A village dreams of becoming a town, a town strives to become a city, a city then aspires to become a metropolis. And when a city becomes a metropolis, it looks toward an even bigger metropolis for inspiration and imitation. This process has been the “natural course of history” of the development of an ambitious village into a leading metropolis.
Although cities are created by humans, they also tinge their residents with the color of their own personality, which is reflected in various sectors. Perhaps the most abiding characteristics of a city in relation to human health is the deep schism in the living conditions of the urban rich and the urban poor.
City lures people from the countryside with its promises of job, opportunities, and power. It also serves as a refuge to the exploited and uprooted marginalized rural population who are forced to migrate from their communities in search of better living conditions. In an ill-managed urban community, the urban poor often lives in an environment quite detrimental to health. Although, it is the urban poor who fall victim to the common health hazards associated with urbanization, the urban rich is also not safe. Despite its best efforts to maintain a healthy environment, it too is vulnerable to health hazards linked to urbanization.
In my opinion, it is a small group of urban rich that is responsible for most of the health problems in the cities. Driven by the cut-throat competition of hoarding profit from industrialization, the industrialists vie with each other in polluting the natural environment, depleting the forest reserve, burning fossil fuels, encouraging habits detrimental to health such as smoking, drinking and fast food through advertisements in the media. Top it up with ill-managed urbanization and we have the example of urbanization gone wrong. Kathmandu is a leading example of this phenomenon/process.
Kathmandu’s rivers are turning into open sewages and the air pollution is comparable to that of Mexico City. There are other problems too. For example, there are no proper facilities to dispose off plastic and hospital wastes. The pipe water supplied by the Kathmandu Upatyaka Khanepani Limited is contaminated with fecal organism and the solid waste mis-management keeps the valley foul smelling throughout the year. As a result, Kathmandu has become the typhoid capital of the world, with many co-existant endemic infectious diseases including cholera. And there’s been a surge in the diseases related to our lifestyle, such as heart disease, cancer, diabetes, chronic lung disease and mental illness.
In fact, more than any other place in Nepal, Kathmandu faces mixed epidemiological transition and double burden of diseases. Communicable diseases have not been effectively controlled, and non-communicable diseases are becoming a major public health concern. Once a pristine valley of ancient folklore, Kathmandu today is one of the most polluted cities in the world.
Kathmandu is just a leading example of haphazardly imposed urbanization. Many urban centers in Nepal in different geographic areas are also going through similar effects, especially from the public health point of view. Compared to rural health care delivery system, the urban settlements lack the primary health care institutions and the benefits associated with free health care in Nepal. Although the need of urban primary health care is reflected in policy, it has not materialized so far.
Even if we do get these facilities in future, one has to be aware that health sector alone will fail miserably in dealing with the health problems germinating from urbanization. A concerted effort from all the sectors through a sustained mechanism is the only way to deal with this colossal problem. The health sector can play a catalytic role for such mechanism. Moreover, it must strive for this inter-sectoral collaboration if it wants to bring about a positive change in the urban health, and put its weight behind the public health policies to be adopted by different sectors.
To conclude, it is the city dwellers of Nepal who have to come forward to protect the health and environment of their own cities. The enlightened city dwellers and the urban poor have to join hands to force the government to come up with policies to safeguard the environment and rigorously promote eco-friendly urbanization. No small task, but such resolve would be a proper response to the message of World Health Day, 2010.
(Write is Chair, Nepal Public Health Foundation.)
Related story
Urban Agriculture for Sustainable Urban Development in Nepal
