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Editorial Articles

volume-25, 21 - 27 September 2019

Status of Urban Health in India

Prof. S.K. Kataria

Good health, hygiene and sanitation including family welfare services are the minimum expectations of a civilized society from the modern administrative state. WHO defines health as- "a state of complete physical, mental and social well-being  and not merely an absence of disease or infirmity". In recent decades, this definition has been amplified by including the ability to lead a 'socially and economically productive life.' Since the ages, the health or 'Aarogya' has been a core concern for daily life of the Indians that is why it said that - dharmaarth kaam mokshanaam aarogyam ch mool uktam means all the purushartha i.e.dharam (righteousness, moral values), artha (prosperity, economic values), kaam (pleasure or love, psychological values) and moksha (liberation, spiritual values) can be done effectively if we have sound health.  Virgil says- "the greatest wealth is health." Ayurveda or the science of life had been a traditional system of medicine from 2500 BC to 17th century AD. During British colonial period the European or Allopathic system of medicine was the official health care system along with Ayurveda and other indigenous systems. After independence, apart from allopathy the other systems of medicine like unani, siddha, homeopathy, naturopathy alongwith Ayurveda, were recognized as official systems of medicine in the country.  During the 80s, the private sector was allowed in the mainstream of medical care in India. Presently, India has become a hotspot for those seeking world-class treatment at very low cost. But the fact remains that a lot more needs to be done in terms of infrastructure upgrading. 

The urban population in India is projected to be 46 % by 2030 considering the rapid decadal growth rate of urbanization.  This rapid urbanization poses numerous challenges to the government and the foremost of them is 'urban health' as the cities are often identified as hotbeds for life-style diseases often described as 'modern epidemics.'

Urban Life Style Originated Diseases: Modern Epidemics

Conventionally, the term 'epidemic' was used for the large number of cases of a particular disease happening at the same time in a particular community, especially infectious diseases. However in modern societies, most of the fatal infectious diseases have either been eliminated or controlled. In the present global context, the definition and causes of epidemic has changed with life-style diseases dominating the most.

Due to rapid industrialization induced air, water and noise pollution, over population, deforestation, climate change, mechanization of routine life, revolution in information and communication technology and automobile industry, high  use of pesticides in crop fields, artificial ripening of fruits, processed and preserved food items, numerous non- infectious diseases have gripped the urbanites.

Some of the most crucial health issues of Indian urbanites are the following-

  1. Obesity
  2. Cardio-vascular problems
  3. Psycho-neurological disorders
  4. Cancer
  5. Diabetes
  6. Under- nutrition
  7. Allergies and respiratory disorders
  8. Hormonal imbalances
  9. Viral diseases

Obesity has become a big health problem in urban India due to many reasons, mainly wrong and unhealthy food habits, stressful life and less physical activities. India ranks 2nd with 155 million obese citizens and this number is increasing at 33.50 % per year.  Among individuals aged between 15-49 years, nearly 21 % women and 19 % men have been found to be overweight or obese. As per various scientific studies the presence of obesogenic chemicals such as DDT (dichloro diphenyl trichloroethane), bisphenol A ( plastic material ), MSG (mono sodium glutamate) and arsenic  trigger obesity  as well as late night dinner, prolonged watching on TV,  long sitting on laptop or  desktop,  video games, cell phone  chatting, street and fast foods and avoiding routine physical activities etc ultimately lead to obesity. Obesity is considered as one of the most serious health challenges of 21st century since it is identified as a major cause of various chronic diseases and death. As per National Family Health Survey, the people of Punjab, Kerala, Goa and Tamil Nadu are most obese states in the country while people of Tripura and Jharkhand are least obese. 

As per a survey conducted by Lancet in 2017, on behalf of the WHO, 34 % of Indians do inefficient physical activities as compared to neighboring countries like China, Nepal and Pakistan.  India stands at 52nd out of 168 countries.

Cardio Vascular Diseases (CVDs) have now become the leading cause of mortality in India. About 25 % of all deaths in the country are attributed by Cardio Vascular Diseases. Hypertension, arteriosclerosis; ischemic heart disease and stroke are the main threats. Globally, the CVDs death rate is 235 per 100000 pepole while it is 272 in India. In Indian cities, 30-40 % of CVDs deaths occur in the age group of 34-64 years, which is considered the productive segment of the population.

Diabetes is most common in India with 52 million patients making the country 'the diabetes capital of the world.' The prevalence of Diabetes type -2 has increased by 64 % across the country in 25 years. WHO estimates that the number of diabetic patients will cross the figure of 80 million by 2030. The country witnesses 3.4 million deaths every year due to diabetes which is known as 'the silent killer.' Going by a study conducted by the University of Sydney, people in developing countries have faced multi-generational under-nutrition and are currently undergoing major lifestyle changes, contributing to an epidemic of metabolic diseases, though the underlying mechanisms remain unclear. According to a study (2016-17) conducted by the Madras Diabetes Research Foundation the prevalence of diabetes is just double in urban areas (11.2 %) in comparison to rural areas (5.2 %).

The number of type-1 diabetics (no secretion of insulin from the pancreas) is about 0.1 million in the country and these young people are mainly city based and dependent on insulin shots twice a day.

Cancer or carcinoma (malignancy) is a fast increasing disease in allmost every country since the middle of 20th century. According to an estimate, India currently has 2.5 million cancer patients.  More than 71 % deaths in the age group of 30-69  are  caused due to various types of cancer.  Cancer of oral cavity, lungs, stomach, colorectum, pharynx, liver, prostate and pancreas are more common among men, while cancer of breast, cervix, ovary and colorectal is widely found in the Indian women. Although, exact cause of cancer is still not known, however the triggering factors i.e. use of tobacco, alcohol, pesticides, household chemicals, cosmetic items, environmental pollution, exposure to radiation  and various types of infections especially virus etc are well identified and proved. Fruit ripening chemicals like calcium carbide, ethylene and ethephon, processed food and fried foods  are also causing gastro-intestinal cancers.

