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Suman Bery: Healthy cities

In the coming decade Indian cities will grow massively. Who will keep them healthy?

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Suman Bery
Last Updated : Jan 20 2013 | 10:13 PM IST

More by accident than design, India’s Five-Year Plans are today well-synchronised with its population census. The 12th Five-Year Plan is due to commence in 2012, a year after the population census of 2011 was conducted. Both the caste and poverty-line censuses are also to be conducted in the course of this year. A great deal of fresh, authoritative information will accordingly be available as India’s planners flesh out the prime minister’s directive to aim for growth in the range of 9 to 9.5 per cent over the period of the 12th Five-Year Plan, even while attempting to improve the distributive reach and ecological sustainability of this growth.

Interestingly, China also entered its 12th Five-Year Plan earlier this year. In contrast to the mandate given to our planners, its already approved plan seeks to slow down rather than increase aggregate growth performance over that achieved in the previous plan period. This is in order to allow the economy space in which to address the severe economic and social imbalances that have emerged over the course of the rapid growth over the past decade.

In a wide-ranging article published recently in Economic and Political Weekly (“Prospects and Policy Challenges in the Twelfth Plan”May 21, 2011), Planning Commission Deputy Chairman Montek Singh Ahluwalia provides his assessment of the main accomplishments in the 11th Five-Year Plan now in its final year, the prospects for improving growth performance in the 12th Five-Year Plan, and emerging challenges to be addressed in the 12th Five-Year Plan. One of these emerging challenges is managing India’s urban transition.

It is in this context that the Census 2011 becomes relevant. The Census 2011 revealed that the increase in India’s rate of urbanisation over the prior decade had been slower than projected earlier, both by experts at the United Nations and by scholars in India. The Census 2011 figures, once tabulated, will provide a definitive assessment of what happened in the last decade, and what might be expected in the decade to come*.

In his article, Mr Ahluwalia reckons the current urban share of the population at around 30 per cent, not much changed from the estimated share of 27.8 per cent estimated by the Census 2001. The Planning Commission currently projects this share to reach 30 per cent by 2030, implying an increase of 250 million urban dwellers over and above the 350 million already residing in urban areas. China’s latest census puts its urban share at almost 50 per cent, up by 13 per cent since 2000. Indeed, for the first time in history, the world as a whole now has more than 50 per cent of its population living in urban areas.

A broad range of factors influence the growth of the urban population, notably differentials between average household incomes in urban and rural areas. The Chinese experience suggests if we succeed in achieving our ambitious growth objectives, the rate of urbanisation could well increase even more rapidly than currently expected.

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On the whole, increased urbanisation is to be welcomed, since most modern economic activity takes place in cities, and the growth in productivity and, therefore, incomes is easier in an urban context. Well-designed cities are also efficient users of energy when compared with dispersed habitations, whether rural or suburban. Efficiently functioning cities are a key element in the competitiveness of a modern economy.

With increasing urbanisation being both predictable and inevitable, the government has been primarily seized of two aspects of the challenge: the financing of urban infrastructure and the energy needs of our emerging cities. The first has been comprehensively discussed in the recent Report of the High Powered Expert Group Estimating the Investment Requirements of Urban Infrastructure (Chair Dr I J Ahluwalia) issued by the ministry of urban development, while the second is being addressed under the Action Plan for Climate Change. To my knowledge, systematic attention is not being paid to a third important element of the urban challenge, which is the health status of urban citizens.

The challenges for the health of urban populations posed by the fast growth of cities in emerging markets were the focus of a workshop at Oxford in January. The workshop, with which I was involved*, was organised under the aegis of the Emerging Markets Symposium, located at Green-Templeton College. I attended as a member of the steering group for these symposia. The workshop brought together public health experts, economists and practitioners from cities in emerging markets from around the globe.

There were several reasons for conducting a focused discussion of urban health issues in emerging markets. First, the growth and scale of emerging market cities over the next few decades will be unprecedented in human history. Second, this level of urbanisation will take place at rather lower levels of per capita income than was the case in the now-rich countries. This has implications both for the resources available to governments and for the degree of inequality in urban populations. The enormous resources devoted to accommodating the private car as against the need of the pedestrian and public transport user are only one example of the distortions that such inequality can generate.

Perhaps the most important reason for focused attention was that health outcomes in cities have relatively little to do with healthcare expenditures, and much more to do with broader elements of urban design and public health: water, air, transportation, recreational facilities and the like. As at the national level, these issues are typically seen in isolation, and resource allocation is determined within each “silo” rather than optimising expenditure across functions. Yet health outcomes are critical not only for the welfare of the citizens but also for the productivity of the urban workforce.

Each urban conurbation is distinctive, and solutions will need to be found locally, as has been done in Latin American cities such as Bogota and Curitiba. Three things seem essential to make progress: effective and politically empowered mayors (or, as in Delhi’s case, a dynamic and engaged chief minister); a well-developed tracking and information system that helps monitor and analyse trends in health status; and flexibility in allocation of resources at the city level, irrespective of where those resources ultimately originate.

It is hoped that those involved in preparing the 12th Plan will give this dimension of India’s urbanisation the attention it deserves. Not doing so at this critical juncture could trap millions of Indians in avoidable misery.

The author is country advisor, International Growth Centre and member of the Prime Minister’s Economic Advisory Council.
Views are personal.
suman.bery@theigc.org

* http://ems.gtc.ox.ac.uk/uhs/recommendations.html  

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First Published: Jun 14 2011 | 12:08 AM IST

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