Urban health – from Bangladesh to India
The 12th International Conference on Urban Health was held last month for the first time in a developing country, something remarkable given that almost all urban population growth in our lifetime is predicted to take place in developing countries.
As I hopped into the hotel car the driver proudly announced that the vehicle was equipped with wifi. “Wifi in a car? Impressive!” was my response. Since the drive to the conference center was only 4 kilometers, I didn’t even bother to search for my phone hidden somewhere deep in my bag. However, this was not just any conference center – this was the Bangabandhu International Conference Centre in Dhaka, Bangladesh, which meant that during the first ten minutes out of the hotel, we had painfully crawled along no more than about 50 meters, centimeter by centimeter. I now understood why the car was equipped with wifi.
The 12th International Conference on Urban Health was held last month for the first time in a developing country, something remarkable given that almost all urban population growth in our lifetime is predicted to take place in developing countries. It was also fitting that it should be held in Dhaka, currently ranked 11th among the world’s top 28 megacities. The meeting provided an opportunity to present evidence and information about various global urban health initiatives in countries such as Bangladesh, India, Nepal, Kenya, Pakistan, Malaysia, Nigeria, and even the United States. The focus of the presentations ranged from primary health care interventions such as family planning, antenatal care (ANC) and immunization, all the way to the creation of age-friendly cities to better accommodate the needs of a growing elderly population.
The conference confirmed the challenges in defining a slum area and the multisectoral response needed to find solutions to improve urban health, and it also destroyed a few preconceptions: for example, evidence from Dhaka indicates that respiratory disease incidence between slum and non-slum dwellers is similar, suggesting that high population density may therefore not be as important a risk factor as commonly thought.
Also, surprisingly, rates of diarrheal disease did not differ between urban slum and non-slum populations, suggesting perhaps that sharing water supply with more families is also not an important risk factor. Yet, overall levels of under-five child mortality were found to be 40% higher in slums compared to non-slum urban areas, suggesting that there are potentially other risk factors to consider, such as poor nutritional status, environmental degradation, or traffic accidents. In summary, the biggest health gains among the urban poor over the past decade in Bangladesh have been sparked by the decline in fertility due to increased short-term contraceptive use (supplied almost exclusively by the private sector) and an increase in ANC from non-medically trained providers. Immunization services were found to be comparable between slum and non-slum areas. However, inequity persists between slum and non-slum populations with regards to the number of ANC visits as well as stunting, mainly due to under-nutrition.
With over a decade of experience investing in the urban health sector in Bangladesh through partnering with NGOs, ADB is now pursuing a new, larger-scale program in supporting the National Urban Health Mission in India, where improving the quality of care, working with the private sector, and strengthening health information systems are identified as key tools to improve health outcomes. It will be interesting to see whether we can apply the learnings from this conference in terms of innovative mapping, systems thinking approaches, and adapting global evidence to the India context. This will be a key challenge, and one that I am keen to respond to.