Allergy or hypersensitivity disorder of human body has become a big threat for modern generations and it is mainly due to environmental imbalance and changes in human body. It is estimated that nearly 25 -30% population of the country is facing mild or severe allergic health problems and most common is allergic rhinitis, sinusitis, asthma, eczema  and various food-drug- insect allergies. Being a tropical country, wide -ranged weather changes are very common and at the same time the atmosphere is full of allergens, dust, aerial pollen, silica, chemical in food,  toxic elements and some plants e.g. parthenium (gaazar ghaas) and  cape gum ( keekar ) which cause allergies.

Psycho- neurological disorders among Indians are hardly considered as a health problem due to social taboos and superstitions. As per a nationwide study conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) in 2014-16, about 13.7% population of the country is suffering from mental illness and 10.6% persons require immediate intervention. These disorders include anxiety, stress, phobia, depression, schizophrenia, autism etc.  The working couple of urban India do not have substantive time to care for their children so socio- psycho problems of these children is on hike causing overall personality defects. About 8 million people commit suicide every year in the world; of these 17% are Indians mainly between the age group of 15-40 years. Similarly 30 million people are suffering from neurological disorders like epilepsy, Parkinson's disease, Alzheimer's disease, febrile convulsions, peripheral neuropathy and migraine etc.

Under nutrition and malnutrition exist in medium, higher and very high income group families of the country. Protein, iron, calcium, folic acid, vitamin B-12, vitamin -D and zinc deficiency are very common in Indian urban as well as rural population.  About 33 % malnourished children of the world are in India and 43 % children (below 5 years age) of the country are under weight. Most of the youth and college going girls of the country are anaemic.

Other life style diseases and health problems in urban India are dry eyes and back pain  due to prolonged working on desktop, laptop and cell phone; facial palsy due to sudden variation in temperature ( exit from AC room to road directly), dental caries, hepatitis A, B and C, HIV-AIDS, insomnia, food poisoning (gastro enteritis), infertility and hormonal imbalances. Puberty, pregnancy and menopause are some time period of hormonal imbalance but the increasing number of thyroid (hypo and hyper both) patients in the country is a warning sign. About 42 million people are suffering from thyroid problem. It is believed that auto-immune failure is the main cause of thyroid problem and auto - immune system failure also cause stomatitis (aphthous ulcer), diabetes( type-1), rheumatoid arthritis, psoriasis, multiple sclerosis, irritable bowel syndrome ( IBS ), Addison's disease, mysthania gravis, vasculitis and many more.

Decreasing immunity power or disease resistance is a new emerging problem in the urbanites due to their life style and malnutrition. Since last two decades the country is facing recurrent attacks of dengue, chikungunya, swine flu, bird flu, H1N1, Ebola virus, nipah virus and many other viral fevers. Although the traditional infectious diseases are under control but 11% population of Indian cities are still infected by tuberculosis, hepatitis, amoebiasis, typhoid and malaria. It is also strange to see that most of the deaths in urban areas, due to these infections, are of young people in the range of 15-45 years.

Health in Urban Slums

As per Census- 2011 data there were 65.49 million inhabitants living in 13.92 million households in slums.  About 5.4 % population of the entire country and 17.4% of urban population was residing in slums.  Most of the slums are very congested, overly populated and unhygienic conditions have Poverty is the root cause of all the problems of any slum.  Non -availability of clean drinking water, piles of garbage, open defecation, mosquitoes, flies, pollution, alcoholism, drugs addiction, industrial hazards (e.g. silicosis) and poverty lead to increase in morbidity and mortality including  infectious diseases ( mainly tuberculosis, hepatitis, typhoid, measles, AIDS, cholera,  parasitic infestations and malaria), anemia and malnutrition among mother and children. A total 89.6 % death in the Indian slums occur due to respiratory diseases as studied by the  International Institute of Population Studies in 2015. While about 1.9 million children die every year in these slums due to malnutrition, pneumonia, measles and diarrhea.

Towards Healthy India: Some Remedies

The modernization process of human civilization explains the transformation of a traditional society to a modern society which is mainly secular, industrial, urban, technological sound with scientific tempera-ment, while globalization is considered as an integration of economic, social and political cultures across the globe. The Constitution of India makes a provision 'to develop scientific temper, humanism and the spirit of inquiry and reform' as a fundamental duty under Article 51-A (h).

All the fake advertisements in newspapers or on TV and internet must be banned effectively and proper action must be taken under the 'Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954'. Similarly, the Food Safety and Standards Act, 2006' is to be enforced effectively and any adulteration in food items must be treated with immediate concern.

The National Health Policy, 2017 makes the provision of highest possible level of good health and well-being through a preventive and promotive care orientation in all development policies.  National Urban Health Mission (NUHM) was launched as a sub-mission of National Health Mission in 2013, needs further revamping and reforms according to the needs of urban diseases.  There are nearly 250 national programmes and schemes operational in whole country and more than 20% of these national schemes are of health sector. Only around 27 % people of the country are covered under any health insurance plan. Health insurance is still not a serious concern and practice of Indians. It is hoped that the universal health coverage under 'Aayushmaan Bharat' will change the fate of resourceless people of the country because health and happiness are siblings.

(The author teaches at the Department of Public Administration UCSSH, Mohanlal Sukhadia University, Udaipur, e-mail id: skkataria64@ rediffmail.com

Views expressed are personal.

(Image Courtesy : Google)