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This chapter aims to situate the environmental problems of the urban poor in their international context and draw some action-oriented conclusions. The relationship between sustainability, poverty and the environment is complex and at times confusing. In the urban context, affluence is neither unambiguously harmful nor unambiguously beneficial to the physical environment. The urban environmental hazards causing the most ill health are those found in poor homes, neighbourhoods and workplaces, principally located in the South. Accompanying the shift in the scale of environmental problems, from household and neighbourhood, to city and regional, to global, is a shift from issues of health to those of ecology and sustainability. A 19th century precursor to the modern environmental movement was the sanitary movement and, at that time, sanitation was very much an environmental concern. The environmental …