This paper uses DHS data on the urban populations of Ghana, Egypt, Brazil and Thailand to investigate the effect of poverty and environmental conditions on diarrhoeal disease, nutritional status and survival among children. Differentials in health are moderate in urban Ghana, whereas in Egypt and Brazil reductions in morbidity and, above all, mortality have accrued largely to the better off. In Thailand, the poor fare better and inequalities in mortality are no larger than those in morbidity. Children’s health is affected by environmental conditions as well as by their family’s socio-economic status