Healthy Cities India


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Healthy Cities India

  1. 1. Promoting health and well-being in cities of India – towards Healthy Cities in IndiaUNHABITAT, State of the World Cities, 2008-09 Amit Samarth MBBS MPH
  2. 2. Amit SamarthOur collective purpose as a society• To be economically progressive• To be socially cohesive• To promote health and well-being• To enable individuals to achieve their intellectual and physical potential• To ensure that citizens today and tomorrow will be able to enjoy the basic amenities of life in a sustainable and eco-friendly way
  3. 3. Amit Samarth Ecological model of Human Health Dahlgren and Whitehead model Source: Barton and Grant, 2006Human health should be seen in a physical, social, behavioural, and ecological context.Health promotion activities should involve other sectors making a contribution tohealth, such as education, food, nutrition, and environment.
  4. 4. Amit SamarthGrowth in urban population of India • Population of India - increase from 1029 million to 1400 million in a period from 2001 to 2026 • Urban population – from 286 million to 575 million • Increase in urban population will almost account for two- thirds of population increase • Slum dwelling population is also increasing - major contributor • Growth due to natural increase • More than 40% population will be living in the urban areas by 2026 • Change in population dynamics of India - major implication for health and well being 4
  5. 5. Amit Samarth What have our cities achieved?• Drivers of economic growth• Hubs of world class education, commerce and specialized health care servicesChallenges –• Rapidity of growth of urban population• Pressure on basic infrastructure – housing, water, sanitation, transport, gre en cover, education, employment and health servicesWhat can we learn from the challenges ofpresent cities? Source: India’s Urban Awakening. Building Inclusive cities , Sustaining Economic Growth
  6. 6. Half of us will be living in cities by 2030
  7. 7. Rapid growth of Indian Cities
  8. 8. Amit Samarth Cities in India are of great contrast• 90 million or more urban poor live in cities of India• Informal sector one of the key drivers of economic growth• Growing inequalities and growing exclusion• Poor living conditions• Poor health outcomes• Loss of productivity• Increasing crime and violence• Environmental degradation due to lack of waste management Source: India Urban Poverty Report 2009
  9. 9. Amit Samarth Poor health status of the urban poor• High infant and maternal mortality Urban areas in India• High water-borne diseases have better specialized• High vector borne disease like malaria healthcare services and dengue but facilities for• Higher incidence of chronic diseases like promotive and primary hypertension, diabetes and coronary care are non-existent heart disease• Poor occupational health• Higher mental illnesses• Road traffic injuriesIn Andhra Pradesh, there are 7500 slum localities but there areonly 250 Urban Healthcare Centres. Better primary careservices needed. Source: Living conditions in 8 cities of India. NFHS-III Survey 2005-06
  10. 10. Amit SamarthEpidemic of non-communicable diseases (NCDs) Triple burden of disease Diabetic capital of the world High prevalence of Hypertension Obesity and overweight is on the rise Nutritional transition More than 50 percent deaths occur in India due to cardiovascular diseases Reference – Report of National Commission on Macroeconomics and Health, 2005 10
  11. 11. Amit SamarthPopulation in India will Age..! Projections for Old Population (>60 yrs) in India (in millions) 350 308 300 248 250 223 195 200 167 150 119 100 77 50 0 Yr 2000 Yr 2015 Yr 2025 Yr 2030 Yr 2035 Yr 2040 Yr 2050 % Population of Old (>60 years) of Total population in India Source: 25 20.14% Population 20 15.3% 16.7% 13.76% division, 15 12.22% 9.56% Department of 10 7.55% Economic and 5 Social 0 Development, Yr 2000 Yr 2015 Yr 2025 Yr 2030 Yr 2035 Yr 2040 Yr 2050 United Nations
  12. 12. Amit Samarth Population Pyramid for India in year 2000 and projected for year 2050Source: Population division, Department of Economic and Social Development,United Nations
  13. 13. Amit SamarthPopulation of India will Age• By 2040, 248 million people > 60 yrs of age• By2050, 308 million people > 60 yrs of age – Constituting 20 percent of overall population• With rapid urbanization most of this population will be living in urban areas• Need to build our cities to become age-friendly and create settlements Need to design/develop which will help promote well-being cities for them too…! across all age-groups
  14. 14. Amit Samarth WHO launches Global Network of Age-friendly Cities• Launched in 2010• Part of a broader response to the rapid ageing of populations• By 2050, it is estimated that 80% of the expected 2 billion people aged 60 years or over will live in low or middle income countries• The Network aims to help cities create urban environments that allow older people to remain active and healthy participants in society• WHO has also established formal agreements with the French government, the Irish Ageing Well Network and the Slovenian Network of Age-friendly Cities to develop affiliated national programmesSource:
