The lack of access to clean water and proper sanitation facilities can lead to the spread of waterborne diseases such as cholera and dysentery (World Health Organization, 2019).
Urbanisation is a global phenomenon with a significant impact on developing countries, where rapid urban growth has created a host of health challenges for urban citizens. In this write-up, an attempt has been made to examine the multifaceted health issues facing city dwellers in large cities of developing countries, emphasising factors such as inadequate healthcare infrastructure, air pollution, sanitation problems, infectious diseases, and the social determinants of health. In this article, we will also discuss India’s efforts to combat these health challenges, highlighting initiatives, policies, and interventions aimed at improving urban health outcomes.
Urbanisation has become a defining global trend, with over half of the world’s population residing in urban areas. About 56% of the world’s population—4.4 billion inhabitants—lives in cities. This trend is expected to continue, with the urban population more than doubling its current size by 2050, at which point nearly 7 out of 10 people will live in cities. This urban shift is particularly pronounced in developing countries, where urban population growth occurs at an unprecedented rate (World Bank, 2019). While urbanisation offers economic opportunities and improved living standards, it simultaneously presents complex challenges for the urban population.
Inadequate healthcare infrastructure is a critical issue plaguing urban areas of developing countries. Overcrowded cities often struggle to provide accessible, affordable, and quality healthcare services. Public healthcare facilities are frequently overburdened, resulting in long waiting times and subpar care (United Nations Development Programme, 2020). The lack of health insurance coverage exacerbates the problem, rendering healthcare unaffordable for many urban citizens (World Health Organization, 2017).
India has recognized the importance of strengthening its healthcare infrastructure in urban areas. Initiatives like the Ayushman Bharat program aim to provide health insurance coverage to vulnerable populations, enhancing their access to healthcare services (Government of India, 2019). Moreover, public-private partnerships have been established to improve healthcare delivery in urban centers (NITI Aayog, 2020).
Air pollution stands as a severe health hazard in urban environments of developing nations. The concentration of vehicles, industrial activities, and construction projects contributes to high levels of air pollutants, including particulate matter and toxic gases (World Bank, 2019). Prolonged exposure to such pollutants can lead to respiratory diseases, cardiovascular problems, and increased mortality rates, particularly among vulnerable populations (Landrigan et al., 2018). More than a dozen Indian cities, like Delhi & NCR, Chennai, Mumbai, Bengaluru, Kolkata, Lucknow, Hyderabad, Patna, Kanpur etc. are like gas chambers full of smog for at least 4-5 months in a year.
India has taken several measures to combat air pollution, especially in cities like Delhi and NCR. The National Clean Air Programme (NCAP) was launched to reduce air pollution levels in urban areas (Ministry of Environment, Forest, and Climate Change, 2019). Initiatives promoting cleaner fuels, stricter vehicular emission standards, and enhanced public transportation have been implemented to address this issue. National Green Tribunal(NGT) is also putting strict guidelines to regulate the poisonous gas carbon monoxide (CO), which is a colorless, odorless gas produced by the incomplete combustion of fossil fuels, such as gasoline, diesel, and wood.
It is highly toxic to humans and animals when inhaled in sufficient quantities. When carbon monoxide is inhaled, it binds to hemoglobin in the blood, reducing the blood’s ability to carry oxygen to vital organs and tissues. This can lead to symptoms of carbon monoxide poisoning, which can range from mild headaches and dizziness to severe symptoms such as loss of consciousness and death in cases of high exposure.
Carbon Monoxide (CO) is not the only poisonous gas but many other pollutants associated with air pollution include nitrogen dioxide (N02), sulfur dioxide (SO2), ozone (O3), particulate matter (PM),volatilee Organic compounds (VOCs), and Lead(Pb). Their cumulative effect on people’s health is multifold. It’s essential to monitor and address these pollutants to mitigate the health risks associated with air pollution. Regulations, emission controls, and efforts to reduce reliance on fossil fuels can help reduce the levels of these poisonous gases and pollutants in the air
Inadequate sanitation infrastructure in urban slums and informal settlements remains a significant health concern. The lack of access to clean water and proper sanitation facilities can lead to the spread of waterborne diseases such as cholera and dysentery (World Health Organization, 2019). Poor sanitation also contributes to malnutrition and stunted growth in children, impacting their long-term health and well-being (UNICEF, 2019).
India’s Swachh Bharat Abhiyan (Clean India Mission) is a notable effort to improve sanitation and access to clean water. The program aims to construct toilets, promote proper waste disposal, and eliminate open defecation, particularly in rural and urban areas (Government of India, 2014). These endeavours help reduce the risk of waterborne diseases in urban and peri-urban regions. Since 2014, the Govt. of India, has encouraged people living in villages to construct their own toilets, and about 110 million(11 crores) houses now have their own toilets. The government of India also ranks cities every year on the basis of the Swachh Bharat Mission (Clean India Mission).
India has made significant strides in controlling infectious diseases. Programs like the National Tuberculosis Elimination Program (NTEP) aim to diagnose and treat tuberculosis cases promptly, especially in urban settings (Government of India, 2020).
Urban areas in developing countries often serve as breeding grounds for infectious diseases due to overcrowding, poor sanitation, and limited healthcare access. Diseases like tuberculosis, HIV/AIDS, and dengue fever tend to thrive in these environments, posing a constant threat to urban residents (Harries et al., 2018). The spread of infectious diseases can be further exacerbated by inadequate disease surveillance and public health interventions (World Health Organization, 2019).
India has made significant strides in controlling infectious diseases. Programs like the National Tuberculosis Elimination Program (NTEP) aim to diagnose and treat tuberculosis cases promptly, especially in urban settings (Government of India, 2020). India’s response to the COVID-19 pandemic included measures such as lockdowns and vaccination drives to mitigate the spread of the virus in densely populated urban areas. In the two years, more than 220 crore (2200 million) doses of Covid-19 vaccines have been administered domestically. Further 29 crore(290 million) doses have been exported to all over the world, including those poor countries, who had no money to buy expensive kits from developed nations. India’s vaccination became the saving grace for a large number of developing countries during COVID-19.
Social determinants of health, including poverty, education, and access to clean water and nutritious food, play a pivotal role in urban health disparities. These factors contribute to a cycle of poor health outcomes, making it essential to address these underlying determinants to improve urban health.
India recognizes the importance of addressing social determinants of health. Efforts to promote education, poverty reduction, and skill development programs have been implemented to uplift the socio-economic conditions of urban citizens (NITI Aayog, 2020). Schemes such as the National Urban Livelihoods Mission (NULM) aim to enhance livelihood opportunities for the urban poor.
The health issues facing urban citizens in developing countries are complex and multifaceted. Rapid urbanisation, coupled with inadequate healthcare infrastructure, air pollution, sanitation problems, infectious diseases, and social determinants of health, pose significant challenges. Addressing these issues requires concerted efforts from governments, international organisations, and civil society to ensure that urbanisation leads to better health outcomes for all citizens. India’s efforts in these areas exemplify the potential for change, but on-going commitment and innovation are crucial to improving the health and well-being of urban populations in developing countries. By implementing effective policies and interventions, urban areas in developing countries can become healthier and more sustainable places to live.
“Composed by: Vinod Passy retired from the Indian Foreign Service as a senior officer. Many of his articles were also published in prestigious research books.”
