Urban Health in Tanzania: Questioning the Urban Advantage

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania’s health outcomes—to question both the idea of an urban advantage in health and the extent of urban–rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania’s urban and rural areas; how are health inequalities articulated within Tanzania’s urban and rural areas; and how are health inequalities articulated across age groups for rural–urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children’s morbidity, and women’s BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban–rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons?