urban health - issues and challenges

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URBAN HEALTH: ISSUES & CHALLENGES

Presented by: Dr. Timiresh Kumar DasModerator: Dr. D. K. Raut

Dir. Professor & Head, Dept. of Community Medicine, VMMC & SJH

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OUTLINE OF PRESENTATION Definitions Urban health issues & problems

› Global scenario› Indian scenario – health status, challenges

Programmes in urban health: Global & Indian› WHO Healthy Cities Initiative› World Health Day 2010› National Urban Health Mission

Urban planning & Health Research & Training in Urban Health – innovations

& solutions References

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Definitions Urbanisation: (Urban drift)

› The process of making or becoming urban in character.http://oxforddictionaries.com/definition/urbanize?q=urbanisation#urbanize__2

› The physical growth of urban areas as a result of global change or the increasing proportion of the total population becomes concentrated in towns.

UN-HABITAT

Urban area:› Communities of 100,000 or more, with a nucleus of at

least 50,000 and surrounding communities that share a high degree of social and economic integration.

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Health Promotion: The process of enabling people to increase control over and to improve their own health.› It is a comprehensive social & political process.

› Not only improving skills and capabilities of individuals, but also action directed towards changing social, economic & environmental conditions so as to alleviate their effect on individual & public health.

› It is the process of enbling people to increase control over the determinants of health and thereby improve their health.

Ottawa Charter for Health Promotion. WHO, Geneva. 1986

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Urban Health: The health status and health concerns of the population in urban areas.

(Oxford Online Dictionary)

Urban Medicine: Refers to the patterns of disease that are more common in urban settings than elsewhere.

(Urban Medicine & Metropolitan Health, 1st International Conference, Berlin, 2007)

Evaluate and help develop programs that lessen urban health risks and promote well-being of people living in urban areas.

(International Society for Urban Health)

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Healthy urban governance and integrated approaches to interventions are key pathways to reducing health inequity.

Securing more resources for health investments in urban settings, coupled with fairer distribution of those resources, is vital.

› Urban poverty is not because of distance from infrastructure and services but from exclusion.

(Knowledge Network for Urban Settings)

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Urban health problems are not markedly different from those in rural area, but their solution are quite different.› Urban health is based on core healthy cities

principles of equity, intersectoral cooperation, community involvement and sustainability.

World Bank

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Urban Health: Why does it matter? With the majority of the world’s population now

living in urban areas and this proportion expected to grow, urban health should become a major focus of global public health policy. › Whilst urbanization and the growth of cities is associated

with increasing prosperity and good health in general, urban populations demonstrate some of the world’s most prominent health disparities – in both low- and high-income countries.

› Rapid migration from rural areas as well as natural population growth are putting further pressure on limited resources in cities, especially in low-income countries.

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Urban Health: Why does it matter? Much of the natural and migration growth in urban

populations is among the poor. › More than one billion people – one third of urban

dwellers – live in slum areas which are often overcrowded with life-threatening conditions.

› In low-income countries, disparities will increase as the combination of migration, natural growth and scarcity of resources results in cities being unable to provide the services needed by those who come to live there.

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Urban Health: Why does it matter? There is evidence of poorly planned or unplanned

urbanization patterns which have negative consequences for the health and safety of people. › This includes increased risk of road traffic injury.› The increase of risk factors (such as physical inactivity

and unhealthy diets) for heart disease, cancer, diabetes and chronic lung diseases.

› Overcrowding, lack of proper sanitation lead to increased risk of communicable diseases.

› Increased exposure to environmental pollution.› Unsafe living conditions leading to accidents.

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Non-communicable diseases like heart disease, high blood pressure, diabetes and obesity are linked to lifestyles in cities.

Communicable diseases such as diarrhoea caused by unsafe food and water or tuberculosis due to overcrowded living conditions.

Increased risk of road traffic accidents, injury and violence.

Mental health disorders and substance abuse. Exposure to air pollution and second-hand smoke.

Urban Health Issues

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Urban health issues & problems:

Global Scenario

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Urban population increase:› More than ½ of the world population in urban areas.

› Most of this in lesser developed countries.› 2.4 billion in 2007 to 5.2 billion by 2050.

› Developed countries – 0.9 billion in 2007 1.1 billion by 2050.

