India is rapidly becoming urbanised. By 2030, around 40% of the country's population will live in urban areas. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. In The Lancet Global Health, Sundeep Salvi and colleagues1 offer a glimpse into India's urban health situation by reporting on the medical symptoms and diagnoses and the characteristics of patients who sought treatment from qualified primary health-care practitioners across 880 cities and towns on one day in 2011.
2. Urbanization: Trends and Patterns
• Movement of people from rural to urban
areas with population growth equating to
urban migration.
• It’s a double edged sword
• On one hand - Provides people with varied
opportunities and scope for economic development
• On the other- Exposes community to new threats
• Unplanned urban growth is associated with
• Environmental degradation
• Population demands that go beyond the environmental
service capacity, such as drinking water, sanitation, and
waste disposal and treatment
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3. Urbanization trends in India
Year
1800
1950
2000
2008
2030
2%
30%
47%
50%
60%
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Source: UN, Urbanization prospects, the 1999 revision
Total
population
360
1027
140
1160
In million
Urban
Population
2050
5. Urban Vs Rural health
Is urban health better than rural health?
Almost all health indicators are better for urban when compared
to rural
When the urban slums are taken many are worse than rural !!!
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6. Factors Affecting Health in Slums
• Economic conditions
• Social conditions
• Living environment
• Access and use of public health care services
• Hidden/Unlisted slums
• Rapid mobility
6* Agarwal S, Satyavada A, Kaushik S, Kumar R. Urbanization, Urban Poverty and Health of the Urban Poor:
Status, Challenges and the Way Forward. Demography India. 2007; 36(1): 121-134
7. Urban poor - key elements of health
• Marriage & Fertility
• Maternal health
• Child survival
• Family planning
• Environmental Conditions, Infectious Diseases and
Access to Health Care
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8. Double Burden of Diseases
Overcrowding and related health issues
• Rapid growth of urban centers has led to substandard
housing on marginal land and overcrowding .
• Outbreaks of diseases transmitted through respiratory
route due to increased population density.
• It increases the health risks related to insufficient and
poor water supply and poor sanitation systems
• Lack of privacy leading to depression, anxiety,
stress etc.
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9. Double Burden of Diseases
Air pollution and its consequences
• Increase in the numbers of motorized vehicles and
industries in the cities of the developing world
causes problems of noise and air pollution.
• Air pollution can affect our health in many ways
with both short-term and long-term effects.
• Short-term air pollution can aggravate medical
conditions like asthma.
• Long-term health effects can include chronic
respiratory diseases, lung cancer, heart diseases,
and even damage to other vital organs.
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10. Double Burden of Diseases
Water and sanitation problems
• Due to increasing urbanization coupled with
existing un-sustainability factors and conventional
urban water management, nearly 1.1 billion
people worldwide do not have access to clean
drinking water and 2.6 billion people i.e. over 400
million people, lack even a simple improved
bathroom.
• This problem can lead to increased episodes of
diarrhea and economic burden.
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11. Double Burden of Diseases
Upsurge of Non-communicable diseases
• The rising trends of non-communicable diseases
are a consequence of the demographic and
dietary transitions.
• Urbanization is an example of social change that
has a remarkable effect on diet in the
developing world.
• In India, chronic diseases are estimated to
account for 53% of all deaths and 44% of
disability-adjusted life-years (DALYs) lost in 2005.
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18. The Solutions
• Ensure adequacy and reliability of health
related data.
For understanding the depth of situation and for
planning purposes.
• Need for inter - sectorial co-ordination.
• Sharing of successful experiences and
best practice models.
Successful experiences from other countries can be
adopted. These can be adopted with local
adaptations to suit the need of the people and the
current situation
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19. The Solutions
• Reducing the financial burden of health care
through –
Community health funds
Health insurance
Subsidized out patient care provision by private providers
• Application of PURA (Provision of Urban amenities
to Rural Areas) model to slums.
• To improve the infrastructure
• To increase community participation through SHGs
• To enhance self reliability of the communities
• Strengthening public private partnerships.
• Strengthening public health care facilities
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