India’s cities, their non-communicable disease burden

• The recent tragic death of a Bengaluru Metropolitan Transport Corporation (BMTC) bus driver due to cardiac arrest underscores the increasing health challenges faced by urban workers in India. These issues reveal systemic failures in addressing the health needs of marginalised urban populations, which include informal workers, migrants, and the urban poor.

The Triple Health Burden of Urban Marginals

• Urban communities, particularly the marginalised, face three primary health challenges:
• Hazardous Work Environments: Workers in sectors like sanitation, transport, and gig economy face health risks due to unsafe conditions, lack of hygiene, and poor nutrition.
• Limited Health Access: Public health systems remain overburdened and inaccessible, particularly for informal workers without health insurance or stable contracts.
• Financial Vulnerability: Health crises lead to catastrophic out-of-pocket (OOP) expenditure, jeopardising the financial stability of families and worsening generational poverty.

Non-Communicable Diseases (NCDs): A Silent Epidemic

• Prevalence of NCDs: The burden of non-communicable diseases such as hypertension, diabetes, and obesity has risen sharply. According to the NFHS-5 data, these diseases often go undetected due to inadequate screening and awareness.
• Impact on Marginalised Communities: Without early detection and treatment pathways, NCDs create severe health and economic consequences for urban poor families.

Underlying Issues in Urban Health Systems

Fragmented and Overburdened Systems:

• Rapid urbanisation and poor urban planning have created disjointed health systems that fail to meet the needs of growing populations.

Social Determinants of Health (SDoH):

• Factors like housing, workplace conditions, and migration status significantly influence health outcomes, especially among marginalised groups.

Policy Implementation Gaps:

• While India has a National NCD Surveillance Policy and preventive care frameworks, poor execution and lack of community involvement limit their effectiveness.

Universal Health Coverage Failure:

• Public health systems designed to cater to the bottom 40% of the population fail to deliver on their mandate, leaving vulnerable groups with minimal support.

The Role of Technology and Community Engagement

Real-Time Health Monitoring:

• Digital tools can empower individuals with hypertension or diabetes to monitor their health regularly, providing both personal insights and data for public health planning.

Screening and Awareness:

• Community-based health screening can create awareness, promote preventive care, and provide evidence for public health initiatives.

Social Protection Schemes:

• Increased awareness of health schemes can reduce OOP expenses, especially for those in informal settlements.

The Way Forward: Building Healthy Cities

Strengthening Primary Health Care:

• Public health systems must focus on providing accessible and affordable primary care, particularly for informal workers and slum dwellers.

State-Level NCD Action Plans:

• These plans should prioritise access to care for marginalised communities, emphasising prevention, early detection, and affordable treatment.

Collaboration Across Stakeholders:

• Urban local bodies, municipal administrations, health departments, and community-based organisations must co-create solutions tailored to urban health challenges.

Community-Led Surveillance Systems:

• Empowering communities to lead health surveillance initiatives can provide sustainable, localised solutions to health challenges.

Conclusion

• Urban health challenges, particularly the rise in NCDs, are a reflection of broader systemic issues. Addressing these requires an integrated approach combining policy reform, technological innovation, and community engagement. By focusing on preventive care and strengthening urban health systems, India can build healthier cities that ensure better outcomes for all, especially its most vulnerable citizens.