United Nations. World Urbanization Prospects: The 2007 revision. New York: United Nations; 2008.

15United Nations. Department of Economic and Social Affairs, Population Division

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Proportion of world population in urban & rural areas

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Urban population increase & slums:› Slum population: 1.14 billion in 2010 to 1.5 billion by

2020.› Over 90% of slum population is in developing

countries.

› Slums: Recognised slums, Unrecognised/ Hidden slums, Squatter settlements.

› Slums represent significant concentrations of urban poverty – physical & psychological well-being of residents being severely compromised due to poor living conditions.

World Health Organization/UN-HABITAT. Hidden Cities: Unmasking and overcoming health inequities in urbans settings. WHO/UN-HABITAT; 2010.

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Problems unique to urban health & slums:

Urban health vs rural health?

Almost all health indicators are better for urban when compared to rural

When the urban slums are taken many are worse than rural

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Urban health problems :› Poor roads, drainage and lack of playing spaces

for children. Vulnerability: Land rights, Drainage, Waste

disposal. Open drains Blockage (d/t solid waste) Open waste disposal in vacant spaces, no

clearance . Lack of proper playing spaces Children play in

dumps or near open drains health risks

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› Lack of safe water and sanitation.

83% of urban population of African cities & 55% of people in large cities of Asia lack toilet facilities.

Greater problem for women & adolescent females.

4% of all deaths directly attributable to lack of clean water supply.

UN-HABITAT. Slums of the World: The face of urban poverty in the new millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003.

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Urban health problems:

› Housing, Land tenancy & Unrecognised slums: Located on marginal land ( near railway tracks, river banks,

near garbage dumps, etc) or illegally on Govt. or Private owned lands. Prone to accidents, disasters, eviction.

Not counted No official records No services

48% of slums in Indian cities are unrecognised. In Nairobi, 60% of the urban population is in unrecognised

slums.

National Sample Survey, India, 2008-09UN-HABITAT. Slums of the World: The face of urban poverty in the new millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003

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Urban health problems :

› Health Inequities: Urban averages mask intra-city disparities. Urban poor face equal or greater health risks than rural

population.

Infant Mortality Rates for Urban poor, Urban non-poor & Rural populations, by region

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Rates of Under-5 mortality according to residence in selected cities of Africa & South America

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Urban health problems:

› Child under-nutrition: Poor diet, repeated morbidity, unhygienic living

conditions lead to malnutrition.

Cities in Brazil have malnutrition rates of 19% in urban slums compared to 5% in other urban residents.

In Cote d’Ivorie, child malnutrition is 37% and 10% in urban slums & non-slums respectively.

UN-HABITAT. State of the World’s Cities 2006/07

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› Low access to health services: Proximity to quality health services Barriers – economic, social.

In Mozambique, only 42.6% of urban children belonging to poorest quintile received complete immunisation in comparision to 90.5% among the richest quintile.

In Kenya, rates of home delivery among urban poor is 72.6% compared to 65.5% in rural and 23.3% in urban rich.

Gwatkin DR, Rutstein S, Johnson K et al. Socio-economic Differences in Health, Nutrition, and Population within Developing Countries: An overview. Washington, DC: The World Bank; 2007.

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› Uncertain livelihoods: The level of livelihood stability is closely

linked to health. Stability mitigates fear of uncertain

livelihood Sense of responsibility for health and

surrounding. Improved healthcare & education of children. Greater community participation as well as

urge to improve local conditions.

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Urban health problems :› Injuries: Road traffic accidents -

Unplanned development Improper road & traffic infrastructure Mixed nature of vehicles & pedestrians Overuse and overloading of 2-wheelers

› Injuries: Occupational & Residential – Living near construction sites, railway tracks, etc Unsafe, poorly constructed housing, Overcrowding Waste & garbage – within slums or in children’s play areas.

