"Urban Health Matters"
- The theme for this year World Health Day -

By Indian Medical Association, Manipur State Branch *

Primary health centres, primary health sub-centres and of late, National Rural Health Mission, from the names they all focused on the health of the rural mass. True, at a point of time as majority of the population dwell in rural areas. For the first time in the history of the world, the urban population surpassed 50% in 2007. It is projected that by 2030 six in ten will be an urban dweller, rising to seven in ten by 2050. And it is going to be there and it's a reality.

So what? Good, many people will be living in the urban areas getting all the basic amenities, facilities and we can progress! But, it is not without problems. This urbanisation is occurring at a pace that the Governments, especially in the developing countries, are not able to handle. Determinants like physical, infrastructure, access to social and health services, local governance, income inequalities, educational opportunities, etc affect health of the urban people.

Moreover, inequalities in health status among the urban dwellers are bigger than among the rural dwellers. One in three urban dwellers lives in slums and the total population of slum dwellers could be about one billion. The complex web of factors or conditions that affect the health of the urban dwellers is going to be one of the greatest challenges of this 21st century. Let us remind ourselves of some of the consequences of this rapid urbanisation to our health.

* Poor physical infrastructure, lack of basic sanitation and safe drinking water facilities make the urban dwellers prone to many communicable diseases like diarrheal diseases, respiratory diseases including tuberculosis, hepatitis (A & E), etc. Another big issue is the deformed environment out of the human activities in these urban set-ups, which also help in spreading different types of diseases.

* Lack of space for physical activities in the congested urban areas and change in the dietary habit make them more vulnerable to non-communicable diseases like obesity, hypertension, diabetes, cardio-vascular diseases, osteoporosis (weakness of the bone), etc.

* Because of easy availability of tobacco products and targeted marketing, smoking is common leading to cancers, especially of the lungs, and many other diseases of the mouth cavity, heart, lung and blood vessels. It is not only the smokers who are affected but also the "second-hand smokers" (passive smokers, those who also inhale tobacco smoke even if not smoking personally).

* Inadequate town planning, congestion of traffic, poor traffic management, traffic mixing (different types of road users including animals sharing the road space) makes road traffic accidents common.

* Violence, prostitution and other crimes are higher in urban settings because of unequal economic, educational, employment opportunities and deranged social structure among the urban dwellers. This may lead to the increase spread of sexually transmitted diseases including HIV. Alcohol abuse and substance abuse are common in such environment.

* Another emerging issue out of this deranged social environment is the psychiatric problems among the urban dwellers.

* Many of the factors above are interlinked and can produce different diseases and disorders.

The policy makers and the executives many not sit comfortably from the better urban health statistics as it masks the disparity inside the urban area. The disparity between the few elites and slum dwellers in the urban set-up is bigger than the one seen in the rural areas. Involvement of sectors beyond health department is needed to tackle the problem of urbanisation. It should be a concerted effort from all the sectors—health, transport, environment, police, municipality and town planning, engineering, PHED, etc.

On the top of it, commitment of the politicians to bring a change for the better is a must. Realising the importance of urbanisation and its impact on health, World Health Organization has chosen the theme "Urban Health Matters" for the World Health Day this year, which falls on April 7. Observance of the Day on the theme with the slogan "1000 cities, 1000 lives" is occurring throughout the world, not only by the health sectors but also by many other sectors and organisations. Main activities can be carried out from 7th to 11th April 2010.

Primary health centres, primary health sub-centres and of late, National Rural Health Mission, from the names they all focused on the health of the rural mass. True, at a point of time as majority of the population dwell in rural areas. For the first time in the history of the world, the urban population surpassed 50% in 2007. It is projected that by 2030 six in ten will be an urban dweller, rising to seven in ten by 2050. And it is going to be there and it's a reality.

So what? Good, many people will be living in the urban areas getting all the basic amenities, facilities and we can progress! But, it is not without problems. This urbanization is occurring at a pace that the governments, especially in the developing countries, are not able to handle. Determinants like physical infrastructure, access to social and health services, local governance, income inequalities, educational opportunities, etc affect health of the urban people.

Moreover, inequalities in health status among the urban dwellers are bigger than among the rural dwellers. One in three urban dwellers live in slums and the total population of slum dwellers could be one billion. The complex web of factors or conditions that affect the health of the urban dwellers is going to be one of the greatest challenges of this 21st century. Let us remind ourselves of some of the consequences of this rapid urbanization to our health.

*Poor physical infrastructure, lack of basic sanitation and safe drinking water facilities make the urban dwellers prone to many communicable diseases like diarrheal diseases, respiratory diseases including tuberculosis, hepatitis (A&E), etc. Another big issue is the deformed environment out of the human activities in these urban se-ups, which also helps in spreading different types of diseases.

* Lack of space for physical activities in the congested urban areas and change in the dietary habit make them more vulnerable to non-communicable diseases like obesity, hypertension, diabetes, cardio-vascular diseases, osteoporosis (weakness of the bone), etc.

* Because of easy availability of tobacco products and targeted marketing, smoking is common leading to cancers, especially of the lungs, and many other diseases of the mouth cavity, heart, lung and blood vessels. It is not only the smokers who are affected but also the 'Second-hand smokers" (passive smokers, those who also inhale tobacco smoke even if not smoking personally).

* Inadequate town planning, congestion of traffic, poor traffic management, traffic mixing (different types of road users including animals sharing the road space) makes road traffic accidents common.

* Violence, prostitution and other crimes are higher in urban settings because of unequal economic, educational, employment opportunities and deranged social structure among the urban dwellers. This may lead to the increase spread of sexually transmitted diseases including HIV. Alcohol abuse and substance abuse are common in such environment.

* Another emerging issue out of this deranged social environment is the psychiatric problems among the urban dwellers.

* Many of the factors above are interlinked and can produce different diseases and disorders.

The policy makers and the executives many not sit comfortably from the better urban health statistics as it masks the disparity inside the urban area. The disparity between the few elites and slum dwellers in the urban set-up is bigger than the one seen in the rural areas. Involvement of sectors beyond health department is needed to tackle the problem of urbanization. It should be a concerted effort from all the sectors- health, transport, environment, police, municipality and town planning, engineering, PHED, etc. On the top of it, commitment of the politicians to bring a change for the better is a must.

Realizing the importance of urbanization and its impact on health, World Health Organization has chosen the theme "Urban Health Matters" for the World Health Day this year, which falls on 7th April. Observance of the Day on the theme with the slogan "1000 lives" is occurring throughout the world, not only by the health sectors but also by many other sectors and organizations. Main activities can be carried out from 7th to 11th April 2010.