that changes in government policies and funding were to occur—would help ease the burden of urbanization.
Working to eliminate the push factors: The Millennium Development Goals (MDGs) and combating scarcities in rural health: The MDGs are powerful ways to focus local policies and international aid. I believe that the issues they bring forward are essential keys to battling unhealthy urbanization and insufficient health care in Ecuador. The three I found to be most prominent in terms of health care are as follows: MDG #4—Reduce by two-thirds the under-five mortality rate by 2015, MDG #5—Reduce by three quarters the maternal mortality ratio by 2015 and achieve universal access to reproductive health, and MDG #6—Have halted and begun to reverse the spread of HIV/AIDS, the incidence of malaria, and other major diseases by 2015. If the MDGs were accomplished in Ecuador they would certainly help to stabilize the rural and urban populations and improve their standard of living.

A large problem among rural communities in Ecuador is the lack of doctors and health care workers. Migrations only perpetuate the problem of poor rural health by removing the more educated individuals from poor areas and leaving these areas without sufficient means to fix common disease and health problems. Non-government organizations (NGOs) in Ecuador and around the world seek to ease this burden by donating immunizations and training volunteers, but the majority of rural citizens are still left behind. However, by working to accomplish MDG #4 and achieving a lower under-five mortality rate, rural populations would increase and fewer children would feel forced to urbanize. This would lead to a larger work force and more incentive to develop and practice skills locally instead of permanently migrating to urban areas. NGOs would also be able to amplify their efforts by educating and donating to larger, more self-sufficient portions of the population.

The lack medical technology, such as common immunizations and maternal sanitation contributes substantially to rural-urban migration. Families, and especially single mothers, are often compelled to migrate in search of cleaner conditions for their children. Children often end up as orphans because of AIDS or other major diseases and are compelled to migrate to larger cities where they can receive aid. As MDG #6 suggests, halting these diseases, especially malaria and AIDS, would help urban/rural equalization considerably. Rural populations would increase with less risk to family units and cross-state travel in search of simple medicines and cures would not be necessary. Also, as suggested by MDG #5, a higher health status for women would help them to become more self-sufficient. Since women form the majority of rural communities anyway, improvements in health care would help those communities to better sustain themselves and support local employment opportunities. Risks of childbearing and child rearing would go down and sanitation in health institutions and communities in general would go up. This would encourage rural populations to develop their own communities instead of abandoning them, therefore easing the burden of urbanization.

Working to equalize the pull factors: Improvements in Ecuador’s slums: I have discussed how improvements in basic health care would ease the influx of rural communities to urban centers, but what about health problems in extremely poor urban communities such as slums? Important to the easing of urbanization is not only the alleviation of health care deficiencies among rural Ecuadorians, but also the equalization of basic health care among all less fortunate communities. Achieving the MDGs in Ecuador’s slums would also serve to ease the burdens of urbanization by eliminating the “breeding grounds for social problems.”
A lower under-five mortality rate among slum dwellers would initially create a surge in the urban population, but I think this sharp increase would stabilize as more children reached working age. As they did, and as health conditions continued to improve in both rural and urban settings, the workforce would spread throughout the country to suburban and rural areas. Health care improvements would also decrease emigration, especially given the fact that Ecuador’s neighbors both suffer from health care deficiencies and have even higher infant and under-five mortality rates. Therefore, accomplishing MDG #4 in poor, urban communities would cause healthier migration among slum dwellers and reduce the health problems inherent in these communities.

As proposed by MDG #6, the spread of healthier immunizations and maternal care in slum communities would also have an equalizing effect among Ecuador’s population. At first there might be a slight increase in urbanization, especially since these innovations would develop slower among rural communities, but eventually the population would stabilize. Also, as projected by MDG #5, women would not have to travel or migrate in order to raise a family and fewer children would be left as orphans because of disease and poor maternal care. This would encourage stability among Ecuadorian families in all communities; from rural-indigenous to suburban-working class to urban-middle class. The MDGs are essential to achieving this stability and self-sufficiency and will definitely make a difference in combating unhealthy urban conditions.

Conclusion: Clearly, advances in health care through achieving the MDGs would improve the standard of living in Ecuador and help to equalize both the diminishing rural and overwhelming urban populations. It will help the distribution of Ecuador’s workforce and encourage stability in families and communities throughout the county. Working to accomplish these goals and maintain their benefits among both rural and urban populations will encourage local development and help to ease the burdens of unhealthy social problems such as urbanization.

Works Cited

1) Economy of Ecuador. (2008, April 1). In Wikipedia, The Free Encyclopedia. Retrieved 04:55, April 3, 2008, from

2) Raul and Homero Harari (2006) Children’s Environment and Health in Latin America: The Ecuadorian Case. Retrieved from MedicLatina on April 3, 2008. Website:

3) La pobreza rural en Ecuador (16 de Marzo, 2007) Realizado por el FIDA. Retrieved April 2, 2008 from Portal de la Pobreza Rural. Website:

4) List of countries by infant mortality rate. (2008, March 15). In Wikipedia, The Free Encyclopedia. Retrieved 05:35, April 3, 2008, from

5) Dr. Yuri Carvajal B., et al. (5 de septiembre de 2007) Propuesta para el desarrollo de la salud en el ámbito rural. Retrieved from MedicLatina on April 3, 2008. Website:

6) Global health. (2008, March 26). In Wikipedia, The Free Encyclopedia. Retrieved 06:45, April 3, 2008, from

7) Slum. (2008, March 29). In Wikipedia, The Free Encyclopedia. Retrieved 04:59, April 4, 2008, from

8) Thomas Klak and Michael Holtzclaw (1993). The Housing, Geography, and Mobility of Latin American Urban Poor: The Prevailing Model and the Case of Quito, Ecuador. Retrieved April 3, 2008 from