› Injuries: Intentional/ Violence/ Crime – Need to work & commute late (for women) Improper lighting, Inadequate policing. Stress Alcohol/ Drug abuse Domestic violence

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Urban health problems:› Communicable diseases:

HIV & Sexually transmitted diseases Vector borne diseases – Malaria, Dengue, Chikungunya Tuberculosis

Factors – Poverty in slums Overcrowding, Migration, Floating population Poor water management Unhygienic living conditions – sanitation, solid waste, drainage Increased unsafe sex Low knowledge & awareness of healthy practices Weak public health system + low access to available services Lack of preventive measures, Fragmented response

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Urban health issues & problems:

Indian Scenario

Urbanization trends in India

Year

1800 1950 2000 2008 2030

2% 30% 47%~50%~ 60%

Source: UN, Urbanization prospects, the 2008 revision

Total population

3601027

140

1160

In million

Urban Population

2050

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Urbanization: Trends in India

286 million people in India live in urban areas (around 28% of the population)*

Estimated to increase to 357 million in 2011 and to 432 million in 2021*

After independence• 3 times growth - Total population • 5 times growth - Urban population*

* Census of India 200132

Urbanization: Trends in India 4.26 crore people live in slums

A large number of slums are not notified*- around 50%

Urban growth has led to rapid increase in the number of urban poor

In-migration and a floating population has worsened the situation

2-3-4-5

* NSSO Report No. 486 33

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Migration: Causes & Consequences

CAUSES CONSEQUENCES

Increased family size-limited agricultural land -Land use Pattern-Irrigation facilities

Overcrowding

Better income prospects Mushrooming of slums

Better educational facilities Unemployment

Better “Life style” Poverty

Amenities – health, transport, water, electricity

Physical & mental stress

Disasters - refugees Family structure-Nuclear families-Single males

Migration-cobweb

Migration

Stretching of overburdened

systems

Overcrowding Unemployment

Crimes

Poverty

Illiteracy

Communicable diseases

Unhygienic conditions

Slums

Injuries

Mentalillness

StressLife style

modification

Non-Communicable diseases

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Marriage & Fertility Indicators of Urban Poor in India

Indicators UrbanPoor

UrbanNon

poor

Overall Urban

OverallRural

AllIndia

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

Total fertility rate (children per woman)

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

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Maternal Health Indicators of Urban Poor in India


UrbanNon

Poor

Overall Urban

OverallRural

AllIndia

Urban Poor

NFHS 2

Mothers who had at least 3 antenatal care visits (%)

54.3 83.1 74.7 43.7 52.0 49.6

Mothers who consumed IFA for 90 days or more (%)

18.5 41.8 34.8 18.8 23.1 47.0

Mothers who received tetanus toxoid vaccines (minimum of 2) (%)

75.8 90.7 86.4 72.6 76.3 70.0

Mothers who received complete ANC (%)

11.0 29.5 23.7 10.2 15.0 19.7

Births in health facilities (%) 44.0 78.5 67.4 28.9 38.6 43.5

Births assisted by a doctor/nurse /LHV/ANM/other health personnel (%)

50.7 84.2 73.4 37.4 46.6 53.3

Women age 15-49 with anaemia (%) 58.8 48.5 50.9 57.4 55.3 54.7

The statistics for urban poor much lesser than urban

non-poor and comparable to rural population

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Maternal Health Indicators by place of residence

NFHS-338

Child Survival Indicators of Urban Poor in India: NFHS 3


UrbanNon

Poor

Overall Urban

OverallRural

AllIndia

Urban Poor

NFHS 2

Children completely immunized (% 39.9 65.4 57.6 38.6 43.5 40.3

Children under 5 year’s breastfed within one hour of birth (%)

27.3 31.5 30.3 22.4 24.5 17.7

Children age 0-5 months exclusively breastfed (%)

44.7 38.6 40.7 48.6 46.4 44.3

Children age 6-9 months receiving solid or semi-solid food and breast milk (%)

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 74.3 102.039

Completely Immunized Children in 12-23 months age by place of residence

NFHS-340

Child Survival by Residence

NFHS-341

Environmental Conditions, Infectious Diseases and access to Health Care in Urban Poor


UrbanNon

Poor

Overall Urban

OverallRural

AllIndia

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

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PROGRAMMES & INITIATIVES FOR URBAN HEALTH

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WHO Healthy Cities Initiative

Originated with the 1st International Conference for Health Promotion, Ottawa, 1986.

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WHO defines the Healthy City as: "one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential.“

World Health Organization. Health Promotion Glossary 1998


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Principles:› Equity› Participation & Empowerment› Working in partnership› Solidarity & Friendship› Sustainable development

Zagreb declaration for healthy cities. WHO 2009.


