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

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. 
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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