India’s cities, their non-communicable disease burden

Indian cities are the places full of energy, ideas and development. However, beneath the surface of this dynamism lies a growing health crisis: the increasing pressure of the NCDs. Non-communicable diseases like cardiovascular diseases, diabetes, chronic respiratory illness and cancers are the principal killers and disabilities in Indian cities. Here we will discusses causes of this burden, the experiences of urban health systems, and the approaches that are required to solve this problem.

Factors Contributing to NCDs

The social change that has characterized the nation in the recent past is as a result of rapid urbanization and economic development of Indian cities. Acceleration of these changes has fostered economic growth, increased the rate of modernization but this has been accompanied by increased burden of non-communicable diseases commonly known as NCD including cardiovascular diseases, diabetes, chronic respiratory diseases and cancers. These NCDs have however emerged and challenged the public health systems leading to high morbidity and mortality. The factors resulting in the growing burden of NCDs in urban India are as follows;

1. Urban Lifestyle and Dietary Habits: New lifestyles have changed the eating habits by shifting from rural standards to urbanity levels. Most urban residents take complex carbohydrate diets rich in sugars, unhealthy fats, and processed foods hence; low nutrient density diets. This dietary change is associated with increased incidences of obesity, diabetes and cardiovascular diseases.
2. Physical Inactivity: This is because majority of the population in the Indian cities lead a more and more inactive lifestyle, doing very little exercises. Sedentary lifestyles due to dependence on automobiles, long hours of sitting at offices or workbenches and low or practically non-existent access to recreational facilities. The former is a major risk factor for the following NCDs, cardiovascular diseases and diabetes.
3. Air Pollution: the air quality of several major cities in India is poor and it is a major problem in the country. Emission from automobiles, industries, construction sites etc… there is substantial amount of particulate matter, and other pollutants. Living in an area with polluted air increases the probability of developing respiratory diseases.
4. Work-Related Stress and Occupational Hazards: Stress caused by high pressure at workplace in cities has been associated with hypertension, heart diseases and mental health disorders. There are sensitive occupations which make workers come into contact with toxic substances and handling dangerous conditions thus increasing their NCD risk.
5. Socioeconomic Inequality: There are inequities of health service delivery, access to quality foods and safe physical environments based on the status of those in urban areas. Populations that are affected most by NCDs are the marginalized and low-income earners are most affected since they are financially and health wise constrained. This inequality increases the health risk of these groups of people.
6. Aging Population: The population with increased prevalence of NCDs is the aging urban population in India, who are also more vulnerable to NCDs. As life expectancy increases, the prevalence of age-related diseases such as diabetes, hypertension, and cancer also rises, placing additional strain on healthcare systems.
7. Inadequate Healthcare Infrastructure: However, as already pointed out, many cities still experience a broad range of barriers in an efficiently and effectively responding to the needs of their populations to support adequate care for NCDs even when such facilities exist within the urban environment. Overburdened health centres a shortage of healthcare professionals, and fragmented services hinder effective disease management and prevention.
8. Limited Awareness and Preventive Measures: using data for urban residents, it is seen that there is little knowledge on common risk factors for and ways to avoid NCDs. Political measures such as public health campaigns and educational programs are needed to encourage people to make necessary changes to their lifestyle, but those measures are commonly insufficient or performed poorly.
9. Tobacco and Alcohol Use: 'The statistics of tobacco smoking and alcohol consumption show high magnitude in urban areas where the burden of NCDs is high. Tobacco use is responsible for cases of lung cancer, chronic respiratory diseases, cardiovascular diseases, alcoholism contributes to liver diseases, hypertension, and cancer.
10. Cultural Practices: Cultural beliefs and practices as well as social habits known as cultures have an impact on health. For instance, the widespread use of smokeless tobacco and the acceptance of sedentary leisure activities can negatively impact health outcomes.

Challenges faced urban health systems

Urban health systems have a very significant position in ensuring health and maintaining health of urban population. However, they exist with very many challenges that limit their efficiency and equal health care services provision. Many challenges characterize the urban health systems including population growth, division of income status, the environment, and limitation on the availability of resources available. Let’s look at some of them:

