Unhealthy Urban India Must Get into Street Fight Mode 

Syllabus: GS3/ Indian Economy & Related Issues, GS2/ Health

In News

• The cities of India are amidst an epidemic of historic proportions in non-communicable diseases (NCD).

Non-communicable diseases (NCDs)

• Non-communicable diseases (NCDs), also known as chronic diseases, are non-transmissible diseases of often long duration. 
• NCDs have been one of the major concerns of the Health Ministry. It has identified the four major NCDs:
  • Cardiovascular diseases, 
  • Cancers, 
  • Chronic respiratory diseases and 
  • Diabetes. 
• Causes:
  • NCDs are driven primarily by behaviours that often start during childhood and adolescence including physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol.

Urban India and challenge of multiple health risks

• India’s urban inhabitants experience multi-scalar health risks like:
  • World’s highest levels of air and noise pollution, 
  • Limited greenery, 
  • Lack of access to sidewalks and parks that limit active lifestyles, 
  • Archaic modes of transport that contribute to air pollution, 
  • Pernicious access to nutritionally dense unhealthy foods and 
  • Unprecedented exposure to toxic chemicals and heavy metals. 
• Dysfunctional provisioning systems:
  • Globally, there are seven key physical provisioning systems that lie at the core of human health, well-being, equity and sustainability
    • Food, 
    • Energy, 
    • Mobility-transportation, 
    • Housing, 
    • Green infrastructure, 
    • Water and 
    • Waste management. 
  • Dysfunctional provisioning systems consume more than 90% of the world’s water and global CO2 emissions and facilitate an estimated 19 million premature deaths annually. 
  • These provisioning systems are also ‘Dysfunctional’ in most urban ecosystems in India.
• Socio-spatial-political design:
  • The socio-spatial-political design of urban provisioning systems in India, many of which are legacies of a colonial past, manifests in and exacerbates social inequalities in cities, by class, race, age, migrant and disability status.
  • It ultimately translates to vast disparities in health risks and outcomes.

Outcome/Impact

• Health risks: This concatenation of exposures dramatically magnifies health risks for heart disease and diabetes, referred to as cardiometabolic disease, especially when combined with a lack of physical activity.
  • Unhealthy diets, reduced physical activity and air pollution in cities in India pose a greater risk to morbidity and mortality than most other risk factors combined including drugs, tobacco, alcohol and accidents. 
• Impact on family & community: The epidemic of NCDs poses devastating health consequences for individuals, families and communities, and threatens to overwhelm health systems.
• Socioeconomic costs: The socioeconomic costs associated with NCDs make the prevention and control of these diseases a major development imperative for the 21st century.
  • Apart from the lives they take, NCDs take a heavy toll on economies, cutting down people in their most productive years.

Suggestions

• Focussing on India’s cities for its future: Based on the primal importance of India’s cities for its future, a new narrative for improving health and well-being in cities is needed.
  • This is reflected in several high-level policy frameworks, such as the United Nations Sustainable Development Goals (SDG) framework, the New Urban Agenda, and the Health in All Policies approach.
• Giving equal priorities to provisioning systems: Investments such as clean energy and electric mobility which are underway in India offer a once in a lifetime opportunity to improve health through their immediate and dramatic impact on air pollution levels, while also helping meet India’s climate and equity goals.
  • But, the magnitude of their impact on health outcomes is at risk of being limited.
  • It should rather be simultaneously accompanied by changes in other provisioning systems such as food, mobility and green infrastructure.
• Improving green infrastructure: Studies show that even small changes in improving green infrastructure may have a large catalytic effect on health and productivity.
  • For example, making way for safe walking and biking lanes, pavements and no-car zones, can help not only improve physical activity and reduce sedentary lifestyles but also reduce the risk from air pollution.
• Focussing on physical activity: Of all behaviours well known to mitigate the development of cardiometabolic disease, physical activity is by far the most effective deterrent.
  • Regular physical exercise has been to effectively mitigate the impact of other risk factors such as poor diets, particularly those rich in calories and saturated fats. 
• Improving dietary policies: Policies that encourage fresh fruits and vegetables and limit sugars and salt in beverages, which may have the largest impact on health outcomes such as obesity, Type 2 diabetes (T2D) and cardiovascular disease, may help contribute to not only better health outcomes but also economic productivity.

Government Initiatives targeting NCDs in India 

• National Health Mission (NHM): The Department of Health & Family Welfare provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), (launched in 2010) as part of National Health Mission (NHM), based on the proposals received from the States/UTs and subject to the resource envelope.
  • The programme focuses on strengthening infrastructure, human resource development, health promotion & awareness generation for prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the Non-Communicable Diseases (NCDs).
• Ayushman Bharat Health Wellness Centre scheme: Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. 
• Other initiatives for increasing public awareness about NCDs and for the promotion of healthy lifestyle includes:
  • Observation of National & International Health Days and 
  • Use of print, electronic and social media for continued community awareness. 
  • Furthermore, healthy eating is also promoted through FSSAI.
  • Fit India movement is implemented by the Ministry of Youth Affairs and Sports, and various Yoga-related activities are carried out by the Ministry of AYUSH. 
  • The Health Department is taking up a new initiative as part of the NCD Control programme to conduct population-based screening for non-communicable diseases (NCDs) and its risk factors, covering the entire State.
    • The idea is to prepare a Statewide community registry of those above 30 years with NCDs with the support of local self-governments so that the State has a clear estimation of the actual population suffering from various NCDs.

Way ahead

• Urban policies are powerful public health interventions that can serve to promote population health. 
• Health is, unfortunately, an afterthought in most national urban planning policies and mostly non-existent in national urban policy documents from lower and middle-income countries.
• These need to be dealt with on a war footing if India is going to make progress in its fight against cardiovascular disease, obesity and T2D.