Cities are centres of business, industry and economy. Rapid urbanisation is universally considered a symbol of development. The benefits of urbanisation can be better amenities like transport, roads, water supply, drainage, educational institutions, markets, housing, entertainment, and health care.
The drawbacks of urbanisation can be higher costs of living, pollution, traffic congestion and long commuting times, higher rates of conflict and crime, inequality, poor community participation, climate change, extreme climate events, higher risks of life style diseases and disease outbreaks (as per the contributions of multi stakeholder workshop participants). As mentioned by O’Flaherty, cities can survive—as they have for thousands of years—only if their advantages offset the disadvantages. Thus, sustainable resilience is not an effort to balance benefits and drawbacks but instead to ensure that benefits outweigh drawbacks.
Happiness, for which health is a major indicator, is the ultimate goal of urbanisation and prosperity. Health is not synonymous with the absence of disease or the availability of medical care. The assumption that better medical care ensures better health is challenged by the fact that, in developing countries, the burden of communicable diseases continues to increase rapidly and is added to the burden of non-communicable diseases. This is despite the expansion and scaling up of medical care networks which do not seem to reduce the overall disease burden. The medical world is currently facing challenges of managing resistant strains of infections, viral infections, non-communicable diseases of which many are allied with life style, environment, climate, disturbed ecology, which endorses the value addition of prevention.
Three components of the epidemiological triad of health and disease, i.e. agent, host and environment, remain under threat in terms of sustaining public health in the urban domain. Environment in this triad includes physical, socio-economical, political. The city brings the environmental factors closer to community and the impact of environmental risk is increasing under the influence of climate change.
Understanding urban health, which is a new and dynamic domain, is a major priority. The Urban Health and Climate Resilience Centre (UHCRC) studied urban factors and urban health relations through a series of multi stakeholder workshops, with 170 members and about 600 man-hours. Major statements drafted during interactions are:
- Health is an important determinant of productivity and development
- Urban health is an outcome of several factors beyond the domain of urban health services
- Urban health should have a strong prevention focus
- Health should be a focus in all urban planning as:
- City cleanliness can reduce the major burden of water borne and vector borne diseases in the city.- City transport policy and air quality can contribute to prevention of non communicable diseases- City residential zone planning can prevent heat islands as well as chronic and acute shocks- Climate change is rapidly changing the disease profile in the city and also coinciding with resurgent zoonotic infections
"Understanding City Specific Public Health Vulnerability is a First Step Towards Sustainable City Public Health Resilience Planning"
Urban practitioners prioritised adaptive capacity as a major determinant of vulnerability, followed by exposure and sensitivity. The adaptation was further integrated into four domains with highest grading to environment and infrastructure followed by integrated urban policy, socio economic profile of the city and urban health system.
This information is an outcome of career-long experience of 170 multi stakeholder urban practitioners in Surat city, which is the economic capital of Gujarat state in India and has faced serious public health challenges under prosperity, which metamorphosed after the 1994 public health shock as well as economic shocks, and which faces high risks from climate and socio demographic changes, and is in climate resilience mode. This trading city of migrants has understood the value of a public health focus for its sustainable economy, development and resilience.
Multi stakeholder urban practitioners experience sharing echoes city experience that public health is an important determinant of city resilience. Sustainable city resilience even under sound economy need health focused integrated urban planning.