Urban Health in India- PHFI


Overview

Urbanization trends in India are reflected in the rapid and varying demographic and epidemiological transitions in Indian cities making urban health a timely and important theme to address. The health of urban populations is of national priority since urbanization profoundly affects the economic, social and political fabric of the country. At a time when health and health care services in the country are being subject to growing fiscal constraints there is a shared and urgent need for viable solutions.

Health is a unique theme in the context of urbanization, both in terms of scope and cross-sectoral convergence where urban health is influenced and affected by social determinants, education, the built environment, migration, physical space, governance, economic policy and human security. Ill health urbanization and social disadvantage are strongly linked. Lack of urban planning and changes in urban morphology has resulted in a changing disease spectrum in urban environments where Indians now face a dual burden of communicable and non-communicable diseases. Urban spaces often constitute obesogenic environments encouraging low physical activity, unhealthy diets and stressful lifestyles that increase the risk for chronic diseases and circulatory disorders. Inhabitants in industrial towns and cities also have unique occupational health problems that need to be addressed.  Megacities characterized by harsh physical and social environments, poor quality housing and service provision and lack of social support increasingly have stress and depression as a leading disease burden to contend with. There is insufficient research and data on the health needs of the urban populations where much of research attention in urban health continues to focus on poverty rather than intra-urban inequities.

The objective of this theme is to initiate debate, share knowledge and foster collaboration between and across health, social science, and humanities disciplines as well as community and decision making stakeholders who are involved in urbanization and health at various levels. Areas of focus would involve:

  • Prioritization and definition of key urban health issues as a critical dimension of urban growth and development.
  • Consider the dynamic relationships between urban health and rural health, housing, infrastructure, physical and social environments and economic health policies
  • Research evidence that explores the current scenario of urban health governance both in terms of health needs and health system shortfalls.
  • The challenges of gathering comprehensive and relevant evidence while empowering citizens to demand and providers to deliver quality and equitable health.
  • Exploring the roles of, boundaries between and scope for convergence across, public and private players; urban governance dynamics and the split between central, state and municipal authorities
  • Partnerships, pathways and solutions to bridge health gaps for urban populations, drawing on prior innovations, may also be explored in this theme.
 
 
 
 

Plenary 1: Urban Disease Dynamics – Epidemiological Transitions and the Changing Disease Spectrum

This plenary will address disease trends and transitions in urban environments. The session will explore the current evidence on shifting disease burdens between communicable and non-communicable diseases, the impact of urban lifestyles, and demographics on the health of populations, the growing challenge of chronic diseases and the rapidly altering disease dynamics between urban and rural health. Issues of convergence that include the influence of social determinants, physical infrastructure, migration, unhealthy spatial planning and economic policy amongst others will be highlighted in the context tackling these multiple disease burdens to achieve health equity in diverse urban spaces.

 
 

Plenary 2: Urban Health Governance: Challenges and Innovations

The plenary will speak to issues relating to urban health governance:  identifying gaps, providing solutions, and seeking ways forward to better address health as a critical dimension of urban growth and development. The session will focus on:

  • Examining the split between central, state and municipal authorities in terms of health policy, health needs and health system shortfalls.
  • The need for inter-sectoral convergence and cooperation between various local urban governing bodies and non-health sectors (relating to infrastructure, sanitation, poverty, growth, non profits, the private sector, etc.) to impact and  improve health outcomes.
  • Identifying urban health priorities and exploring collaborative partnerships between public and private sectors for the improved delivery of urban healthcare.
  • Drawing on existing innovations and finding new solutions to bridge health gaps for urban populations.
 
 

Deep Dive 1: Debates in Nutrition and Food Security

The main themes of this session will be a) the Food Security Bill and the larger question of food security in urban India, b) unpacking the social determinants shaping lifestyle choices and the built environment in relation to urban food production and consumption, access, and physical activity, as well as c) approaches towards and challenges remaining in addressing the dual burden of overnutrition (obesogenesis) and under-nutrition (malnutrition) in Indian cities.

 
 
 
 

Deep Dive 2: Urban Poverty and Migration

Internal labor migration has become an important livelihood strategy for many poor groups across India. However, this segment of the population faces exclusion from the various mainstream programs such as education, health, adequate living conditions, minimum wages and freedom from exploitation and harassment. This increases the vulnerabilities of migrants and lead to their poor health status which has significant public health implications.

India is facing migration challenges and has increasing needed to formulate and implement policies to improve migrants’ health. Currently, India has less or no structural policies or programs targeting the migrant issues in totality. There is urgent need to ensure coherence between national policies for migration, health and employment. Effective implementation of the available programs, as well convergence of these programs (health, education, insurance and food security), at both inter and intra state levels would be important to improve the status of migrants’ health. For this, interstate collaboration is required among government departments, to assess and subsequently tackle occupational risks and their health consequences before, during and after migrants’ period of work.  The central government has a major role to play in the whole process including alliance among key health services providers and their respective departments, capacity building, and resource allocation.

 
 
 

Deep Dive 3: ‘PareshaaniKyaHai, SujhaavKyaHai?’User-provider interface in Urban Health

This deep dive will tackle some of the key issues and problems that service users face with the healthcare delivery system and healthcare providers. The session will provide a platform for service users to voice their opinions and concerns, and for providers to resolve issues and provide ‘solutions’. The dialogue will touch upon an array of themes, ranging from service provision in tertiary care to the role of NGOs, from mental health to innovative solutions. This forum will seek to understand and incorporate user views for better quality health care.