• Overcrowding and Strain on Resources: A consequence of urban growth is overpopulation of cities this creates pressure on health facilities and equipment. It’s not uncommon to find that the population density in these regions has put immense pressure on health facilities whereby there are extremely long waiting lists, over worked staff and poor quality health care.
• Inadequate Healthcare Infrastructure: Health systems in many urban areas are ill equipped to provide care to the ever increasing population. These are issues of inadequate numbers of hospitals, clinics, and diagnostic centres, out-dated tools and techniques. The variation between patient needs and healthcare delivery hitches contribute to less than desirable patient results.
• Inequitable Access to Healthcare: This leads to physical disparity or economic difference in health care services in urban regions. Minorities and vulnerable economically receive limited health care; charges, no health insurance, and restricted access to care. The given imbalance deepens health inequalities and leads to poorer health status of the most vulnerable population subgroups.
• Health Literacy and Awareness: There is evidence that those urban dwellers with low health literacy are incapable of making health related decisions. Lack of knowledge on preventive measures, available healthcare services and the impact of timely health check-up results to compromised health and the health systems as compiled with untreated conditions.
• Pollution and Environmental Hazards: Air and water pollution is more pronounced in the developed regions hence leading to respiratory diseases, cardiovascular diseases and cancers among others. These challenges are made worse by environmental factors such as poor industrial outputs like waste disposal and poor supply of sanitary products.
• Shortage of Healthcare Professionals: A concern that is common with most urban health systems is the shortage of human resources in the health sector-range from doctors, nurses, and allied health workers. This shortage can be due to poor training, health workers migration, and their poor retention incentives. There is no professional staffing which makes it hard to deliver quality treatment.
• Financial Limitations: Lack of funds prevents urban health systems from expanding infrastructure, procuring technologies and developing a quality health care workforce. Shortage of funds at hospitals, clinics, etc. affects in the proper supply of medicines needed and other related products.
• Fragmented Health Services: To promote effective and efficient service delivery and delivery in urban areas there is need for health system integration. This leads to complications when the patient is receiving health care; they may find it difficult to manoeuvre the system, therefore, receive too much care that is uncalled for. Inter/Intra organisational relationship between various levels of service delivery and healthcare workers is critical.
• Public Health and Emergency Preparedness: An urban health system therefore needs to be designed in a position to offer treatment in a situation of event for example an epidemic or a natural calamity. Nonetheless, lack of preparedness and response capacity can worsen the effect realised by such occurrences. Improvement of emergency response frameworks and enhancing the capacity of health systems forms a part of protective strategies.

Measures for the Management of Non-Communicable Diseases (NCDs)

Chronic diseases including cardiovascular diseases, diabetes, chronic respiratory diseases and cancers, have gained prominence and are the main killers globally. The level of Non-Communicable Diseases is increasing significantly in the developing countries particularly in urban Setting. This equation must be solved differently, and the solution should not only be an improvement in medical treatment but require changes in policies, people’s interaction, and perception. Nonetheless the following strategies could be useful in combating NCDs:

• Enhancing Primary Healthcare: The improvement of the primary health care has the potential to offer early identification, treatment and management of NCDs. This includes expanding access to diagnostic equipment, core clinical drugs and trained human resources for health in primary care units. Hence, increased availability and utilization of basic care in regard to NCDs would be effective in the grassroots level management of the diseases.
• Integrating NCD Services: There are models of integrating NCD services into the currently existing health care systems that will allow a streamlined form of health management. This encompasses extending NCD screening and management as a component of other primary care, antenatal and postnatal care, and child health, and infectious disease prevention and control. This could go along way in aiding the early identification as well as constant screening of NCDs in the population.
• Public Health Campaigns: Such communication to the targeted communities on the risk factors for NCDs and how to prevent them is crucial. These campaigns can help people know how they should take their meals, the effects of taking many products that have tobacco and alcohol among other things that can help people have a healthy lifestyle. Public advocacy like the use of social media platforms, television and radio, and fliers and posters can reach everyone.
• Encouraging Physical Activity: It is particularly important to encourage people engage in physical activity as NCDs are prevented and managed. An effective urban planning includes the design and provision of parks, recreation places, and walkways and bike lanes. Employees and Students can also be made to adopt a physical active lifestyle by availing facilities for exercise at the workplace/school and endeavouring to support fitness activities.
• Improving Air Quality: The decrease of emissions that cause air pollution is crucial to decrease the risk of some diseases such as respiratory and cardiovascular diseases. Regulations should be put in place in as far as emissions are concerned, the society should be encouraged to embrace the use of clean energy where possible and the use of public transport should be encouraged. Traffic jams, and industrial pollution, should also be addressed by urban planning.
• Occupational Health Programs: Mentioned occupational health programs can be useful in recognition and prevention of risk factors causing NCDs at places of work. The preventive measures regarding the NCD’s among workers are; voluntary health check-ups, offer of stress-related check-ups, and encouraging healthy-working environments.
• Reducing Socioeconomic Inequalities: Addressing socioeconomic disparities is crucial in reducing the NCD burden. Governments and organization have the responsibility to ensure every individual or household has equal chances to access health care facility, healthful food and live in hygienic environments. Social protection programmes and policies for reducing poverty and enhancing education can bring improvement in health.
• Access to Healthy Foods: A possibility to access cheap but nutritional food is one of the critical barriers to NCDs. Governments should encourage and adopt policies like provision of incentives for consumption of health – promoting foods like fruits and vegetables, provision of laws governing foods labelling, and ban on consumption of harmful foods by children.
• Implementing Tobacco and Alcohol Control Policies: Strong regulatory measures to control tobacco and alcohol use can significantly reduce the prevalence of NCDs. This includes raising taxes on tobacco and alcohol products, establishing and enforcing no-smoking measures in public areas and ceaseless anti-tobacco and anti–alcohol campaigns.
• Global Collaboration and Research: Research and collaboration across countries and borders is immeasurably useful in addressing NCDs. Conference can assistance to identify the best practices and experience of different countries to find the ways to deal with the NCD burden. Promoting such systems requires governments and organizations to invest in collecting research data for policy-making and tracking progress.