Urban health

Submitted by :
415206101001 d.sudas
415206101005 s . Ramana rao
415206101007 s.m.sudhakar
Submitted to : Dr.P.Sudhir ,
vamsi sir

Abstract review on Urban health

Definitions
Urbanization trends
Impacts of Urbanization on Health
WHO Initiatives on Urban Health
Urban Health Care Delivery System in India
Policies & Schemes relevant to India
National Urban Health Mission
Role of Various Sectors

Definitions
What is an urban area?
According to Census of India
A. All statutory places with a municipality, corporation, cantonment board or notified town
area committee, etc.
B. A place satisfying the following three criteria simultaneously:
i. a minimum population of 5,000;
ii. at least 75 per cent of male working population engaged in non-agricultural pursuits;
and
iii. a density of population of at least 400 per sq. km. (1,000 per sq. mile).

Definitions
What is an urban slum?
i.

All specified areas in a town or city notified as Slum by State/Local Government and UT
Administration under any Act including a Slum Act
ii. All areas recognized as Slum by State/Local Government and UT Administration,
Housing and Slum Boards, which may have not been formally notified as slum under any
act
iii. A compact area of at least 300 population or about 60-70 households of poorly built
congested tenements, in unhygienic environment usually with inadequate infrastructure and
lacking in proper sanitary and drinking water facilities

Definitions
What is urbanization?
Urbanization refers to the change in size, density and heterogeneity of
cities

What is urban health?

The health of a population that lives and works closely together, usually in an incorporated
area, such as a city or town, with a common water supply and with similar environmental
conditions
The status of health in urban populations
Urban Health means putting the needs of people and communities at the heart of the urban
planning process to ensure better access to urban services which improve human health for all

Urbanisation trends
Indian Scenario 2011
Total Population
1028.6 Million
Urban Population
286 Million (27.8%)
Growth rate
Rural 17.9 %
Urban 31.2 %
Estimated Slum
Population
60 Million

World Scenario 2010

Total Population
6906.5 million
Urban Population
349.4 million (50.6%)
Growth rate
Rural 0.22 %
Urban 1.91 %

Urbanization trends
Movement of people from rural to urban areas with
population growth equating to urban migration
A double edged sword
On one hand- Provides people with varied opportunities and scope for
economic development
On the other- Exposes community to new threats

Unplanned urban growth is associated with

Environmental degradation
Population demands that go beyond the environmental service capacity,
such as drinking water, sanitation, and waste disposal and treatment
7

Urbanization trends
Slums

Migration

Illiteracy

Unhygienic
conditions

Overcrowding

Unemployment

Communicable
diseases

Non-Communicable
diseases

Stretching of
overburdened
systems

Poverty

Crimes
Injuries
Stress
Life style
modification

Mental
illness
Migration-cobweb

Impact of urbanization on
health

Impact of urbanisation on health

Environmental concerns
Housing and shelter quality: strong health determinants
Health hazards of poor water supply and sanitation
Violence and crime
Mental health, loneliness and depression
Substance abuse
Road traffic accidents
Climate change
Fuel
Health inequity

Marriage & Fertility Indicators of Urban Poor in India: NFHS-3

Indicators

Urban
Poor

Urban Overall Overall

Non Urban
Rural
poor

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

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

Total fertility rate (children per

woman)

11

Child Survival Indicators of Urban Poor in India: NFHS 3

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 12

74.3

102.0

Children completely immunized (%

Children under 5 years 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 (%)

Family Planning Indicators of Urban Poor in India: NFHS 3

Indicators

Any modern method (%)

Urban
Poor

Urban Overall Overall

Non Urban
Rural
Poor

All
India

Urban
poor
NFHS 2

48.7

58.0

55.8

45.3

48.5

43.0

7.6

19.8

16.9

7.2

10.1

4.6

Permanent sterilization method rate

(%)

41.1

38.2

38.9

38.1

38.3

38.4

Total unmet need (%)

14.1

8.3

10.0

14.6

13.2

16.7

Unmet need for spacing (%)

5.7

4.1

4.5

6.9

6.2

8.5

Unmet need for limiting (%)

8.4

4.2

5.2

7.2

6.6

8.2

Spacing method (%)

13

Environmental Conditions, Infectious

Diseases and access to Health Care in
Urban Poor : NFHS 3
Indicators

Urban
Poor

Urban
Non
Poor

Overall
Urban

Overall
Rural

All
India

Urban
poor
NFHS 2

Households with access to piped water supply

at home (%)

18.5

62.2

50.7

11.8

24.5

13.2

Households accessing public tap / hand pump

for drinking water (%)

