Humanity has entered the Anthropocene era and is in the midst of the greatest urbanization in history. Asia and Africa are the fastest growing and fastest urbanizing continents. In addition, climate change induced by man-made activities is leading to change in health patterns and emerging diseases. The traditional dual burden of communicable and non-communicable diseases has become a triple burden caused by disability due to road accidents. In 2007, we reached a threshold where 50% of the world’s population lived in cities. It is projected that 70% of the population would be urban dwellers by 2050. The rapidity of urbanization combined with climate changes is presenting challenges to all countries but more so to low and middle income countries. Migration of refugees due to conflicts and internal migration from rural to urban areas pose additional problems.
Informal settlements provide manpower for the cities but also breed illnesses due to poor infrastructure and density of people. Urbanization also leads to development of heat islands which change vector behavior and thus infectious diseases. Whereas malaria vector breeds in clear water and may reduce in heat spots and seen more in rural areas, mosquitoes causing chikangunya and dengue breed in heat islands and in stagnant water within water coolers, empty vessels, tires etc. Cholera associated with bad sanitation is another problem in urban areas. Floods caused in cities due to bad city planning aggravate water borne diseases. Migration further brings in diseases that may not have existed locally. Life style diseases such as cardiovascular diseases, diabetes, obesity and hypertension have been linked to urban living.
Managing cities and providing services for health and wellbeing requires an integrated trans disciplinary approach and cannot be handled in silos. Decision makers need to be provided holistic advice. A systems approach is required as a city has an integrated organic structure. Thus policies and informed decisions can be made with relevant data provided by multiple agencies and experts. Policy makers need to interact with experts, doctors, city planners as well as members of the civil society. Economies are in danger if health of a nation is severely affected. Thus analysis of systemic issues with credible data is essential for managing health in the urbanized world of the Anthropocene era.
Professor Indira Nath, FNA, Former, Sr. Professor and Head, Department of Biotechnology, AIIMS and Raja Ramanna Fellow, National Institute of Pathology, New Delhi