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Urban health - issues and challenges

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Urban health - issues and challenges. …

Urban health - issues and challenges.
Kindly note that this presentation focusses more specifically on the Indian scenario even though the concepts are applicable everywhere


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  • The huge increases in urban population in poorer countries are part of a “second wave” of demographic, economic and urban transitions, much bigger and much faster than the first. The first wave of modern transitions began in Europe and North America in the early 18th century. In the course of two centuries (1750-1950), these regions experienced the first demographic transition, the first industrialization and the first wave of urbanization. This produced the new urban industrial societies that now dominate the world. The process was comparatively gradual and involved a few hundred million people. In the past half-century, the less developed regions have begun the same transition. Mortality has fallen rapidly and dramatically in most regions, achieving in one or two decades what developed countries accomplished in one or two centuries, and the demographic impacts of these mortality changes have been drastically greater. Fertility declines are following—quite rapidly in East and South-East Asia and Latin America and more slowly in Africa.
  • United Nations. World Urbanization Prospects: The 2007 revision. New York: United Nations; 2008.World Health Organization/UN-HABITAT. Hidden Cities: Unmasking and overcoming health inequities in urbans settings. WHO/UN-HABITAT; 2010.
  • Women & Adolescent girls at greater inconvenience: d/t lack of sanitation facilities in home, restricted access to common sanitation area during daylight hours.
  • Women & Adolescent girls at greater inconvenience: d/t lack of sanitation facilities in home, restricted access to common sanitation area during daylight hours.
  • DHS = demographic & health surveys
  • Total pop growth = 2%Urban pop growth = 3%Mega cities pop = 4%Slum pop = 5%
  • The main graphic elements of the HP logo are:one outside circle,one round spot within the circle, andthree wings that originate from this inner spot, one of which is breaking the outside circle.a) The outside circle, originally in red colour, is representing the goal of "Building Healthy Public Policies", therefore symbolising the need for policies to "hold things together". This circle is encompassing the three wings, symbolising the need to address all five key action areas of health promotion identified in the Ottawa Charter in an integrated and complementary manner.b) The round spot within the circle stands for the three basic strategies for health promotion, "enabling, mediating, and advocacy ", which are needed and applied to all health promotion action areas . (Complete definitions of these terms can be found in the Health Promotion Glossary, WHO/HPR/HEP/98.1)c) The three wings represent (and contain the words of) the five key action areas for health promotion that were identified in the Ottawa Charter for Health Promotion in 1986 and were reconfirmed in the Jakarta Declaration on Leading Health Promotion into the 21st Century in 1997.
  • Equity: addressing inequality in health, and paying attention to the needs of those who are vulnerable and socially disadvantaged; inequity is inequality in health that is unfair and unjust and avoidable causes of ill health. The right to health applies to all regardless of sex, race, religious belief, sexual orientation, age, disability or socioeconomic circumstance. Participation and empowerment: ensuring the individual and collective right of people to participate in decision-making that affects their health, health care and well-being. Providing access to opportunities and skills development together with positive thinking to empower citizens to become self-sufficient. Working in partnership: building effective multisectoral strategic partnerships to implement integrated approaches and achieve sustainable improvement in health. Solidarity and friendship: working in the spirit of peace, friendship and solidarity through networking and respect and appreciation of the social and cultural diversity of the cities of the Healthy Cities movement. Sustainable development: the necessity of working to ensure that economic development – and all its supportive infrastructural needs including transport systems – is environmentally and socially sustainable: meeting the needs of the present in ways that do not compromise the ability of future generations to meet their own needs.
  • Equity: addressing inequality in health, and paying attention to the needs of those who are vulnerable and socially disadvantaged; inequity is inequality in health that is unfair and unjust and avoidable causes of ill health. The right to health applies to all regardless of sex, race, religious belief, sexual orientation, age, disability or socioeconomic circumstance. Participation and empowerment: ensuring the individual and collective right of people to participate in decision-making that affects their health, health care and well-being. Providing access to opportunities and skills development together with positive thinking to empower citizens to become self-sufficient. Working in partnership: building effective multisectoral strategic partnerships to implement integrated approaches and achieve sustainable improvement in health. Solidarity and friendship: working in the spirit of peace, friendship and solidarity through networking and respect and appreciation of the social and cultural diversity of the cities of the Healthy Cities movement. Sustainable development: the necessity of working to ensure that economic development – and all its supportive infrastructural needs including transport systems – is environmentally and socially sustainable: meeting the needs of the present in ways that do not compromise the ability of future generations to meet their own needs.
