Of lately we have been talking a lot about smart cities in India.  Majority of the population being below poverty line lacking even basic amenities and with empty coffers at the local level, smart cities with central outlay of about 100 crores per city per year, may turn out to be another catchy slogan. Smart city is a concept of urban planning where sanitation and health also find a mention but without sufficient emphasis, may get back seat as usual. Despite one year of Swachh Bharat campaign, cleanliness and disposal of solid waste has not progressed beyond  tokenism.  Can a city be smart with healthcare system in the tatters? Even in the national capital people are running from pillar to post for getting a platelet count or antigen test in suspected dengue cases. Beds are not available even for serious cases. Affordability of healthcare is a big issue with most citizens even in public hospitals. While the doctors are visiting TV studios  in droves and journalist pushing their way into hospitals the sorry state is obvious.  States and centre are passing the buck of healthcare management; other political parties  are engaged in scoring brownie points out of the misery of the public. While facility of ‘fever clinics’ can be provided even in primary health centres, why the patients are hanging around tertiary public hospitals or corporate hospitals. Whenever there is an outbreak of any infectious disease the situation is the same as far as provision of services is concerned. The reason is simple- adequate attention is not given to health or healthcare delivery, since health is not a vote catcher, in India.  The need for public health education is paramount.There is a need to set up healthy cities all over the country. Healthy cities are smart cities and not the other way round.

 

What is a healthy city? A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential. Healthy Cities is a global movement that engages local authorities and their partners in health development through a process of political commitment, institutional change, capacity-building, partnership-based planning and innovative projects. Healthy Cities seek to apply Health for All principles such as equity, empowerment, inter-sect oral collaboration and community participation through local action in urban settings. Healthy city concept is used to stress the impact of policy on human health. Its modern form is derived from World Health Organization (WHO).   An International Healthy Cities Conference held in Athens, declared “all city and health leaders and everyone who lives in urban settings to join in this Endeavour to create a healthier and sustainable future”.

Can one say ‘Chandigarh is among India’s top healthy cities?’ Not really! There is no satisfactory arrangement to deal with serious cases of Dengue or other infections or any other emergency that any citizen may be faced with. Ultimate destination is PGI where thousands of people are lost in the crowd and nobody knows how to seek treatment. Less said the better about the corporate hospitals and their ethical practices and affordability. Why cannot the civil dispensaries and health centres in the city provide services of a ‘fever clinic’ near the homes or even at the doorstep of the citizens?

 

What are the points that do not go well with healthy city concept?

High infant and maternal mortality

High water borne diseases

High vector borne diseases like malaria and dengue

High incidence of chronic diseases like obesity, hypertension, diabetes and coronary heart disease

Poor occupational health, poor sanitation and poor waste management

High incidence of mental ailments

Road traffic injuries, poorly planned transport system and high pollution levels.

 

What are the essentials of a healthy city?

A clean, safe physical environment of high quality (including housing quality);  An ecosystem that is stable concurrently and sustainable in the long term;  A strong, mutually supportive and non-exploitive community;  A high degree of participation and control by the public over the decisions affecting their lives, health and wellbeing;  The settlement of basic needs (for food, water, shelter, income, safety and work)l for all city’s people;  Access to a wide variety of experiences and resources, with the chance for a broadl channel of contact, interactions and communication;  A diverse, vital and innovative city economy;  The encouragement of connectedness with the precedent, with the cultural andl biological heritage of city dwellers and with other groups and individuals;  A form that is compatible with and enhances the preceding characteristics; An optimum level of appropriate public health and sick care services that is accessible to all; and  High health status (good health and low diseases profiles). Proper implementation of Healthy Cities project can thus raise public awareness on health policies and issues; reduce health problems and enhance living standard; and provide a natural, comfortable, trusting, harmonious and enterprising environment.

 

The primary focus of a healthy city in an aging society should be the prevention of frailty and disability by developing innovative models supported by high-tech services and solutions towards the overarching goal of ‘healthy communities’.  Use of Mobile phones as “an emerging and rapidly developing field” has the potential to play a part in the transformation of healthcare and increase its quality and efficiency. In case of an epidemic internet should be able to provide all out information and help in getting appointments, rather than being pushed like cattle in the hospital corridors for a consultation, lab test or bed, This can save the victims from being exploited by the hospitals also.

October 3, 2015

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