What is killing our citizens? Not so long ago, epidemics such as cholera and plague could depopulate cities. Now, heart diseases are the biggest killers.
Ischemic heart disease, a condition where the arteries contract and prevent blood and oxygen from reaching the heart causing a cardiac attack, will cause the maximum number of deaths in 2017, predicted an analysis in UN Dispatch last week. The World Health Organization (WHO) estimates that even in 2030, it will remain the world’s deadliest disease.
Its risk factors include high blood pressure, diabetes, obesity, high cholesterol, smoking, excessive alcohol intake and depression. Many of these conditions are triggered not only by how we live but also where we live.
Badly planned cities also expose its people to severe health risks. Urban living and its increased pressures of mass marketing, availability of unhealthy food choices and accessibility to automation and transport — all have an effect on lifestyle and health, says WHO.
Delhi is an example. The municipal records show that heart diseases, diabetes and digestive problems are responsible for more than 20% deaths in the national capital.
These diseases are assuming a rather democratic pattern. While infectious and parasitic diseases due to bad sanitation and no access to clean water still kill 15% residents, mostly in city’s slums, a survey by the Directorate of Health Services in 2011 found that at least 20% of the 100,000 slum dwellers screened were suffering from hypertension and 10% from diabetes.
For a city to be considered healthy, its citizens must enjoy equal access to clean water and air, sanitation, and good healthcare. But haphazard urbanisation denies citizens these basic rights. Large urban sprawls contribute to a city’s ill-health, says the 2016 Global report on Urban Health by WHO and UN Habitat. In the absence of density, access to public transport, hospitals, schools, businesses, parks and planned public spaces for certain communities can be infrequent or non-existent.
In Delhi, secondary and tertiary healthcare facilities are not equally distributed. The Delhi government is trying to address the primary health care needs through mohalla clinics. But most emergency services and specialised hospitals are concentrated in certain districts. The NCR towns are pretty much in private hands.
The global report also points out that in compact cities, intra-urban distances tend to be shorter — the things people require and the places people need to access are close by. This reduces time spent in a vehicle and lowers travel costs. The lower cost of transport can substantially help low- and middle-income households. Decreased transit time often reduces exposure to pollution and also boosts mental health.
The Marchetti’s constant, developed by Italian physicist Cesare Marchetti, states that anything beyond a 60-minute commute stresses one out. Delhi drivers have long surpassed this limit. According to IBM’s 2011 Commuter Pain Index, 70% respondents in Delhi said traffic increased their stress levels, upped their anger, and negatively affected their performance at work or school.
The rising levels of air pollution, mainly from vehicular fumes and construction dust, are suppressing our immunity, making us vulnerable to lung infections, heart attacks and cancer. In 2015, 8% deaths in Delhi were caused by respiratory ailments and 6% by cancer. A study by CSE says half of Delhi’s population lives within 500 metres from arterial roads and is directly affected by vehicular pollution.
Noise disturbance in Delhi is as severe as air pollution. But it remains the most underestimated threat. We absorb the din without realising that prolonged exposure to noise can boost stress hormones and contribute to cardiovascular maladies and hearing damage. At least 70% of these damaging sounds emanate from Delhi’s nearly 10 million vehicles.
On the other hand, unregulated compactness can constrain the housing stock and inflate real estate prices, and at the extreme, can lead to unhealthy crowding, warns the Global Health report. This is exactly what has happened in Delhi’s Walled City and numerous unauthorised colonies, which are so tightly packed that they have little open space or access to fresh air.
Our health or wellness often depends on how we live. Our lifestyle choices, in turn, are dictated by where we live and the options it offers. Wellness, therefore, is also an urban planning issue that demands a lot more than providing access to healthcare. It is a reflection of how we plan, reinvent and run our cities. As always, prevention is better than cure.