  • www.youtube.com/whd2010
  • Family Health International (FHI) leads the consortium working on the Urban Health Initiative in Uttar Pradesh (UP) and provides overall management, leadership and strategic direction to the project, including monitoring and improving quality.CARE India’s dynamic multi sector relief and development programme addresses the interests of millions of disadvantaged women and girls.Hindustan Latex Family Planning Promotion Trust (HLFPPT), a nonprofit organization promoted by Hindustan Latex Limited, has supported RCH and HIV prevention and care programs in partnership with international development agencies, state governments, and the Ministry of Health and Family Welfare across 10 states in India. In UP, in addition to contraceptive social marketing and Community Care Centers, HLFPPT pioneered a social franchising model, the Merry Gold Health Network, to deliver quality maternal neonatal and child health services at affordable prices. Johns Hopkins University Center for Communication Programs JHUCCP will document the overall UHI communication strategy and design and implement the mass media strategy focused especially on TV and radio, focused on increasing contraceptive acceptance.
  • GIS = Geographic Information SystemsJNNURM = Jawaharlal Nehru National Urban Renewal MissionRAY = Rajiv AwasYojanaSJSRY = SwarnaJayantiShahariRojgarYojanaBSUP = Basic Services for Urban PoorIHSDP = Integrated Housing & Slum Development Programme
  • RAY = Rajiv AwasYojanaSJSRY = SwarnaJayantiShahariRojgarYojanaBSUP = Basic Services for Urban PoorIHSDP = Integrated Housing & Slum Development ProgrammeVAMBAY = ValmikiAmbedkarAwasYojanaNSDP = National Slum Development Programme
  • Transcript

    • 1. URBAN HEALTH: ISSUES & CHALLENGES Presented by: Dr. Timiresh Kumar Das Moderator: Dr. D. K. Raut Dir. Professor & Head, Dept. of Community Medicine, VMMC & SJH 1
    • 2. Definitions  Urban health issues & problems  › Global scenario › Indian scenario – health status, challenges  Programmes in urban health: Global & Indian › WHO Healthy Cities Initiative › World Health Day 2010 › National Urban Health Mission Urban planning & Health  Research & Training in Urban Health – innovations & solutions  References  2
    • 3.  Urbanisation: (Urban drift) › The process of making or becoming urban in character. http://oxforddictionaries.com/definition/urbanize?q=urbanisation#urbanize__2 › The physical growth of urban areas as a result of global change or the increasing proportion of the total population becomes concentrated in towns. UN-HABITAT  Urban area: › Communities of 100,000 or more, with a nucleus of at least 50,000 and surrounding communities that share a high degree of social and economic integration. 3
    • 4.  Health Promotion: The process of enabling people to increase control over and to improve their own health. › It is a comprehensive social & political process. › Not only improving skills and capabilities of individuals, but also action directed towards changing social, economic & environmental conditions so as to alleviate their effect on individual & public health. › It is the process of enbling people to increase control over the determinants of health and thereby improve their health. Ottawa Charter for Health Promotion. WHO, Geneva. 1986 4
    • 5.  Urban Health: The health status and health concerns of the population in urban areas. (Oxford Online Dictionary)  Urban Medicine: Refers to the patterns of disease that are more common in urban settings than elsewhere. (Urban Medicine & Metropolitan Health, 1st International Conference, Berlin, 2007)  Evaluate and help develop programs that lessen urban health risks and promote well-being of people living in urban areas. (International Society for Urban Health) 5
    • 6.  Healthy urban governance and integrated approaches to interventions are key pathways to reducing health inequity.  Securing more resources for health investments in urban settings, coupled with fairer distribution of those resources, is vital. › Urban poverty is not because of distance from infrastructure and services but from exclusion. (Knowledge Network for Urban Settings) 6
    • 7.  Urban health problems are not markedly different from those in rural area, but their solution are quite different. › Urban health is based on core healthy cities principles of equity, intersectoral cooperation, community involvement and sustainability. World Bank 7
