In the history of our planet, the number of megacities now is greater than ever. During the course of time, rural areas have entered industrialisation, and where that didn’t take place, rural communities experienced migration from rural to urban areas.
These socio-demographic changes have led to the formation of densely populated urban areas, and based on recent projections, the world population will likely reach 9.3 billion by the middle of this century. It is estimated that 75% of this population – approximately 7 billion people, and the equivalent of the entire world population of today – will be living in cities by the time we reach the middle of this century.
Despite the fact that urbanisation brings numerous opportunities, it also brings new and unique health challenges. So, what are the hazards of living in a city? Unfortunately, along with better livelihood opportunities and access to facilities, urbanisation also brings hazardous water environments, pollution, accidents, violence, and lastly, non communicable diseases (NCDs) including cardiovascular diseases (CVDs), cancers, chronic respiratory diseases and diabetes.
Today, a little more emphasis will be given on CVDs since that is the major cause of death for Bangladeshi adults. CVD is a group of disorders/diseases of the heart and blood vessels that may result in a heart attack or a stroke. The modifiable risk factors for developing CVD include smoking, hypertension, dyslipidemia, type 2 diabetes, obesity, poor dietary habits, and physical inactivity.
City living may aggravate these, along with the decreased availability of safe, green spaces for exercise and recreation, increased pressures from mass marketing of unhealthy food, and the availability of cheap but unhealthy food options.
So, what are the links between urbanisation and heart health? Let’s look at some examples of different countries to get the lay of the land.
In China, a spatial analysis of urbanisation, migration, and CVD risk factors indicates that improved standards of living and life expectancy resulting from rapid rural to urban migration are countered by an increase in CVD risk factors.
A separate piece of research into the emergence of CVD during the urbanisation of South African countries concludes that deaths caused by stroke are likely related to an increase in hypertension, obesity, and smoking habits.
Coming back to South Asia, another study considered the relationship between heart health and urban living, and that study concluded that urbanised lifestyle, particularly when combined with other factors like undernourishment, could be a major determinant of heart disease morbidity and mortality.
Such studies and literature are significant, as the findings provide the evidence base for the impact of urban settings on heart health. When considered in context of the burden of CVD, they unmask the importance of addressing CVD risk within urban planning to protect the health, economic stability, and the sustainability of our future societies.
So, what is the way out? The World Health Organisation published a paper “Our Cities, Our Health, Our Future,” with detailed interventions that need to occur to achieve healthy cities. These include: Improving the living environments in substandard housing, promoting and facilitating good nutrition and physical activity, community action to prevent substance abuse (including tobacco consumption and alcohol abuse), and ensuring access to essential healthcare services.
Since CVDs are largely preventable, measures to decrease risk factors coupled with improved access to healthcare could save millions of lives.
However, although many stakeholders are already taking action, finite resources mean that in many cases, the burden of CVD is outpacing actions implemented to tackle it in countries like Bangladesh.
Lack of awareness and overstretched health services mean that many people with CVD in LMICs remain undiagnosed, or cannot access the treatment they need. As the WHO explains, “bold steps” and a “scale-up” of action is needed to achieve better housing and health services for the 1 billion people who live in slums or informal settlements today, and to avoid an additional billion people living in such conditions in the next 25 years.
Such an expansion of action is beyond the scope of the health sector alone, and calls on cross-sector policy-makers as well as civil society and industries to address all of the drivers of ill-health in urban environments, including agriculture, urban planning, trade, and other stakeholders.
The collaborative process necessary for effective action is complex, but is broadly encompassed within the SPACE approach: stakeholder collaboration, planning cities, access to healthcare, child-focused dialogue, and evaluation.
