About half of rural populations have in one lifetime moved into a town environment. ‘Access’ was one of the most used words in Public Health some 40 years ago. Long distances separated most people from the best of care. Now to our vocabularies we must add ‘transitional’. Dermatologists have never populated the Developing World but now the Transitional World can provide many of them with an income almost to its borders with the countryside. The car and the motor bike increase access but raise the injury level of the pedestrian. While the railway and bus station, school and supermarket may be more accessible to some, they are less accessible to others and where there is rising human density there is a rise in criminal activities including assault.
Warning Skin Health following general health and well being has changed proportionately with this rural to urban shift. Access to water, firewood, shops and schools, different quality of housing and availability of a different kind of employment brings with it a change in body weight, different foods, more smoking and more sex workers. There is no where to disperse sewage or plastic bags. These block drainage and house mosquito larvae in small amounts of retained water. For children, overcrowding brings more head lice, scabies, impetigo and superficial fungus infections. Road side sellers provide counterfeit drugs and there is less instant advice from herbalists. These too move into cities with less reliable purchase of their favourite remedies as their homelands become deforested.
Action Availability of electricity in urban and transitional centres adds health messages from local radio TV and the mobile phone, as well as more pamphlets and posters. There is street lighting and frequent public transport. As people survive childhood and live longer, there is a double burden of only partly controlled infectious disease, such as tuberculosis or HIV/AIDS, plus degenerative age associated illness. In factories and mines with little accident prevention, children are employed as cheap labour and health centres see more wounds and burns. As described in the Capacity to Benefit section of this website a disease such as leprosy can be well managed in a large city such as Mumbai.