    • 8.  With the majority of the world’s population now living in urban areas and this proportion expected to grow, urban health should become a major focus of global public health policy. › Whilst urbanization and the growth of cities is associated with increasing prosperity and good health in general, urban populations demonstrate some of the world’s most prominent health disparities – in both low- and highincome countries. › Rapid migration from rural areas as well as natural population growth are putting further pressure on limited resources in cities, especially in low-income countries. 8
    • 9.  Much of the natural and migration growth in urban populations is among the poor. › More than one billion people – one third of urban dwellers – live in slum areas which are often overcrowded with life-threatening conditions. › In low-income countries, disparities will increase as the combination of migration, natural growth and scarcity of resources results in cities being unable to provide the services needed by those who come to live there. 9
    • 10.  There is evidence of poorly planned or unplanned urbanization patterns which have negative consequences for the health and safety of people. › This includes increased risk of road traffic injury. › The increase of risk factors (such as physical inactivity and unhealthy diets) for heart disease, cancer, diabetes and chronic lung diseases. › Overcrowding, lack of proper sanitation lead to increased risk of communicable diseases. › Increased exposure to environmental pollution. › Unsafe living conditions leading to accidents. 10
    • 11. 11
    • 12. Non-communicable diseases like heart disease, high blood pressure, diabetes and obesity are linked to lifestyles in cities.  Communicable diseases such as diarrhoea caused by unsafe food and water or tuberculosis due to overcrowded living conditions.  Increased risk of road traffic accidents, injury and violence.  Mental health disorders and substance abuse.  Exposure to air pollution and second-hand smoke.  12
    • 13. 13
    • 14.  Urban population increase: › More than ½ of the world population in urban areas. › Most of this in lesser developed countries. › 2.4 billion in 2007 to 5.2 billion by 2050. › Developed countries – 0.9 billion in 2007  1.1 billion by 2050. United Nations. World Urbanization Prospects: The 2007 revision. New York: United Nations; 2008. 14
    • 15. United Nations. Department of Economic and Social Affairs, Population Division 15
    • 16. Proportion of world population in urban & rural areas 16
    • 17.  Urban population increase & slums: › Slum population: 1.14 billion in 2010 to 1.5 billion by 2020. › Over 90% of slum population is in developing countries. › Slums: Recognised slums, Unrecognised/ Hidden slums, Squatter settlements. › Slums represent significant concentrations of urban poverty – physical & psychological well-being of residents being severely compromised due to poor living conditions. World Health Organization/UN-HABITAT. Hidden Cities: Unmasking and overcoming health inequities in urbans settings. WHO/UN-HABITAT; 2010. 17
    • 18. 18
    • 19.  Problems unique to urban health & slums: Urban health vs 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 19
    • 20.  Urban health problems : › Poor roads, drainage and lack of playing spaces for children.  Vulnerability: Land rights, Drainage, Waste disposal.  Open drains  Blockage (d/t solid waste)  Open waste disposal in vacant spaces, no clearance .  Lack of proper playing spaces  Children play in dumps or near open drains  health risks 20
    • 21. › Lack of safe water and sanitation.  83% of urban population of African cities & 55% of people in large cities of Asia lack toilet facilities.  Greater problem for women & adolescent females.  4% of all deaths  directly attributable to lack of clean water supply. UN-HABITAT. Slums of the World: The face of urban poverty in the new millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003. 21
    • 22.  Urban health problems: › Housing, Land tenancy & Unrecognised slums:  Located on marginal land ( near railway tracks, river banks, near garbage dumps, etc) or illegally on Govt. or Private owned lands.  Prone to accidents, disasters, eviction.  Not counted  No official records  No services  48% of slums in Indian cities are unrecognised.  In Nairobi, 60% of the urban population is in unrecognised slums. National Sample Survey, India, 2008-09 UN-HABITAT. Slums of the World: The face of urban poverty in the new millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003 22
