April 7 : World Health Day this year brings back the focus on the impact of urbanization on health. WHO has come out with the campaign “1000 cities – 1000 lives”, events will be organized worldwide calling on cities to open up streets for health activities. Like everywhere else this theme assumes a disconcerting urgency in the Indian context too where the Health Minister Shri Ghulam Nabi Azad is on record “though we are improving our economic indices, yet, we continue to be one of the largest contributors of disease burden in the world.”
Estimates are scary. Today the Non Communicable Diseases (NCDs), especially Cardiovascular Diseases (CVD’s), Diabetes Mellitus, Cancer, Stroke and Chronic Lung Diseases have emerged as major public health problems, due to an ageing population and more importantly hectic pace of urbanization. Surveys in India reveal that about 10 % of adults suffer from hypertension. The increase in cardiovascular disease prevalence and mortality rates is expected to continue in the coming years in the majority of countries of the Region. The number of deaths due to Ischemic Heart Diseases in India is projected to increase from 1.2 million in 1990 to 1.6 million by the year 2000, and to 2 million by 2010. The premature morbidity and mortality in the most productive phase of life is posing a serious challenge to Indian society and its economy. It is estimated that in 2005 NCDs accounted for 5,466,000 (53%) of all deaths (10,362,000) in India. Cities face a very big brunt of this horrific statistic. Future has no solace if remedial measures are not taken- World Bank estimates that by 2035, cities will become the predominant sites of poverty globally. Health problems of the urban poor include an increased risk for violence, chronic disease, and for some communicable diseases such as tuberculosis and HIV/AIDS.
Dealing with the Menace
India has taken a note of this situation and firm beginning has been made to tackle the situation. Pilot Project of the National Program for Prevention and Control of Diabetes, Cardio-vascular Diseases and Stroke (NPCDS) has been launched in ten states with one district each. Total plan allocation envisaged for 11th plan is Rs 1620.5 crores. NPCDS among other things, seeks to facilitate early detection of this disease. Plan which will cover the entire country eventually. Health promotion is a key component for the prevention and control of NCDs. It must combine educational activities with policy interventions to provide a supportive environment. It is pertinent to mention that Health promotion for NCD control can be carried out with simple messages e.g. use of less salt and sugar, exercise, avoiding stress, tobacco and alcohol and increased use of vegetable and fruits. These simple interventions can prevent or delay many of the NCDs.
Several new initiatives have been taken in the field on non communicable diseases e.g. National Deafness Control Program, National Program for Health Care of Elderly, National Oral health Program. An estimated 275 persons are killed and 4,100 injured in our roads everyday. In view of this fact, The Ministry of Health initiated the National Highway Trauma Care Project which is an ambitious project in its scale and reach intending to cover the entire Golden Quadrilateral and North-south-east-west corridors with over 200 hospitals being upgraded with pre hospital care and integrated communication system. Rashtriya Swasthya Bima Yojna is another initiative for bringing health services within reach for a large chunk of excluded population.
Planning is the Key
According to World Health Organization, Urbanization is not inherently positive or negative. Underlying drivers – also referred to as social determinants – converge in urban settings which strongly influence health status and other outcomes. These determinants include physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities. Communicable diseases such as HIV/AIDS and tuberculosis, chronic diseases such as heart disease and diabetes, mental disorders, and deaths due to violence and road traffic injuries are all driven by these underlying social determinants. WHO has expressed concern on growing inequities with regard to access to health services in urban centres. WHO firmly believes that Urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents. Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.
Urbanization is a reality of our time how we respond to its positive and negative facet is up to us. In this context urbanization is both a policy challenge and a crucial individual choice also. Adopting healthy habits and having a concern that goes beyond immediate consumption can enable the society to deal with this reality in more meaningful way.