  15. 15. Amit SamarthPoorly planned transport system• Only 2 per cent cities have low air pollution on the basis of PM10• In 80 per cent of cities at least one criteria pollutant exceeded the annual average ambient air quality standards• Exponential growth in private vehicles in last few years -17 million vehicles in last 7 yrs• Personal vehicles – cars and two-wheelers -- use up more than 75 per cent of the road space, but meet only 20 per cent of the city’s commuting demand Are we creating more• Transport study for Hyderabad – Multi space for cars rather mode Mass Rapid Transport can achieve than for people? 30% reduction in Vehicle Kms Travelled per day Source: State of Air Pollution in Indian Cities 2007, Centre for Science and Environment
  16. 16. Amit SamarthDramatic motorization of India Source: Road Traffic and Injury Prevention in India. NIMHANS and WHO India. 2004-05
  17. 17. Amit Samarth Poor Road Safety in India • Results in deaths of > 100, 000 people in India • Results in 2 million hospitalizations • 7.7 million minor injuries • Road traffic accidents next only to cardio-vascular diseases • Affect age group 5 to 44 yrs – most productive years • Man-made epidemicSource: Road Traffic and Injury Prevention in India. NIMHANS and WHO India. 2004-05
  18. 18. Amit SamarthPoor Road Safety – Role of urban planning• Road safety – a complex problem• Road accidents are preventable• Urban design and engineering has a major role to prevent accidents• Designing urban spaces to reduce environmental factors responsible for accidents Car/motor-cycles are equal to an weapon on unsafe and ill- designed roads….We need to make our roads safer and nicer for everyone in the city…currently there is too much of priority on the roads for cars/motor-cycles
  19. 19. Amit SamarthPromoting and protecting health has become a challenge…..• Poor waste management• Poor housing• Poor sanitation• Lack of good footpaths• Absence of dedicated cycling paths• Lack of green spaces• Lack of sports and recreation facilities• Lack of social space
  20. 20. Amit SamarthGreen cover and social space is important• To improve air quality and reduce pollution• To reduce heat island effects• To improve physical activity• To improve opportunities for social interaction• Reduce urban heat island effect To address Cardio-respiratory diseases, mental illnesses and Cancer
  21. 21. Temperature related Modulating Pathways by which influences illness and death climate change Extreme weather related health affects human effects Contamination health Pathways Air pollution related Transmission health effects Human Exposure dynamics Regional Weather Water and food Climate changes borne diseases Change •Heat waves •Extreme weather Changes in agro- Vector-borne and •Temperature ecosystems and rodent borne •Precipitation hydrology diseases Effects of food and water shortages Socioeconomic Mental, nutritional and demographic infectious and other disruption health effectsSource: Climate Change and Human Health – Risks and Responses, Summary., WHO 2003 Amit Samarth
  22. 22. Amit SamarthBuilt Environment• The built environment encompasses land-use patterns and all buildings, spaces and elements that people construct or modify• This includes homes, schools, workplaces, parks, recreation areas, green spaces, business districts and transport systems• Urban design is an aspect of urban planning that focuses on creating a desirable environment to live, work and play• Conditions in the built environment can both negatively and positively affect participation in physical activity• Need to design the built environment for people• Street layout, land use, the transport system and the location of recreation facilities, parks and public buildings, are all components of a community that can either encourage or discourage active living• Growing dependence on cars and motorization is a serious concern
  23. 23. Amit SamarthBuilt Environment • Urban sprawl has been correlated with higher body weight, obesity and associated chronic diseases • Crowded city centres and a resurgence of urban living may make finding room for green spaces difficult, especially in older, established cities • In many countries, cycling and walking have been marginalized in transport decision-making • Traffic injuries and fatalities resulting from high vehicular speed, heavy traffic flow and a lack of separate lanes, tracks and paths are major reasons why people do not walk or cycle in cities • Factors like lack of quality lighting; a lack of access to open spaces and to sports and recreation facilities; rundown houses and neighbourhoods; poor aesthetics; and locked stairwells in workplaces and public buildings also discourage physical activity • Cycling or taking public transport to work may be seen as a sign of lower status since affluent people typically drive to work
  24. 24. Amit SamarthImpact of Built Environment on healthBuilt environment can address issues like:• Obesity• Non-Communicable diseases• Mental health• Air pollution• Road Traffic accidents• Safety to women, children and old people• Availability of nutritious food• Helping cities to become more energy efficient• Easy access to recreational facilities• Easy access to healthcare and educational facilities• Healthy ageing• Waste disposal and Recycling• Water borne diseases
  25. 25. Amit SamarthImpact of built environment on our health
  26. 26. Amit Samarth What we need to do in emerging cities of India to promote andprotect health…?
