Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities^1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity^3–6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Multimorbidity defined as the “the coexistence of two or more chronic diseases” in one individual, is increasing in prevalence globally. The aim of this study is to compare the prevalence of multimorbidity across low and middle-income countries (LMICs), and to investigate patterns by age and education, as a proxy for socio-economic status (SES). Chronic disease data from 28 countries of the World Health Survey (2003) were extracted and inter-country socio-economic differences were examined by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions. The mean world standardized multimorbidity prevalence for LMICs was 7.8 % (95 % CI, 7.79 % - 7.83 %). In all countries, multimorbidity increased significantly with age. A positive but non–linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by education suggest that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Higher education was significantly associated with a decreased risk of multimorbidity in the all-region analyses. Multimorbidity is a global phenomenon, not just affecting older adults in HICs. Policy makers worldwide need to address these health inequalities, and support the complex service needs of a growing multimorbid population.

This paper examines the feasibility of spectral mixture analysis (SMA) in deriving comparable physical measures of urban land cover that describe the morphological characteristics of cities. SMA offers a way of analyzing satellite imagery of urban areas that may be superior to more standard methods of classification. Mixing models are based on the assumption that the remotely measured spectrum of a given pixel can be modeled as a combination of pure spectra, called endmembers. SMA, using four image endmembers (vegetation, impervious surface, soil, and shade), was applied to an IRS‐1C multispectral image in order to extract measures that describe the anatomy of the Greater Cairo region, Egypt, in terms of endmember fractions. The resulting fractions were then used to classify the urban scene into eight classes of natural and human‐built features through a decision tree (DT) classifier. The accuracy of the DT classification was compared to the accuracies of two per‐pixel supervised classifications of the IRS‐1C image employing maximum likelihood (ML) and minimum distance‐to‐means (MDM) classifiers. Overall KAPPA accuracies were 0.88 for the DT classification based on SMA fractions, and 0.60 and 0.45 for the classifications conducted through ML and MDM respectively.

Many urban households in developing countries use biomass fuels for cooking. The proportion of household biomass use varies among neighborhoods, and is generally higher in low socioeconomic status (SES) communities. Little is known of how household air pollution varies by SES and how it is affected by biomass fuels and traffic sources in developing country cities. In four neighborhoods in Accra, Ghana, we collected and analyzed geo-referenced data on household and community particulate matter (PM) pollution, SES, fuel use for domestic and small-commercial cooking, housing characteristics, and distance to major roads. Cooking area PM was lowest in the high-SES neighborhood, with geometric means of 25 (95% confidence interval, 21–29) and 28 (23–33) μg/m ³ for fine and coarse PM (PM _2.5 and PM _2.5–10 ), respectively; it was highest in two low-SES slums, with geometric means reaching 71 (62–80) and 131 (114–150) μg/m ³ for fine and coarse PM. After adjustment for other factors, living in a community where all households use biomass fuels would be associated with 1.5- to 2.7-times PM levels in models with and without adjustment for ambient PM. Community biomass use had a stronger association with household PM than household's own fuel choice in crude and adjusted estimates. Lack of regular physical access to clean fuels is an obstacle to fuel switching in low-income neighborhoods and should be addressed through equitable energy infrastructure.