    • 23.  Urban health problems : › Health Inequities:  Urban averages mask intra-city disparities.  Urban poor face equal or greater health risks than rural population. Infant Mortality Rates for Urban poor, Urban nonpoor & Rural populations , by region 23
    • 24. Rates of Under-5 mortality according to residence in selected cities of Africa & South America 24
    • 25.  Urban health problems: › Child under-nutrition:  Poor diet, repeated morbidity, unhygienic living conditions lead to malnutrition.  Cities in Brazil have malnutrition rates of 19% in urban slums compared to 5% in other urban residents.  In Cote d’Ivorie, child malnutrition is 37% and 10% in urban slums & non-slums respectively. UN-HABITAT. State of the World’s Cities 2006/07 25
    • 26.  Urban health problems : › Low access to health services:  Proximity to quality health services  Barriers – economic, social.  In Mozambique, only 42.6% of urban children belonging to poorest quintile received complete immunisation in comparision to 90.5% among the richest quintile.  In Kenya, rates of home delivery among urban poor is 72.6% compared to 65.5% in rural and 23.3% in urban rich. Gwatkin DR, Rutstein S, Johnson K et al. Socio-economic Differences in Health, Nutrition, and Population within Developing Countries: An overview. Washington, DC: The World Bank; 2007. 26
    • 27.  Urban health problems : › Uncertain livelihoods:  The level of livelihood stability is closely linked to health.  Stability mitigates fear of uncertain livelihood   Sense of responsibility for health and surrounding.  Improved healthcare & education of children.  Greater community participation as well as urge to improve local conditions. 27
    • 28.  Urban health problems : › Injuries: Road traffic accidents  Unplanned development  Improper road & traffic infrastructure  Mixed nature of vehicles & pedestrians  Overuse and overloading of 2-wheelers › Injuries: Occupational & Residential –  Living near construction sites, railway tracks, etc  Unsafe, poorly constructed housing, Overcrowding  Waste & garbage – within slums or in children’s play areas. › Injuries: Intentional/ Violence/ Crime –  Need to work & commute late (for women)  Improper lighting, Inadequate policing.  Stress  Alcohol/ Drug abuse  Domestic violence 28
    • 29.  Urban health problems: › Communicable diseases:  HIV & Sexually transmitted diseases  Vector borne diseases – Malaria, Dengue, Chikungunya  Tuberculosis  Factors –         Poverty in slums Overcrowding, Migration, Floating population Poor water management Unhygienic living conditions – sanitation, solid waste, drainage Increased unsafe sex Low knowledge & awareness of healthy practices Weak public health system + low access to available services Lack of preventive measures, Fragmented response 29
    • 30. 30
    • 31. Year Urban Total Population population In million 1800 1950 2000 2008 2030 2% 30% 47% ~50% ~ 60% 140 360 1027 1160 2050 Source: UN, Urbanization prospects, the 2008 revision 31
    • 32.  286 million people in India live in urban areas (around 28% of the population)*  Estimated to increase to 357 million in 2011 and to 432 million in 2021*  After independence • 3 times growth - Total population • 5 times growth - Urban population* * Census of India 2001 32
    • 33.  4.26 crore people live in slums  A large number of slums are not notified*- around 50%  Urban growth has led to rapid increase in the number of urban poor In-migration and a floating population has worsened the situation  2-3-4-5  * NSSO Report No. 486 33
    • 34.  Migration: Causes & Consequences CAUSES CONSEQUENCES Increased family size -limited agricultural land -Land use Pattern -Irrigation facilities Overcrowding Better income prospects Mushrooming of slums Better educational facilities Unemployment Better “Life style” Poverty Amenities – health, transport, water, electricity Physical & mental stress Disasters - refugees Family structure -Nuclear families -Single males 34
    • 35. Slums Migration Illiteracy Unhygienic conditions Overcrowding Unemployment Communicable diseases Non-Communicable diseases Poverty Stretching of overburdened systems Crimes Injuries Stress Life style modification Mental illness 35