  27. 27. Amit Samarth Embedding health in all policies Good urban governance & healthy urban planning Improve availability Healthy Improveand access to Urban health and healthcare Population social equity services Improve living and working condition
  28. 28. Amit Samarth Make Healthy Choice – The Easy ChoiceCommunity Basic services Information Housing Good water & Education Healthcare quality services Sanitation Government Education and Social & services employment Cultural Waste activities Good air Health and management quality Social equity Healthy Environment leading to Green Healthy Urban Cheap Spaces Population Lightings Cheap and Cheap nutritious transport Roads Access to Clean food Infrastructure Energy Nutrition 28
  29. 29. Make Healthy Choice – Amit Samarth The Easy Choice in cities of IndiaPresent cities Promoting health in urban India Future cities Basic services Good water Community Affordable quality Information Housing Sanitation & Education Healthcare Education & Government services employment services Social & Cultural Waste management Good air activities quality Embedding health in ‘ALL Policies’ Cheap Green Spaces Cheap and Cheap nutritious Clean Access to Public Lightings transport food Energy Roads Nutrition Infrastructure Multi-disciplinary & multi-sectoral approach Human and environmental health are intricately linked
  30. 30. Amit Samarth Urban planning and promotion of health  Reduce obesity  Provide better Reduce carbon Reduced levels of public transport emissions and air cardiovascular  discouraging use pollutants diseases of private vehicles  Improve air  Reduced  Facilitate more quality respiratory diseases walking and  Increased  Improved social cycling physical activity capital  Improved social  Reduce road capital traffic accidents  Mitigate climate changeSource: Margalit Younger, Heather R. Morrow-Almeida, Stephen M. Vindigni, Andrew L. Dannenberg. The Built Environment, Climate Change, and HealthOpportunities for Co-Benefits
  31. 31. Amit Samarth Urban planning and promotion of health  Local markets  Urban  Reduced obesity  Improved and agriculture  Reduced levels of better balanced  Promote locally cardiovascular nutrition grown food diseases and  Cheaper diabetes  Provide healthy agricultural food options and  Mitigate climate produce information change  Reduced carbon  Restrict fast  Sustainable emissions food restaurants development and advertisingSource: Margalit Younger, Heather R. Morrow-Almeida, Stephen M. Vindigni, Andrew L. Dannenberg. The Built Environment, Climate Change, and HealthOpportunities for Co-Benefits
  32. 32. Amit SamarthHealthy City Concept
  33. 33. Amit SamarthAttributes of Healthy City (WHO)• A clean, safe physical environment of high quality (including housing quality)• An ecosystem that is stable now and sustainable in the long term• A strong, mutually supportive and non - exploitative community• A high degree of participation and control by the public over the decisions affecting their lives, health and wellbeing• The meeting of basic needs ( for food , water, shelter, income, safety and work) for all the city’s people
  34. 34. Amit SamarthAttributes of Healthy City (WHO)• Access to a wide variety of experiences and resources, with the chance for a wide variety of contact , interactions and communications• A diverse, vital and innovative city economy• The encouragement of connectedness with the past, with the cultural and biological heritage of city dwellers and with other groups and individuals• Urban form that is compatible with and enhances the preceding ch aracteristics• An optimum level of appropriate public health and sick care services accessible to all• High health status (high levels of positive health and low levels of disease)
  35. 35. Amit SamarthAthens declaration on Healthy Cities• Based on key principles of equity, sustainability, intersectoral cooperation and solidarity• Political commitment to reducing the health gap between and within our cities• Implementing ecological policies for the environment• Maximizing the added health value of all municipal programmes through systematic assessment of the health impact of all policies• Determined in making Healthy Cities a global movement• Will develop city health development policies, strategies and plans that set out to improve the social, environmental and economic determinants of
  36. 36. Amit SamarthAthens declaration on Healthy CitiesEspecially address issues related to,• health needs of children and young people, women, ethnic minority groups and older people;• links between poverty and health;• needs of populations at risk;• dangers which arise from tobacco abuse, addiction to drugs and alcohol, pollution and violence; and• other concerns connected to urban planning, ecological management and social support
  37. 37. Amit Samarth Cities should have aHealth/Wellness Plan Case Study - Well London Strategy
  38. 38. Amit SamarthWell London Strategy – was developed with• Extensive consultations and discussions with stakeholders – London Food Strategy – Children and Young People Strategy – Older People’s Strategy – London: Cultural Capital – Strategic framework on mental health and well-being in London – Delivery plan for London Olympics and Paralympics – Economic development strategy – London plan for sports and physical activity• Targeted interventions in 20 communities across London
