Let Urbanization be a Boon, Not a Curse to Develop NCDS
Has the magic wand flipped and turned the boon into a curse? A question to think about!
Since civilization, the human beings are working hard to make a “better” life, leaving their live from cave and forest and moved into places nearer to commodities like water. With the course of time this progress towards “Betterment” has resulted in setting up communities, villages and finally building towns. And this journey has continued and will be continued till the end of this eternity!
Throughout the last centuries, urbanization embodied with a foremost demographic shift – first in developed world and now in developing world. During this time period, the proportion of the global urban population has grown from 14% to over 50% - states a review article in 2005. This shift is accountable for many changes including better public hygiene, ecological sanitation, access to health care, improved individual wealth, changing employment & work force structures, and most importantly shifts in dietary and physical activity patterns. All these basic shifts – specially the last two points – had implication for changed disease patterns, particularly for the rapid emergence of non communicable diseases (NCDs), according to the world health organization (WHO). Between the time periods of 10 years - 1990 to 2000 - the population prevalence of NCDs rose from 47% to 56% in developing world. With this pace, prediction says that within the next 10 years 69% of all deaths from developing world will be due to NCDs – mainly cancer and cardio vascular diseases. The burden of this epidemiological transition will fall heavily on the developing world compared to their counterparts in developed world, mainly because developing world has the burden of both communicable and non communicable diseases. Moreover, from developing world majority of diseased population would come from a younger age group, living in the lower portion of the wealth index and expected to suffer from a ruthless and early onset of NCDs – according to an article published in 1998.
Now, let’s think about the reason behind this flipped flap! Factors related to socioeconomic, cultural and environmental contexts have influence on health outcomes. In case of NCDs the cause might be changed life style, changed dietary pattern, lack of place and scope for physical activity along with health and social services of the people living in extreme poverty – in slums – of urban areas without health insurance, and accessibility, equity, and quality of health services. There are literatures from developing world that revels clear association between urbanization, chronic disease risk factors and chronic diseases – which can also be known as the curse of being urbanized. However, in most cases these are small scale studies without a specific cause identification of exact changes between the process of urbanization responsible for the onset of NCDs and its risk factors. Nevertheless, observations to find the association between modern living style and its association with NCDs, has got some intellectual attention but failed to set up a noteworthy conclusion because of being scant in numbers. Literatures give us the confidence for saying that “urbanization” is linked with the raising emergence of NCDs. However, the exact process of “urbanization” of the element for this causation is still unknown. Because all these vagueness in identifying the exact causality, less attention is being provided to NCD issues whenever an urban policy is being formulated around the world.
Now, what should be the way forward to turn over the wheels and make this curse into a boon? The first need is to admit the fact that urbanization and NCDs are first cousins and they travel by hand to hand. The second way out is to adopt and carry out a number of country and regional approaches to reduce both unhealthy risk factors in their general populations and control heart disease, diabetes, cancers, and other NCDs keeping urban context in mind. The world now needs to think about NCD resilient urban structures and lives. This should include the promotion of healthy eating habits starting in schools along with strict policies for junk food and sugar containing beverages. This effort can be backed by providing health education to cut down on calories - an essential issue to maintain the optimal body mass index and waist circumference. Further emphasis could be given towards facilities to promote exercise such as walking and cycling lanes, public play and walk areas. And all these initiatives should get enhanced with effective measures to reduce cigarette smoking and harmful use of alcohol. For accumulating all these issues the steps could be:
- Revise and health services for NCDs in urban contexts
- Strengthen tobacco control policies and take activities according to that specially for urban areas
- Strengthen injury control policies with a focus on road traffic injuries
- Develop an effective population based national NCD surveillance system or diseases registry system based in urban areas
The last word is, let urbanization be a boon, not a curse to develop NCDs.
Author: Shusmita Hossain Khan
Associate Coordinator, Eminence
and Dr. Md. Shamim Hayder Talukder
Chief Executive Officer, Eminence