Keeping space for good health
Meena Sehgal

It is time to build cities that recognise the need to provide its citizens healthy surroundings and reduce the risk of diseases

As urban population grows, the area available for walking is shrinking

Obesity is now being recognised as a major health problem in both developed and developing countries. Is it a result of only gorging of high calorie food? Could our cities with disappearing sidewalks and manicured parks have a role to play? Is this an emerging public health problem looming large?

In 2008, more than 1.4 billion adults (20 and older), were overweight, according to WHO reports. Overweight schoolchildren are reported to form around 10-20 per cent of the affluent adolescent school kids in Delhi, and obesity among schoolchildren has been reported at 2-5 per cent. More disconcerting is the fact that approximately 10 per cent of all overweight and obese children had some degree of dysglycemia (abnormal blood sugar levels). This may be a harbinger of bad news not just for residents of Delhi, but also for other rapidly growing cities.

Recent worldwide estimates reported in The Lancet (2012) state that physical inactivity causes nearly 6 per cent of the burden of disease from coronary heart disease, 7 per cent of type 2 diabetes, 10 per cent of breast cancer, and 10 per cent of colon cancer. These linkages are important to note as heart diseases have emerged as the number one killer in both urban and rural areas in India. In urban areas, 33 per cent deaths occur because of heart ailments, while this percentage in rural areas is 23, according to a recent study by the Centre for Global Health Research and the Indian Council of Medical Research (ICMR). These statistics gain significance as urban surveys from Indian cities have revealed low level of physical activities in 61-66 per cent of men and 51-75 per cent of women surveyed.

Living on streets with no sidewalks or in commercial areas has been associated with obesity

Besides reducing adult morbidity, children during formative years would benefit from exercise particularly focused on muscle-building and bone-strengthening. It is common knowledge that lower physical activity brings weight gain.

There is growing evidence that overweight is associated with place of residence. Living on a highway, streets with no sidewalks, and perceived lack of paths, poor access to recreational facilities, crowded sidewalks and perceived absence of shops within walking distance have been associated with obesity.

Disproportionate spread of population is another limiting factor. National Capital Region of Delhi, which boasts of a population of more than 11,000 per sq km on average. At the lower end of the spectrum is the New Delhi district presenting around 4,000 people per sq km and North East District at the other extreme of 36,000 people (home to more than 13 per cent of the population) according to primary census abstract (Census of India 2011). Combined, East and North East districts are home to nearly quarter of the population, but a mere 8 per cent of the land. Multiple demands on land have not left much space for walking or strolling.

Like most other cities in India, close to 32 per cent of Delhi’s population is less than 14 years of age and another 7 per cent is above 60 years, clearly putting 40 per cent population in dire need of green space to be physically active and/or socially-mentally engaged. Positive benefits in mental health have been attributed to physical activity. This may be through a combination of the physiological effects as well as participation in social activities and engagement with others.

However, our cities are constantly evolving. Delhi in 1961 had close to 1,000 sq km as rural area, but according more recent reports nearly 1,000 sq km have become urban areas out of the 1,458 sq km. With rapidly disappearing rural areas and exponentially growing urban population, the area available for walking is shrinking.

Also, safety of walking areas becomes a determinant of physical activity. A recently-released Joint Action Research report on Safe City Free of Violence for Women and Girls states that, unfortunately, three out of every five women report facing sexual harassment not only after dark, but through the day time in cities. Safe and well-lit streets would support physical activity in the area. Several studies have noted that adults who perceived their neighborhoods were safe, attractive and had interesting green walks were more likely to walk for recreation and more likely to walk at a recommended level.

Another growing menace is the increasing number of automobiles. In the past six years, the sale of vehicles in India has nearly doubled particularly of two-wheelers and passenger cars. These trends are disturbing and bring unhealthy lifestyle. Not having access to a car for personal use has been associated both with walking more, and walking for public transport.

Key elements of health promoting environment include parks and other green spaces for physical activity, perceived and actual safety, neighborhood upkeep and residential density, the provision of facilities to segregate conflicting road users, and neighborhood attractiveness are needed to keep morbidity away.

To provide enabling or facilitating healthy physical environment, an essential element is convincing, converting and motivating a range of stakeholders for making healthy behaviour plausible. A proactive approach can help develop cities, which promote health, thereby reducing multi-morbidities and contain health costs for both — individuals and the State. Therefore, besides watching out for calorie intake, we also need to watch out for other health determinants such as physical environment of urban conglomerates. We owe it to the next generation to build a safe and health promoting environment.

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