Looking back to leap ahead for health in smart cities

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By: Meena Sehgal, TERI. Views are personal.
In a country as vast and diverse as India, existence of differences between states and within districts; concomitant dichotomy between urban and rural areas and between gender; with pockets of extreme poverty; rapidly transforming urban centers require proactively tracking health trends and planning for health.
Why should health be the center of smart cities?
Recent estimates by UNDP predict thatIndia’s urban population is set to increase at a faster rate than its total population. It is predicted that 41% (575 million people) of India’s population will be living in cities and towns by 2030, as compared to the 28% presently (286million people).  Looking at global experiences a prescription for developing livable smart cities is needed for India.
Cities such as Delhi; Bangalore; Kanpur; Kolkata; urgently need innovations to mitigate effects of extreme congestion. Especially, as we have some districts in these cities with as high as 36,000 persons residing per km, case in point, North-East Delhi district. Burgeoning population, with city centers often having little space for the young and the old – who need open space most- for physical and social interactions; for the youth -to  ward of life style related diseases such as diabetes, cardio vascular problems and obesity.
City characteristics which have been noted globally to significantly increase mortality rates particularly among the elderly are those with higher population density, and high built-up density,  as seen in Paris heat wave in 2003. Particularly significant are poor housing conditions, impervious land cover and high surface temperatures.
Increase in heat results in increased core body temperature, increased heart rate, shift of blood flow from central organs to skin, increased sweating and associated dehydration and even prove fatal. Heat waves have shown to adversely influence incidence of renal disease, fever and electrolyte imbalance among children.
A recent study reports reduced mortality, particularly in the elderly population, has been reported in greener areas in Lisbon, Portugal. Besides mortality, association has been seen between higher levels of greenness and lower odds of preterm and small for gestational age birth. German children living in urban areas surrounded by high level of residential greenness presented lower blood pressure than those living in areas of low or moderate greenness
What can be done to make smart cities livable?
As currently being experienced, sophisticated early warning systems need development for cities which repeatedly experience malaria, dengue and chikungunya to facilitate- timely elimination of breeding sites, provision of mosquito sprays, and medicated nets, stocking of medicine in hospitals and patient care facilities. Needless to say this requires partnership of policy makers, health practitioners and public, if we want to eradicate any one of these diseases or keep their count low.
Ahmedabad has led the way in this direction, by becoming the first Indian city and the first city in South Asia to comprehensively address the threat of extreme heat. Ahmedabad’s Heat Action Plan is designed to initiate an early warning system by equipping residents in illness prevention, training medical and community workers to treating heat-related illnesses better, raising public awareness on health risks, and coordinating an inter-agency emergency response effort when heat waves hit.
As we continue our pursuit to develop large cities which, inherently conjure up images of large scale concretization; accompanied with building of energy guzzling malls and expansion of airports.
To mitigate the effects of creation of such urban heat islands- urban landscaping, has been emphasized- lakes and ponds often called ‘blue zones’ are known to bring down temperature considerably. Water sprays and fountains offer respite both to the tourists and street vendors caught in a heat wave. Development of ‘green zones’ with tree canopy to cool the rising temperature and provide respite to homeless and people working in the open, during the hot sultry months is another recommended intervention. Even perceptions of general health have been reported to be higher for people living in greener surroundings.
Global evidence shows, higher population density townships with more vegetation show reduced risk of lifestyle effects such as- overweight. Measures such as access to school grounds for general public during after-school hours, and access of parks to cyclists so these have more meaning then merely a landscaped area, or at times designated as waste dump site; and many a times neighbourhood-car-park!
Why city level interventions for health?
Without adequate preventive and protective measures; data tracking and analyses; health care focus would remain in the domain of medical treatment with health facilities burdened with treating communicable and preventable diseases. Resulting in a mammoth socio and economic  burden to  individuals, community and economy.
Through a large number of ongoing and past government initiatives the distribution of diseases has changed.Non-communicable diseases (39.1%) and injuries (11.8%) now constitute abulk of the country’s disease burden, communicable diseases contribute to 24.4% of the entire disease burden, while maternal and neonatal ailments contribute to 13.8%. Though some health issues continue to be common in certain subpopulations such as—malnutrition levels are high among the urban poor children (54 percent) and children in rural areas (51 percent); more than three out of five children in urban slums not receiving all childhood vaccinations, neonatal mortality ratio (per 1,000 live births) at 10 in urban (all India level) areas and around 31 in rural areas. Thus, the transformative mantra for cities should be de-medicalization of health through smart development, where the health care system is required to provide less and less for the fully preventable and foreseeable diseases.
Our country where out-of-pocket percentage of total health expenditure continues to stand high at 67% much higher than the world average (World Bank, 2014) of  18% promoting city based innovations for healthy lifestyle and providing targeted interventions would be much welcome. A real game changer would be increasing the share of GDP spent on health from 4.7% closer to world average of over 9%, with an increase in Government spending on health.
What can be smart for the ill in the cities?
The13 districts of Andhra Pradesh appear to be set to revolutionize availability and access to health care. For AP health-facility-use data, hospital inventories, sanitation status of facilities are available through real time data display on the state dashboard ‘CORE’, thereby making it citizen centric. Such tracking of health services is critically important as over time it could help track and trend disease outbreak, help prepare and handle disasters or other emergencies. Several initiatives are being undertaken by the state, significant among them -the blood bank- it is really a ‘bank’ with an ‘App’ to help identify  location of the closest ‘bank’, a credit of past ‘deposits’ or donations is maintained in this ‘bank’  to be used in the future. No opportunity to meet myriad of health needs is lost, even the devotees at religious events are urged to donate or pledge ‘organs’.
Strong policy interventions with concomitant attention to ground realities can successfully bring the desired transformation of the cities to ‘ livable smart cities’. Progress on livability quotient of cities should be the final judgment vis-à-vis smart development.