    • 36. Indicators Urban Poor Urban Non poor Overall Urban Overall Rural All India Urban Poor NFHS 2 Women age 20-24 married by age 18 years (%) 51.5 21.2 28.1 52.5 44.5 63.9 Women age 20-24 who became mothers before age 18 (%) 25.9 8.3 12.3 26.3 21.7 39.0 Total fertility rate (children per woman) 2.8 1.8 2.1 3.0 2.7 3.8 Higher order births (3+ births) (%) 28.6 11.4 16.3 28.1 25.1 29.5 Birth Interval (median number of months between current and previous birth) 29.0 33.0 32.0 30.8 31.1 31.0 36
    • 37. Indicators Mothers who had at least 3 antenatal care visits (%) Mothers who consumed IFA for 90 days or more (%) Mothers who received tetanus toxoid vaccines (minimum of 2) (%) Mothers who received complete ANC (%) Urban Poor Urban Overall Overall Non Urban Rural Poor All India Urban Poor NFHS 2 54.3 83.1 74.7 43.7 52.0 49.6 18.5 41.8 34.8 18.8 23.1 47.0 The statistics for urban poor 75.8 much lesser than urban 90.7 86.4 72.6 76.3 non-poor and comparable to 11.0 29.5 23.7 10.2 15.0 rural population 70.0 19.7 Births in health facilities (%) 44.0 78.5 67.4 28.9 38.6 43.5 Births assisted by a doctor/nurse /LHV/ANM/other health personnel (%) 50.7 84.2 73.4 37.4 46.6 53.3 Women age 15-49 with anaemia (%) 58.8 48.5 50.9 57.4 55.3 54.7 37
    • 38. NFHS-3 38
    • 39. Indicators Urban Poor Urban Non Poor Overall Urban Overall Rural All India Urban Poor NFHS 2 39.9 65.4 57.6 38.6 43.5 40.3 27.3 31.5 30.3 22.4 24.5 17.7 44.7 38.6 40.7 48.6 46.4 44.3 56.2 66.1 63.1 54.7 56.7 52.7 Children who are stunted (%) 54.2 33.2 39.6 50.7 48.0 52.5 Children who are underweight (%) 47.1 26.2 32.7 45.6 42.5 48.0 Children with anaemia (%) 71.4 59.0 63.0 71.5 69.5 79.0 Neonatal Mortality 34.9 25.5 28.7 42.5 39.0 45.5 Infant Mortality 54.6 35.5 41.7 62.1 57.0 69.8 Under-5 Mortality 72.7 41.8 51.9 81.9 74.3 39 102.0 Children completely immunized (% Children under 5 year’s breastfed within one hour of birth (%) Children age 0-5 months exclusively breastfed (%) Children age 6-9 months receiving solid or semi-solid food and breast milk (%)
    • 40. NFHS-3 40
    • 41. NFHS-3 41
    • 42. Indicators Households with access to piped water supply at home (%) Households accessing public tap / hand pump for drinking water (%) Household using a sanitary facility for the disposal of excreta (flush / pit toilet) (%) Prevalence of medically treated TB (per 100,000 persons) Women (age 15-49) who have heard of AIDS Prevalence of HIV among adult population (age 15-49) Children under age six living in enumeration areas covered by an AWC (%) Women who had at least one contact with a health worker in the last three months (%) Urban Poor Urban Non Poor Overall Urban Overall Rural All India Urban poor NFHS 2 18.5 62.2 50.7 11.8 24.5 13.2 72.4 30.7 41.6 69.3 42.0 72.4 47.2 95.9 83.2 26.0 44.7 40.5 461 258 307 469 418 535 63.4 89.1 83.2 50.0 60.9 42.1 0.47 0.31 0.35 0.25 0.28 na 53.3 49.1 50.4 91.6 81.1 na 10.1 5.8 6.8 14.2 11.8 16.7 42
    • 43. 43
    • 44.  Originated with the 1st International Conference for Health Promotion, Ottawa, 1986. 44
    • 45.  WHO defines the Healthy City as: "one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.“ World Health Organization. Health Promotion Glossary 1998 45
    • 46.  Principles: › › › › › Equity Participation & Empowerment Working in partnership Solidarity & Friendship Sustainable development Zagreb declaration for healthy cities. WHO 2009. 46
    • 47. 47
    • 48. An international network aiming at protecting and enhancing the health of city dwellers.  A group of cities and other organizations that try to achieve the goal through the “Healthy Cities” approach .  Founded October 17, 2003 at the 1st Organizational Meeting, held at the WHO Regional Office for the Western Pacific in Manila, Philippines.  Aims to promote and support the “healthy cities” concept through cooperation & dissipation of information  48
    • 49. Urban HEART (Urban Health Equity Assessment and Response Tool).  Decision-support tool to identify and reduce health inequities in cities.  Enables local communities, programme managers, and municipal and national authorities to:  › better understand the unequal health determinants, unequal health risks and unequal health outcomes faced by people belonging to different socioeconomic groups within a city; › use evidence when advocating and planning health equity interventions; › participate in inter-sectoral collaborative action for health equity; › apply a health equity lens in policy-making and resource allocation decisions. 49
