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Opinion | Rapid urbanization has meant more problems than prosperity

It is not just hazardous air that city dwellers must worry about but also an alarming rise in non-communicable diseases

The World Bank, other multilateral organizations and the present National Democratic Alliance regime are obsessed with urbanization as a key to modernization, prosperity and poverty reduction, little realizing that unregulated rapid urbanization could lead, among other problems, to an alarming drop in air quality. In Delhi, the process seems to have culminated in the Supreme Court-mandated Environment Pollution (Prevention and Control) Authority declaration of a public health emergency on 1 November, the closure of schools, a ban on all construction and demolition activity, reports from hospitals of a surge in the number of patients suffering from respiratory and breathing complications.

There are other health hazards too. David Bloom and his collaborators at Harvard University have emphasized that 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. Moreover, the urban population uses motorized transport much more than the rural population does. 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—and, by extension, sedentary recreation such as television viewing and video game playing—more popular. No less insidious is air pollution (indoor and outdoor) as a significant risk factor for NCDs.

A related but distinct concern is that 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. As the elderly population is growing three times faster than the population as a whole, it is projected that the percentage of elderly people will climb from 8% in 2010 to 19% in 2050. This future shift in the proportion of older Indians in the population will take place in the context of changing family relationships and severely limited old-age public income support, raising seemingly insurmountable policy challenges, especially in urban areas.

India is poised to experience significant urban growth over the coming decades. 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. A recent Lancet study issues a dire warning of the devastation that NCDs are likely to wreak if timely action is not taken to slow down its current rapid rise.

From this perspective, we examine the rise in prevalence rates and shares of some NCDs in urban areas from 2005 to 2012, based on the India Human Development Survey 2015. The evidence is somewhat dated but compelling, as it is drawn from an all-India panel survey covering the period.

In 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. As multi-morbidity is also associated with higher fatality rate, this is alarming.

A rapid shift of the share of NCDs towards those aged 60 and above is confirmed for high blood pressure, heart disease, and also—though not so pronounced—diabetes and asthma.

Shares of males suffering from high blood pressure, heart disease, diabetes, asthma and multi-morbidity rose during 2005-12. Although females were more susceptible to high blood pressure, heart disease, asthma and multi-morbidity, their shares fell, except in the case of asthma.

Then, there’s the affluence factor. A comparison of the ratio of NCD shares in the wealthiest quartile to those in the least wealthy shows that it exceeded one or more in all cases, except asthma. However, while these ratios continued to exceed 1 or more, they declined in 2014 for all NCDs.

While our health policy challenges are many and daunting—be it rural-urban migration, emission control or urban health infrastructure—a recent review of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, launched on 23 September 2018 and touted as India’s most ambitious health scheme, draws attention to its abysmal failure. Going by this review (, there are at least two reasons: It has neither been able to alter health-seeking behaviour much in high disease-burdened states, nor succeeded in dismantling barriers for the most vulnerable to access medical care. Whether these shortcomings will be remedied soon is anybody’s guess.

Vani S. Kulkarni & Raghav Gaiha are, respectively, teacher of sociology, University of Pennsylvania, US, and (Hon.) Professorial Research Fellow, University of Manchester, UK

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