The World Health Day (WHD) is celebrated on April
7 every year and marks foundation of the World
Health Organisation (WHO). Each year WHO selects
a “Key Global Health Issue” and WHD marks
beginning of year long activities on the same, this
year’s theme being- “Urbanisation and Health” [1].
In the last year’s World Health Report, urbanisation
was cited as one of the biggest health challenges of
the 21st Century. By 2030, six out of ten people are
expected to be city dwellers which shall further rise
to seven in ten by 2050 [2]. Increasing Global
Urbanisation is classed as threat to “Public Health
Security” due to unprecedented level of population
agglomeration which may facilitate spread of
epidemic diseases [3]. This theme was therefore,
selected in recognition of the effect of urbanisation
on our collective health, globally and also on our
individual health. The main objective of World
Health Day 2010 is to integrate the day in to a
sustained public health strategy to incorporate
health more broadly in to urban public policy.
Various events are planned through the year around
the world.
The “1000 cities, 1000 lives” is a global campaign
[4] to encourage cities, towns, neighbourhoods and
local authorities to conduct health promoting
activities on or around World Health Day (the week
of April 7-11). The goal of “1000 cities” campaign is
to open public spaces to health, either by closing off
portions of streets to motorized vehicles & opening
them to people; holding town hall meetings &
community forums; promoting more active civil
society participation in local planning &
governance; initiating clean-up campaigns and
conducting work-place & school-based initiatives.
The goal of “1000 lives” campaign is to collect 1000
stories of urban health champions. Urban health
champions are people who have taken actions that
have resulted in a significant impact on health in
their cities. In fact, individuals are encouraged to
submit both examples of events they are planning to
run in their cities, towns or neighbourhoods, and
videos about those they nominate to be urban health
champions.
Countries differ in the way they classify population
as urban- based on density, number of residents,
percent population not dependent on agriculture,
provision of public utilities and services, and
depending upon population of a
community/settlement. And “Urbanisation” refers
to ‘Growth in the proportion of population living in
urban areas’. Urbanisation trends could be in the
form of- (a) Industrialisation, (b) Global
urbanisation, (c) Megacities or million cities, (d)
concept of The Livable City.
If we look back, developing countries like ours have
been peasant societies and cities in these
traditional societies used to be either pilgrimage
centres or the seats of administration and
educational centres. But importantly, these cities
always had homogenous relationships with the
villages. However, in the present era of rampant
urbanisation wherein it is anticipated that all
population growth over the next 30 years will be in
urban areas, this homogeneity has been lost.
Industrialisation has developed modern megacities
whose way of life is heterogenous with that in the
villages. Rural poverty has pushed villagers to the
cities, which were never planned to accommodate
immigrants. Public health and social problems have
started arising lowering the quality of life. Half the
world’s population now lives in urban settlements,
because cities offer the lure of better employment,
education, health care and cure. Presently, cities
contribute disproportionately to national
economies. Rapid and unplanned urban growth is
associated with poverty, environmental degradation& population demands, which outstrip service
capacity; thus, placing human health at risk.
Further, reliable urban health statistics are largely
unavailable throughout the world. Health data
masks health conditions of urban poor since it
combines statistics of urban poor concentrated in
the slums, with health statistics of the relatively
affluent who occupy larger areas of the city. This
disaggregated intra-urban health data (for different
areas within a city) are even more difficult to be
found.
A range of urban health hazards & associated health
risks exist and include substandard housing,
crowding, air pollution, insufficient or
contaminated drinking water, inadequate sanitation
and solid waste disposal services, vector borne diseases, industrial and e-waste, increased motor
vehicle traffic, stress associated with poverty and
unemployment, communicable diseases among the
urban poor coexist with non-communicable diseases
among the comparatively affluent and increasing
problems of crime and chronic morbidity.
Significantly, urban health risks & concerns involve
many different sectors viz. Health, Environment,
Housing, Energy, Transportation, Urban planning,
etc. Local & national governments & multilateral
organisations are all grappling with these
multifaceted challenges. While the high-income
countries struggle with health & social problems of
inner-city areas such as drug addiction, violence and
HIV/AIDS; the low & middle income countries are
bothered about health & welfare of the growing
population. There is a plausible connection between
urbanisation & rising levels of non-communicable
diseases. [5]. The urban poor suffer
disproportionately from health problems. More than
one billion (1/3 of the urban population) live in
urban slums. As per World bank estimates, cities will
become the predominant sites of poverty by 2035.
There are two main policy implications to control
urban health hazards- (1) Need for systematic &
useful urban health statistics on a disaggregated
(intra-urban basis), and (2) Need for more effective
partnering across sectors. It is noteworthy that
even, non-governmental organisations though may
have helped in providing relief to needy and poor,
but have failed consistently in creating an
infrastructure for a balanced development. In
effect, the major drivers of health in urban settings
are beyond the health sector and include social
determinants, physical infrastructure, access to
social & health services, local governance and
distribution of income & educational opportunities.
It is important to realise that ‘Urbanisation’
inherently is not positive or negative; and that
actions & solutions exist to tackle the root causes of
urban health challenges. Urban planning can
promote healthy behaviours & safety; while proper
investment in active transport (use of CNG is an
example), designing areas to promote physical
activity, passing regulatory controls on tobacco and
food safety, adequate law enforcement are all
important steps in promoting urban health.
Improving urban living conditions- housing, water
and sanitation is important. Building inclusive cities that are accessible & age-friendly will also benefit
urban residents. Importantly, not additional funding
but commitment to redirect resources to priority
interventions, thus achieving greater efficiency is
the key. Another important issue is forging multisectoral
partnerships. Health is a human right for all
citizens. To protect it, individuals, civil society and
governments have to play a collective role and
responsibility. Platforms where municipalities, civil
society & individuals come together should be
encouraged. By bringing multiple sectors of society
together to actively engage in developing policies,
more sustainable health outcomes will be achieved.
Presently we are at a turning point, wherein we are
moving towards a more urbanised world & with it,
the need to embrace the consequences this can
have on health- both benefits and challenges.
Rather than looking back & pondering ‘what could
have been done’; the time is ripe to take a call and
say- “We will take action now” to ensure that“Growing Cities are Healthy Cities”.
References
- WHO- World Health Day- 7 April 2010. www.who.int/world-health-day/2010/en/index.html. Accessed on April 11, 2010.
- Why urban health matters? http://www.who.int/world-health-day/2010/media/whd2010background.pdf.Accessed on April 11, 2010.
- World Health Organisation. The World Health report 2007: A Safer Future: Global Public Health Security in the 21st Century. World Health Organisation Geneva, 2007.
- 1000 cities and 1000 lives campaign of WHO. http://1000cities.who.int/page/about-the-1000-cities-1000. Accessed on April 11, 2010.
- Leon DA. Cities, urbanization and health. Int J Epidemiol 2008; 37: 4-8.
Anupam Prakash
Assistant Professor of Medicine,
LHMC & SSKH, New Delhi
Gurleen Kaur
Resident Doctor, RML Hospital, New Delhi
SK Agarwal
Consultant Internal Medicine & Academic Advisor,
Apollo Hospital, New Delhi |