    • 50. 12 Urban HEART Core Indicators Health outcomes Physical environment & infrastructure Social and human development Infant mortality Access to safe water Completion of primary education Diabetes Access to improved sanitation Skilled birth attendance Tuberculosis Fully immunized children Road traffic injuries Prevalence of tobacco smoking Economics Unemployment Governance Government spending on health
    • 51. 51
    • 52.  In 2011, WHO launched the Global Health Observatory.  A gateway to health statistics on global public health priorities.  “Urban health” theme developed by WHO Kobe Centre.  Presents data on 16 indicators for 45 countries. 52
    • 53. Tool for building the evidence base for action.  Store, Present and Analyse data on urban indicators.  User friendly software designed in response to UNHABITAT’s data users.  Designed by UN-HABITAT in collaboration with UNICEF & UNDG.  Monitoring Urban Inequities Programme produces the Global Urban Indicators database, which is updated annually.  53
    • 54. 54
    • 55. 55
    • 56. 56
    • 57.  To draw attention to urbanization and health, recognizing that in an increasingly urbanized world, health issues present new challenges that go far beyond the health sector and require action at the global, national, community, and individual levels. 57
    • 58.  Urban planning can promote healthy behaviours and safety through › investment in active transport › designing areas to promote physical activity › 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.  58
    • 59.  1000 cities, 1000 lives campaign: 59
    • 60.  1000 cities: › WHO called upon 1000 cities across the world to open up public spaces to people, whether it be activities in parks, town hall meetings, clean-up campaigns, or closing off portions of streets to motorized vehicles. › To create awareness & to encourage active recreation. › 1558 cities participated.  1000 lives: › To collect 1000 stories of urban health champions who have taken action and had a significant impact on health in their cities. › Videos on youtube. (www.youtube.com/whd2010) 60
    • 61.  Network of community-based organizations of the urban poor in 33 countries in Africa, Asia, and Latin America.  Launched in 1996  “Federations” of the urban poor in countries such as India and South Africa agreed that a global platform could help their local initiatives develop alternatives to evictions. 61
    • 62. The SDI Method 62
    • 63. Implemented by a consortium of international, national, and community based organizations.  Responds to rapid urbanization and poor health indicators among the urban poor in Uttar Pradesh, India.  Prioritizes the implementation and scale-up of effective evidence-based strategies which are aligned with government plans and schemes, as well as innovations that can be piloted and tested.  63
    • 64.  Started under the West Bengal Urban Services Act, 1993. ULBs are required to submit draft development plan.  Working on  › Nutrition › Reproductive & Child Health › School Health Projects › HIV/ AIDS 64
    • 65. By Ministry of Health & Family Welfare, Govt. of India. (MoHFW)  To effectively address the health concerns of urban poor.   To be part of National Health Mission along with National Rural Health Mission (NRHM). 65
    • 66. INSTITUTIONAL FRAMEWORK NATIONAL URBAN HEALTH MISSION STATE URBAN HEALTH MISSION DISTRICT URBAN HEALTH MISSION WARD/ SLUM LEVEL NRHM Mission Steering Group NRHM Empowered Programme Committee National Urban Health Mission Directorate National Urban Health Mission Secretariat State Health Mission State Health Society State Urban Health Directorate State Urban Health Secretariat District Health Mission District Health Society District Urban Health Committee District Urban Health Secretariat Ward Health,Water & Sanitation Committee Slum/Slum Cluster Health, Water & Sanitation Committee
    • 67. 67
    • 68. Encourage participation of community in planning & management of healthcare services.  USHA (Urban Social Health Activist)  › In urban poor settlements/ slums. › 1 USHA for 1000-2500 population (200-500 hh) Mahila Arogya Samiti (MAS) – 20-100 hh  Proactive outreach  › To urban poor settlements › Through Outreach sessions & › Monthly health and nutrition days  Special attention to vulnerable sections › ragpickers, rickshaw pullers, sex workers, construction site workers, etc › Through Public HC system/ PPP/ other models. 68
    • 69.  Promote community risk-pooling › Through MAS – by regular monthly savings 69
