The dichotomy in development trajectories of urbanisation, industrialization and economic change, and the associated environmental health challenges, between the industrialised nations and the developing world, could offer useful lessons, especially for the latter. This paper examines points of convergence in the underlying factors and theories, underpinning urbanisation, sanitation and health in the 19th century industrialised nations and the developing world and explores the major reasons why many low income countries have not managed to redress their urban sanitation and health problems. It concludes that any meaningful developments in low income countries may require strategies, policies and actions, which emphasise local realities over and above global concerns and priorities.