Urbanization, which is driven mainly by the expansion of cities and urban
migration, is considered one of the key drivers of non-communicable
diseases (NCDs) in developing countries. This research aims to investigate
the patterns and associations between different levels of urban exposures
and NCD risk factors, NCD morbidity and NCD mortality in Thailand, to better
understand the mechanisms underlying the link between urbanization and
NCD in Thailand.
Using several study designs and analytical techniques, the research
described in this thesis found that the process of migration and living in an
urban environment were associated with lower social trust and higher levels
of emotional problems. Urban environments were also associated with
behavioural and physiological risk factors for NCDs, including smoking,
heavy alcohol consumption, inadequate physical activity, inadequate
fruit/vegetable consumption, high BMI, and high blood pressure. Both early
life urban exposure and accumulation of urban exposure throughout life
potentially play a role in these increases in behavioural and physiological risk
factors for NCDs. Early life urban exposure was also found to be associated
with an increased risk of developing obesity in adulthood.
Increased psychosocial, behavioural and physiological risk factors
associated with living in an urban environment may not translate directly into
increased prevalence of biological risk factors for NCDs (such as high
cholesterol), the development of NCDs, or into NCD-related mortality. It is
likely that biological risk factors for NCDs, as well as NCD incidence and
mortality are more amendable to change from the positive influences of
urbanization through higher socioeconomic status and potential access to
better health care