    • 70. Aims to provide convergence of all communicable and non-communicable disease programmes.  Common platform and availability of all services at one point – PUHC (Primary Urban Health Centre)   Urban component/ Funds to be identified within the programmes and converged/ located at the PUHC level.  Existing IDSP structure leveraged for improved surveillance. 70
    • 71. 71
    • 72. 72
    • 73. 73
    • 74.  Was to be launched in 2008, (last 4 years of 11th 5-year plan).  However, not yet launched.  Due to be launched during the 12th plan. 74
    • 75. 75
    • 76.  1. WHO supports a framework of actions and solutions for healthy living that includes five priority areas, most of which sit within the realm of urban planning. Use urban planning to promote healthy behaviours and safety: • • • • design cities to promote physical activity. make healthy food available and affordable. provide health services for all. improve road safety. 76
    • 77. 2. Improve urban living conditions: • • • • 3. locate houses in safe places improve housing conditions control indoor and outdoor pollution ensure safe water and improved sanitation. Ensure participatory urban governance: • • • • share information about city planning for health encourage public dialogue involve communities in decision-making create opportunities for participation. 77
    • 78. 4. Build inclusive cities that are accessible and agefriendly: • • • • 5. make public transport accessible to disabled people develop safe walkways for those with special needs build public places and buildings for easy access promote active city life and sports for all. Make urban areas resilient to emergencies and disasters: • • • • locate hospitals in safe areas strengthen health centres to withstand known dangers prepare community emergency response improve disease surveillance. 78
    • 79.  Eco-city (sustainable city ) is a city designed with consideration of environmental impact, inhabited by people dedicated to minimization of required inputs of energy, water and food, and waste output of heat, air pollution - CO2, methane, and water pollution.  An ecocity is… an ecologically healthy city. › An ecologically healthy human settlement modeled on the self-sustaining resilient structure and function of natural ecosystems and living organisms. › An entity that includes its inhabitants and their ecological impacts. › A subsystem of the ecosystems of which it is part — of its watershed, bioregion, and ultimately, of the planet. › A subsystem of the regional, national and world economic system. 79
    • 80.  A sustainable city should be able to feed itself with minimal reliance on the surrounding countryside, and power itself with renewable sources of energy. The crux of this is to create the smallest possible ecological footprint, and to produce the lowest quantity of pollution possible, to efficiently use land; compost used materials, recycle it or convert waste-to-energy, and thus the city's overall contribution to climate change will be minimal, if such practices are adhered to.  The ecocity model seeks to provide a practical vision for a sustainable and restorative human presence on this planet and suggests a path towards its achievement through the rebuilding of cities, towns and villages in balance with living systems.  80
    • 81.  Architecture & Infrastructure components: › Eco- Industrial park › Urban farming › Urban Infill › Walkable urbanism › Individual buildings  Transportation components: › Emphasis on proximity › Diversification of transport options › Transportation access 81
    • 82. 82
    • 83.  Geo-spatial mapping & GIS in conjunction with ground surveys. › To correctly identify slum areas/ poverty clusters. › To delineate areas accurately. › To enumerate urban poor populations in previously unrecognised slums & squatter clusters. › Already being implemented through RAY (Rajiv Awas Yojana) 83
    • 84.  Organizing & strengthening slum community groups and processes. › Desire & resourcefulness › Help in reaching out to vulnerable groups › E.g. Organising TB clubs, Self help financial groups, etc 84
    • 85. To prevent & minimise the impact of accidents and injuries.  Mortality due to all kinds of injuries are higher in low & middle income countries and more so among the poor.  Better constructed homes which meet safety standards incorporated at the city planning stage.  Planning & designing urban built environments to be resilient to natural disasters.  RAY, VAMBAY, NSDP, IHSDP  85