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Alliance for Healthy Cities An international network aiming at protecting and

enhancing the health of city dwellers. A group of cities and other organizations that try to

achieve the goal through the “Healthy Cities” approach .

Founded October 17, 2003 at the 1st Organizational Meeting, held at the WHO Regional Office for the Western Pacific in Manila, Philippines.

Aims to promote and support the “healthy cities” concept through cooperation & dissipation of information

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WHO Urban HEART Urban HEART (Urban Health Equity Assessment and

Response Tool). Decision-support tool to identify and reduce health

inequities in cities. Enables local communities, programme managers, and

municipal and national authorities to: › better understand the unequal health determinants, unequal

health risks and unequal health outcomes faced by people belonging to different socioeconomic groups within a city;

› use evidence when advocating and planning health equity interventions;

› participate in inter-sectoral collaborative action for health equity;› apply a health equity lens in policy-making and resource

allocation decisions.

12 Urban HEART Core Indicators

Health outcomes

Infant mortality

Diabetes

Tuberculosis

Road traffic injuries

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WHO Urban Health Obsevatory In 2011, WHO launched the Global Health

Observatory.

A gateway to health statistics on global public health priorities.

“Urban health” theme developed by WHO Kobe Centre.

Presents data on 16 indicators for 45 countries.

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UN-HABITAT Urban Info Tool for building the evidence base for action. Store, Present and Analyse data on urban

indicators. User friendly software designed in response to UN-

HABITAT’s data users. Designed by UN-HABITAT in collaboration with

UNICEF & UNDG. Monitoring Urban Inequities Programme produces

the Global Urban Indicators database, which is updated annually.

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Urban Health Matters: World Health Day Theme 2010

To draw attention to urbanization and health, recognizing that in an increasingly urbanized world, health issues present new challenges that go far beyond the health sector and require action at the global, national, community, and individual levels.

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Urban planning can promote healthy behaviours and safety through › investment in active transport› designing areas to promote physical activity › passing regulatory controls on tobacco and food safety

Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks.

Building inclusive cities that are accessible and age-friendly will benefit all urban residents.

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1000 cities, 1000 lives campaign:


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1000 cities, 1000 lives campaign 1000 cities:

› WHO called upon 1000 cities across the world to open up public spaces to people, whether it be activities in parks, town hall meetings, clean-up campaigns, or closing off portions of streets to motorized vehicles.

› To create awareness & to encourage active recreation.› 1558 cities participated.

1000 lives: › To collect 1000 stories of urban health champions

who have taken action and had a significant impact on health in their cities.

› Videos on youtube. (www.youtube.com/whd2010)

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Shack/ Slum Dwellers International

Network of community-based organizations of the urban poor in 33 countries in Africa, Asia, and Latin America.

Launched in 1996

“Federations” of the urban poor in countries such as India and South Africa agreed that a global platform could help their local initiatives develop alternatives to evictions.

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The SDI Method

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Urban Health Initiative (UHI) Implemented by a consortium of international,

national, and community based organizations. Responds to rapid urbanization and poor health

indicators among the urban poor in Uttar Pradesh, India.

Prioritizes the implementation and scale-up of effective evidence-based strategies which are aligned with government plans and schemes, as well as innovations that can be piloted and tested.

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Kolkata Urban Services for the Poor (KSUP)

Started under the West Bengal Urban Services Act, 1993.

ULBs are required to submit draft development plan.

Working on› Nutrition› Reproductive & Child Health› School Health Projects› HIV/ AIDS

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NUHM: National Urban Health Mission

By Ministry of Health & Family Welfare, Govt. of India. (MoHFW)

To effectively address the health concerns of urban poor.

To be part of National Health Mission along with National Rural Health Mission (NRHM).

INSTITUTIONAL FRAMEWORK

NATIONAL URBAN

HEALTH MISSION

NRHM Mission Steering Group

NRHM Empowered Programme Committee

National Urban Health Mission Directorate

National Urban Health Mission Secretariat

STATE URBAN

HEALTH MISSION

State Health Mission

State Health Society

State Urban Health Directorate

State Urban Health Secretariat

DISTRICT URBAN

HEALTH MISSION

District Health Mission

District Health Society

District Urban Health Committee

District Urban Health Secretariat

Ward Health,Water & Sanitation Committee

Slum/Slum Cluster Health, Water & Sanitation Committee

WARD/ SLUM LEVEL

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Encourage participation of community in planning & management of healthcare services.

