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Economy
Mahesh

02/12/24 10:34 AM IST

India’s cities, their non-communicable disease burden

In News
  • There is a need to create healthy cities; marginalised communities and urban neighbourhoods must have access to primary health care
Poor Implementation of Policies
  • India has a national non-communicable diseases (NCD) surveillance policy, with screening for NCD risks at the community level, aimed at preventive and promotive pathways for NCD care and treatment pathways.
  • Though these policies are often subscribed from global bodies, they are poorly implemented.
  • Health systems in urban areas are overburdened, fragmented and broken, which is a function of poor urban design and rapid urbanisation.
  • With over half of the world’s population living in urban areas, this figure is projected to reach 70% by 2050.
  • India’s workforce is characterised by significant inter-State migration, with approximately 41 million people moving between States (Census 2011).
  • This dynamic process, constituting nearly 29% of the total migration rate (Periodic Labour Force Survey 2020-21), highlights the fluidity of labour markets.
  • Notably, a substantial portion of the urban population, estimated at 49% (UN-Habitat/World Bank, 2022), lives in slums, further underscoring the complex socio-economic landscape of India’s cities. 
Health Burden in Urban India
  • Poor urban communities face a triple health burden: hazardous work environments, limited health-care access, and financial vulnerability during health crises, that are exacerbated by social and economic marginalisation.
  • As for national data on health indicators, NFHS data showed a decline in tobacco and alcohol consumption from 2005-06 to 2019-21 (NFHS 3 and 5), which is alarmingly juxtaposed with a rise in hypertension, diabetes, and obesity rates (NFHS 4 and 5).
  • Symptomatically, NCDs are silent, necessitating regular screening which needs to sit within a robust health promotion and referral system.
  • The lack of understanding of the need for screening, early detection and preventive pathways for NCDs create catastrophic out-of-pocket (OOP) expenditure, in turn jeopardising financial stability and impacting the overall livelihood and life trajectory of the entire family. 
  • Health in marginalised communities stems from social identities, work and employment, language, migration status, and accessing primary health systems. 
  • In a country whose foundation of health systems sits on strong primary health care, it is problematic that the availability and access to publicly-run primary health care are abysmally poor among urban marginals.
  • Public health systems are, by design, supposed to cater to all, and, most specifically, to the lowest 40% of the population.
  • The idea of universal health coverage fails. Preventing OOP expenditure fails.
  • And our urban marginals are laden with poor health outcomes, which, for many, runs across generations.
  • This necessitates having an active dialogue between employers, municipalities, traffic systems, schools, as well as health systems.
  • As interconnected systems, there is a need to co-create solutions with the community, and for the community. 
Way forward
  • This is the time for State-level action plans for NCD health care, which lay an emphasis on access to primary health care for marginalised communities and poor urban neighbourhoods — migrants, informal workforce, people living in informal settlements.
  • We need to join hands with urban local bodies, the city administration, health departments and community-based organisations, experts and think tanks and discuss ideas to create healthy cities for all.
  • This should also lead to a scaling up of ideas for community-led, community-based NCD surveillance systems for marginalised urban settlements. 
Source- The Hindu

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