Context: Urbanisation and rising risk of Non Communicable Diseases (NCDs).
More in news:
- A recent Lancet study issues a dire warning of the devastation that Non Communicable Diseases (NCDs) are likely to wreak if timely action is not taken to slow down its current rapid rise.
- Urbanisation is an increase in the number of people living in towns and cities. Urbanisation occurs mainly because people move from rural areas to urban areas and it results in growth in the size of the urban population and the extent of urban areas.
- These changes in population lead to other changes in land use, economic activity and culture.
- Historically, urbanisation has been associated with significant economic and social transformations.
- For example, urban living is linked with higher levels of literacy and education, better health, lower fertility and a longer life expectancy, greater access to social services and enhanced opportunities for cultural and political participation (UNDESA, 2014).
- However, urbanisation also has disadvantages caused by rapid and unplanned urban growth resulting in poor infrastructures such as inadequate housing, water and sanitation, transport and health care services.
- The process of urbanisation affects all sizes of settlements, so villages gradually grow to become small towns, smaller towns become larger towns, and large towns become cities. This trend has led to the growth of mega-cities.
- A mega-city is an urban area of greater than ten million people. Rapid expansion of city borders, driven by increases in population and infrastructure development, leads to the expansion of city borders that spread out and swallow up neighbouring urban areas to form mega-cities.
Urbanisation in India:
- Among all the States and Union territories, the National Capital Territory of Delhi and the Union territory of Chandigarh are most urbanized with 97.5 percent and 97.25 percent urban population respectively, followed by Daman and Diu (75.2 percent) and Puducherry (68.3 percent).
- Among States, Goa is now the most urbanised State with 62.2 percent urban population, a significant increase since 2001 when urban population of Goa was 49.8%.
- Another significant instance of rapid urbanisation is that of Kerala, its urban population is now 47.7 per cent, while a decade ago it was just 25.9 percent.
- Among the North-Eastern States, Mizoram is most urbanised with 51.5 per cent urban population, though in terms of absolute contribution to total urban population in the country, Mizoram’s contribution is just 0.1 percent.
How Urbanisation affects health?
- Urbanization plays a key role in the rise of non-communicable diseases (NCDs) and multi-morbidities. Some NCDs cause others and create clusters of comorbid conditions. For example, diabetes can lead to kidney failure and blindness.
- The availability of high-calorie processed food is greater in urban areas than in rural zones, resulting in a greater burden of obesity and diabetes.
- Urbanization has also been responsible for more sedentary lives. The transition from work that requires heavy physical labour (such as agricultural employment) to jobs that require less energy expenditure (such as desk-based roles in offices) has contributed to a considerable reduction in physical activity.
- In cities, rapid growth and lack of planning have resulted in a dearth of secure sidewalks and green spaces, and economic growth in cities has made technology.
- Air pollution (indoor and outdoor) is a significant risk factor for Non Communicable Diseases (NCDs).
- Old-age morbidity has risen rapidly. The swift descent of the elderly in India (60 years-plus) into non-communicable diseases (e.g., cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) could have disastrous consequences in terms of the impoverishment of families, excess mortality, lowering of investment and consequent deceleration of economic growth.
- Overall, by 2030, 39% of India’s population will reside in urban areas, totalling 583 million people, according to 2015 projections by the United Nations. Thus, more individuals will encounter urban risk factors, compounding the NCD burden and related economic losses.
Non communicable diseases (NCDs) in India:
There is rise in prevalence rates and shares of some NCDs in urban areas from 2005 to 2012, based on the India Human Development Survey 2015.
- India is a populous country of about 1.3 billion. Non communicable diseases (NCDs) contribute to around 5.87 million (60%) of all deaths in India.
- According to World Health Organization (WHO) report of 2014, four NCDs mainly responsible for the total NCD mortality and morbidity are cardiovascular diseases, chronic respiratory disease, cancers and diabetes, contributing to about 82% of all NCD deaths.
- A risk factor is defined as “An aspect of personal behavior or lifestyle, an environmental exposure, or a hereditary characteristic that is associated with an increase in the occurrence of a particular disease, injury, or other health condition”
- These behavioral and biological risk factors, with a predisposition to the development of NCDs, are use of tobacco and alcohol, physical inactivity, overweight and obesity, increased fat and sodium intake, low fruit and vegetable intake, raised blood pressure (BP), blood glucose and cholesterol levels.
- In India’s urban areas, the prevalence of high blood pressure almost doubled, heart diseases rose one and a half times, diabetes more than twice, as also of asthma, while multi-morbidity rose most rapidly by about three and a half times.
Surveillance and procurement of details regarding NCD risk factors is essential for health programs/policy planning and implementation, particularly in a country like India with a rapidly increasing burden of NCDs. Currently, a relative lack of adequate risk factor data in its entirety, inadequate coverage (geographically and demographically) and absence of a standardized methodology are the major deficiencies which need to be overcome for a superior and more effective NCD control in the country, which in turn would facilitate reduction of the overall NCD burden by 2025.