  39. 39. Amit SamarthWell London StrategyProjects directed towards improving• Healthy eating• Physical activity• Mental health and well- being• Access to open spaceThe outcomes of all theprojects are measured usingSMART indicators
  40. 40. Amit SamarthUniversity of Central Lancashire - Healthy Settings Unit• Development, delivery and management of externally- funded settings-based health promotion programmes• Research, evaluation and knowledge transfer training• Academic teaching• Healthy Settings module leadership and co-ordination of UCLan’s Healthy University initiative• Co-ordination of the English National Healthy Universities Network• Co-ordination of the UK Healthy Cities Network• Chairing the International Union of Health Promotion and Education’s Global Working Group on Healthy Settings contributing to the development and management of WHO’s Health in Prisons ProjectSource :
  41. 41. Amit SamarthEuropean cities involved in Healthy Cities Network • Austria • Greece • Belgium • Hungary • Bosnia and Herzegovina • Israel • Croatia • Italy • Cyprus • Latvia • Czech Republic • Lithuania • Denmark • Netherlands • Estonia • Norway • Finland • Poland • France • Portugal • Germany • Russian Federation Source: cities/national-healthy-cities-networks/network-of-national-healthy-cities-networks-coordinators
  42. 42. Amit SamarthEuropean cities involved in Healthy Cities Network• Slovenia• Spain• Sweden We should also• Switzerland be having many• Turkey of our Indian• Ukraine• United Kingdom of Great Cities in this Britain and Northern Ireland network• United Kingdom of Great Where are We? Britain and Northern IrelandSource:
  43. 43. Amit Samarth Healthy Cities - Belfast City Health Impact Assessment of the City Master PlanBased on -• Traffic calming – to prioritize pedestrian linkages and encourage “people not cars”• Pedestrian and cycle facilities• Quality public spaces – mixed land use• Encouraging a 24-hour environment• Destination creation• Commercial attractiveness• Employment generation• Affordable housing
  44. 44. Examples are many, but we need some action..!We need to do similar for our cities in India “Knowing is not enough; we mustapply. Willing is not enough; we must do” - Goethe
  45. 45. Amit SamarthDevelop aCenter forHealthy Cities inIndia
  46. 46. Amit SamarthActivities of the Center for Healthy Cities• Advocating “Health” as the important driver of planning process• Develop observatory – urban health observatory – to systematically collect information• Use of information for policy, planning and advocacy• Research on impact of built environment on health in Indian Cities• Health impact assessments of City Master Plans• Developing Joint Learning Network• Communicating the information to stakeholders
  47. 47. Amit SamarthDeveloping partnerships• WHO Healthy City Project• WHO Center for Healthy Development (WKC), Kobe, Japan• WHO SEARO and India• Ministry of Health and Family Welfare• Ministry of Urban Development• Indian Council of Medical Research• National Institute of Epidemiology• Public Health Foundation of India• Urban Health Society of India
  48. 48. Amit SamarthActivities of Joint Learning Network• Practitioner to Practitioner Learning – Get people who have developed and implemented healthy cities concepts – Directly talk to the practioners in India – Motivate and support their work• Researchers to Practitioner Learning and Vice-Versa – Develop evidence – Create actionable measures from the evidence – Support the practitioners in implementation – Document the findings
  49. 49. Amit SamarthNeed for systematic data collection on• Urbanization• Urban population• Social determinants of health• Physical determinants of health• Environmental determinants of health• Health services• Health outcomes• Slum populations• Urban transport
  50. 50. Amit SamarthObjectives of the Urban Health Observatory• Collect information from various urban local bodies• Collect information from other government agencies• Secondary research and review of literature on urban issues and urban health• Conduct primary research to close information gaps on key issues
  51. 51. Amit SamarthObjectives of the Urban Health Observatory• Collect information and data from the major Tier I, II and III cities across India• Create a reporting framework of urban health indicators• These indicators will be cutting across various social, economic and physical aspects of urban environment• Some of the indicators will directly be related to urban poor
  52. 52. Amit SamarthPossible indicators• Air pollution indicators from various cities• Number of two wheelers sold in one year• Number of four wheelers sold in one year• Proportion of people using cycle• Proportion of people using footpaths• Proportion of people using public transport• Number of slums in the city - notified/non-notified• Access to water and sanitation in the slums• Prevalence of diseases chronic and communicable diseases in these cities
  53. 53. • We really need to do this kind of work• Kindly provide your thoughts and