72.4

30.7

41.6

69.3

42.0

72.4

Household using a sanitary facility for the

disposal of excreta (flush / pit toilet) (%)

47.2

95.9

83.2

26.0

44.7

40.5

Prevalence of medically treated TB (per

100,000 persons)

461

258

307

469

418

535

Women (age 15-49) who have heard of AIDS

63.4

89.1

83.2

50.0

60.9

42.1

Prevalence of HIV among adult population

(age 15-49)

0.47

0.31

0.35

0.25

0.28

na

Children under age six living in enumeration

areas covered by an AWC (%)

53.3

49.1

50.4

91.6

81.1

na

Women who had at least one contact with a

health worker in the last three months (%)

10.1

5.8

6.8

14.2

11.8

16.7

14

Double Burden of Diseases

Overcrowding and related health issues
Rapid growth of urban centers has led to
substandard housing on marginal land and
overcrowding
Outbreaks of diseases transmitted through
respiratory and faeco-oral route due to increased
population density
It exacerbates health risks related to insufficient
and poor water supply and poor sanitation systems
Lack of privacy leading to depression, anxiety,
stress etc
15

Double Burden of Diseases

Air pollution and its consequences
Due to increase in the numbers of motorized
vehicles and industries in the cities of the
developing world
Problems of noise and air pollution
Air pollution can affect our health in many ways with
both short-term and long-term effects
Short-term air pollution can aggravate medical
conditions like asthma and emphysema
Long-term health effects can include chronic
respiratory disease, lung cancer, heart disease, and
even damage to other vital organs
16

Double Burden of Diseases

Water and sanitation problems
Due to increasing urbanization coupled with existing unsustainability factors and conventional urban water management
Nearly 1.1 billion people worldwide who do not have access to
clean drinking water and 2.6 billion people i.e. over 400 million
people, lack even a simple improved latrine
Can lead to increased episodes of diarrhea and economic burden

17

Double Burden of Diseases

Upsurge of Non-communicable diseases
The rising trends of non-communicable diseases
consequence of the demographic and dietary transition

are

Decreases in activity combined with access to processed food

high in calories and low in nutrition have played a key role
Urbanization is an example of social change that has a
remarkable effect on diet in the developing world

18

Double Burden of Diseases

Traditional staples are often more expensive in urban
areas than in rural areas, whereas processed foods
are less expensive
This favors the consumption of new processed foods
This places the urban population at increased risk of
cordiac dieases
In India, chronic diseases are estimated to account
for 53% of all deaths and 44% of disability-adjusted
life-years (DALYs) lost in 2005

19

Challenges to Health System

Challenges to Health System

Challenges to Health
System

WHO initiatives on urban health

Theme of World Health Day 2010
Thousand cities, thousand lives

WHO recommends the five calls to action to build a

healthy and safe urban environment:
1.
2.
3.
4.
5.

Promote urban planning for healthy behaviours and safety

Improve urban living conditions
Ensure participatory urban governance
Build inclusive cities that are accessible and age-friendly
Make urban areas resilient to emergencies and disasters

Health system in Urban India

No well organised services in urban areas
Urban family welfare centers (UFWC)
Provide outreach services - primary health care, maternal & child health, and
distribution of contraceptives

Urban health posts (UHPs)

Postpartum centres (PPCs)
Provide outreach family welfare services to various slum populations

Medical colleges
Provide tertiary health care services as well as primary health
to urban areas

care services

Health system in Urban India

Urban ICDS projects
Set up to promote health & development of women & children
through integrated packages of services for urban poor
Urban basic services scheme & urban development projects
Provide basic maternal &child health services
Urban malaria schemes (UMS)
Under UMS, surveillance staff & vector control teams have
been provided to control vector borne disease
Urban RCH projects
Each project covered about 100,000 urban slum population

Health system in Urban India

Other facilities run by

Central/ state govt

Municipalties/ Municipal corporation
NGOs
Private sectors
ESI dispensaries

Health system in Urban India

National Urban Health Mission
In order to effectively address the health concerns of the poor
population, the Health Ministry proposes to launch National Urban
Health Mission (NUHM).
The NUHM would have high focus on
Urban Poor Population living in listed and unlisted slums
All other vulnerable population such as homeless, rag-pickers, street
children, rickshaw pullers, construction and brick and lime kiln workers, sex
workers, any other temporary migrants
Public health thrust on sanitation, clean drinking water, vector control etc.
Strengthening public health capacity of urban local bodies

Study review methodolgy

Taking two area
Densily populated (near industrial areas)
Rarely populated (near greenery area )
Comparing with standards WHO , DM&HO

DATA
NFHS

ANALYSIS

INFERENCE

CONCLUSION

SOLUTIONS