    • 86. Promoting low cost nutritious foods and cooking methods.  Urban planning which integrates food security into basic community goals.  › Regulation of food markets › Food subsidies where required. Improving transport & storage infrastructure to better connect rural production centres and urban consumption centres.  Promoting community grain banks.  86
    • 87.  Ministries of health: › Become more informed about health determinants, and how urban policy choices influence the health of city dwellers. › Proactively engage other sectors, including housing, transport, industry, water and sanitation, education, environment, and finance agencies. › Lead by example: support healthier and more liveable cities. › Support health and environmental impact assessments for urban plans and policies. 87
    • 88.  Local government bodies: › Foster collaboration within local government through forums and dialogue between public health officials and urban planners. › Partner with nongovernmental and community organizations; establish a mechanism that will give health professionals the opportunity to provide input on planning and transport plans. › Provide a mechanism for sharing information, across government and with civil society and the community, on the nature of urban health inequities and progress in reducing them. 88
    • 89.  Civil Society: › Ensure that people participate fully in shaping the policies and programmes that affect their lives. › Include residents of informal settlements in formal processes by establishing groups, associations and federations. To identify the social and economic conditions that they face; to find practical solutions to these problems; to struggle against marginalization; and to ensure access to the goods and services to which they are entitled. › Work with governments on participatory planning and budgeting to allocate a greater portion of the municipal investment budget to priorities determined by neighbourhoods and community groups. 89
    • 90.  Researchers: Generate and systematize knowledge to address the many existing information gaps, including: › potential advantages of urbanization and urban growth; › the inequities of health disaggregated by intra-urban area; › the effectiveness of proactive approaches to deal with health inequity in cities; › the importance of involving all citizens in the decisions that affect their habitat and their health. 90
    • 91.  Urban planners: › Use zoning and land use regulations as a way to prevent exposure of city dwellers to pollution emissions and hazards from industrial and commercial activities, waste and chemicals, and transport. › Develop and adopt building practices that protect health among building users 91
    • 92.       Why Urban Health Matters, WHD-2010. World Health Organisation, 2010. Geneva, Switzerland. Hidden cities: Unmasking and Overcoming Health Inequities in Urban Settings. WHO – UNHABITAT. WHO, Geneva, Switzerland. 2010. Essays in Healthy City Design. ANU College of Medicine, Biology & Environment, Canberra, Australia. July 2011. Basic Principles of Healthy Cities: Evaluating a Healthy Cities Project. Department of Health, Hong Kong. 2010. Agrawal S. Health Inequalities in India’s Cities. Presentation at the Cities, Health and Well Being, Urban – Age Conference, Hong Kong. November 2011. Agarwal S. The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities. 92
    • 93.      Regional Guidelines For Developing A Healthy Cities Project. WHO Regional Office for the Western Pacific, March 2000. http://www.uhiindia.org/index.php?option=com_content&view=article &id=63&Itemid=41 http://sustainablecities.dk/en/blog/2011/04/aretrospective-look-at-world-health-day-2010initiatives-on-urban-health National Urban Health Mission, Framework for Implementation. Draft for Discussion, 2010. Health of the urban poor in India: issues, challenges & the way forward. Report of panel discussion and poster session, March 29, 2007. UHRC, New Delhi. 93
    • 94.          http://www.alliancehealthycities.com/htmls/about/index_about.html UN-HABITAT. Slums of the World: The face of urban poverty in the new millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003 Canon T. Vulnerability Analysis and the Explanation of Natural Disasters. Zagreb declaration for healthy cities. WHO 2009. World Health Organization. Health Promotion Glossary 1998 UN, Urbanization prospects, the 2008 revision http://www.who.int/kobe_centre/measuring/urban_health_obse rvatory/en/ http://www.who.int/kobe_centre/measuring/urbanheart/en/ http://www.who.int/world-health-day/2010/1000-cities/en/ 94
    • 95. THANK YOU THANK YOU 95