USHA (Urban Social Health Activist) › In urban poor settlements/ slums. › 1 USHA for 1000-2500 population (200-500 hh)

Mahila Arogya Samiti (MAS) – 20-100 hh Proactive outreach

› To urban poor settlements› Through Outreach sessions & › Monthly health and nutrition days

Special attention to vulnerable sections › ragpickers, rickshaw pullers, sex workers, construction site

workers, etc› Through Public HC system/ PPP/ other models.


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Promote community risk-pooling› Through MAS – by regular monthly savings


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Aims to provide convergence of all communicable and non-communicable disease programmes.

Common platform and availability of all services at one point – PUHC (Primary Urban Health Centre)

Urban component/ Funds to be identified within the programmes and converged/ located at the PUHC level.

Existing IDSP structure leveraged for improved surveillance.


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Was to be launched in 2008, (last 4 years of 11th 5-year plan).

However, not yet launched.

Due to be launched during the 12th plan.


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URBAN PLANNING & HEALTH

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WHO supports a framework of actions and solutions for healthy living that includes five priority areas, most of which sit within the realm of urban planning.

1. Use urban planning to promote healthy behaviours and safety:• design cities to promote physical activity.• make healthy food available and affordable.• provide health services for all.• improve road safety.

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2. Improve urban living conditions:• locate houses in safe places• improve housing conditions• control indoor and outdoor pollution• ensure safe water and improved sanitation.

3. Ensure participatory urban governance:• share information about city planning for health• encourage public dialogue• involve communities in decision-making• create opportunities for participation.

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4. Build inclusive cities that are accessible and age-friendly:• make public transport accessible to disabled people• develop safe walkways for those with special needs• build public places and buildings for easy access• promote active city life and sports for all.

5. Make urban areas resilient to emergencies and disasters:• locate hospitals in safe areas• strengthen health centres to withstand known dangers• prepare community emergency response• improve disease surveillance.

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Eco-cities concept: Eco-city (sustainable city ) is a city designed with consideration of

environmental impact, inhabited by people dedicated to minimization of required inputs of energy, water and food, and waste output of heat, air pollution - CO2, methane, and water pollution.

An ecocity is… an ecologically healthy city.

› An ecologically healthy human settlement modeled on the self-sustaining resilient structure and function of natural ecosystems and living organisms.

› An entity that includes its inhabitants and their ecological impacts.

› A subsystem of the ecosystems of which it is part — of its watershed, bioregion, and ultimately, of the planet.

› A subsystem of the regional, national and world economic system.

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A sustainable city should be able to feed itself with minimal reliance on the surrounding countryside, and power itself with renewable sources of energy.

The crux of this is to create the smallest possible ecological footprint, and to produce the lowest quantity of pollution possible, to efficiently use land; compost used materials, recycle it or convert waste-to-energy, and thus the city's overall contribution to climate change will be minimal, if such practices are adhered to.

The ecocity model seeks to provide a practical vision for a sustainable and restorative human presence on this planet and suggests a path towards its achievement through the rebuilding of cities, towns and villages in balance with living systems.

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Architecture & Infrastructure components:› Eco- Industrial park› Urban farming› Urban Infill› Walkable urbanism› Individual buildings

Transportation components:› Emphasis on proximity› Diversification of transport options› Transportation access

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RESEARCH AND TRAINING – Innovations & Solutions

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Innovations in Data collection Geo-spatial mapping & GIS in conjunction with

ground surveys.

› To correctly identify slum areas/ poverty clusters.› To delineate areas accurately.› To enumerate urban poor populations in previously

unrecognised slums & squatter clusters.

› Already being implemented through RAY (Rajiv Awas Yojana)

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Social Mobilisation Organizing & strengthening slum community

groups and processes.

› Desire & resourcefulness

› Help in reaching out to vulnerable groups

› E.g. Organising TB clubs, Self help financial groups, etc

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Safer living environments To prevent & minimise the impact of accidents and

injuries. Mortality due to all kinds of injuries are higher in

low & middle income countries and more so among the poor.

Better constructed homes which meet safety standards incorporated at the city planning stage.

Planning & designing urban built environments to be resilient to natural disasters.

RAY, VAMBAY, NSDP, IHSDP

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Addressing food & nutrition security Promoting low cost nutritious foods and cooking

methods. Urban planning which integrates food security into

basic community goals.› Regulation of food markets› Food subsidies where required.

Improving transport & storage infrastructure to better connect rural production centres and urban consumption centres.

Promoting community grain banks.

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The way forward: Role for all

Ministries of health:› Become more informed about health determinants,

and how urban policy choices influence the health of city dwellers.

› Proactively engage other sectors, including housing, transport, industry, water and sanitation, education, environment, and finance agencies.

› Lead by example: support healthier and more liveable cities.

› Support health and environmental impact assessments for urban plans and policies.

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Local government bodies:› Foster collaboration within local government through

forums and dialogue between public health officials and urban planners.

› Partner with nongovernmental and community organizations; establish a mechanism that will give health professionals the opportunity to provide input on planning and transport plans.

› Provide a mechanism for sharing information, across government and with civil society and the community, on the nature of urban health inequities and progress in reducing them.

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Civil Society:› Ensure that people participate fully in shaping the

policies and programmes that affect their lives.

› Include residents of informal settlements in formal processes by establishing groups, associations and federations. To identify the social and economic conditions that they face; to find practical solutions to these problems; to struggle against marginalization; and to ensure access to the goods and services to which they are entitled.

› Work with governments on participatory planning and budgeting to allocate a greater portion of the municipal investment budget to priorities determined by neighbourhoods and community groups.

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Researchers:Generate and systematize knowledge to address the many existing information gaps, including:

› potential advantages of urbanization and urban growth;

› the inequities of health disaggregated by intra-urban area;

› the effectiveness of proactive approaches to deal with health inequity in cities;

› the importance of involving all citizens in the decisions that affect their habitat and their health.

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Urban planners:

› Use zoning and land use regulations as a way to prevent exposure of city dwellers to pollution emissions and hazards from industrial and commercial activities, waste and chemicals, and transport.

› Develop and adopt building practices that protect health among building users

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Why Urban Health Matters, WHD-2010. World Health Organisation, 2010. Geneva, Switzerland.

Hidden cities: Unmasking and Overcoming Health Inequities in Urban Settings. WHO – UNHABITAT. WHO, Geneva, Switzerland. 2010.

Essays in Healthy City Design. ANU College of Medicine, Biology & Environment, Canberra, Australia. July 2011.

Basic Principles of Healthy Cities: Evaluating a Healthy Cities Project. Department of Health, Hong Kong. 2010.

Agrawal S. Health Inequalities in India’s Cities. Presentation at the Cities, Health and Well Being, Urban – Age Conference, Hong Kong. November 2011.

Agarwal S. The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities.

REFERENCES:

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REFERENCES: Regional Guidelines For Developing A Healthy Cities Project.

WHO Regional Office for the Western Pacific, March 2000. http://www.uhi-india.org/index.php?

option=com_content&view=article&id=63&Itemid=41 http://sustainablecities.dk/en/blog/2011/04/a-

retrospective-look-at-world-health-day-2010-initiatives-on-urban-health

National Urban Health Mission, Framework for Implementation. Draft for Discussion, 2010.

Health of the urban poor in India: issues, challenges & the way forward. Report of panel discussion and poster session, March 29, 2007. UHRC, New Delhi.

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REFERENCES: http://www.alliance-healthycities.com/htmls/about/index_about.html UN-HABITAT. Slums of the World: The face of urban poverty in the new

millennium? Working Paper, Global Urban Observatory. Nairobi: UN-HABITAT; 2003

Canon T. Vulnerability Analysis and the Explanation of Natural Disasters.

Zagreb declaration for healthy cities. WHO 2009. World Health Organization. Health Promotion Glossary 1998 UN, Urbanization prospects, the 2008 revision http://www.who.int/kobe_centre/measuring/

urban_health_observatory/en/ http://www.who.int/kobe_centre/measuring/urbanheart/en/ http://www.who.int/world-health-day/2010/1000-cities/en/

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THANK YOUTHAN

K YOU

urban health - issues and challenges

Health & Medicine