The Role City Govts Can Play in the Health of Citizens
Tikender Singh Panwar
The interconnection between
city, citizen's health and city government is very curious. A recent revelation
of the decision taken some time ago by the city government of Philadelphia in
America proves the point. The city council had added an additional tax of 1.5%
per ounce on all sweetened drinks, including diet sodas.
The results are amazing. The
study published by the Journal of the American Medical Association (JAMA) found
that there was a 51% reduction of sales of sweetened products within the city.
How this reduction in sale has impacted the health of its citizens, probably a
further study will reveal.
The hard fact, however, remains
that cities across the world are facing the challenge of increasing health
problems linked to their dietary habits. Of course, sedentary lifestyle is a
major contributor. Better health outcomes are linked to reduction in obesity,
diabetes and reduction in cardio-vascular diseases. Reducing the intake of
added sugar is one of the first steps in this direction.
In Indian cities, all of the
above issues pose a phenomenal challenge. India, till recently had more
diabetic patients than in any other country in the world, according to the
International Diabetes Foundation. More than 62 million Indians, which are more
than 7.1% of the adult population, are affected with diabetes. By 2035, there
will be 109 million individuals with diabetes. The intake of a high calorie
food, low-activity lifestyle, especially by Indiaâ€™s growing middle class, is
attributed to such a high incidence.
Out of every 10 diabetic
individuals in India, seven are from cities, though only 33% Indians live in
the cities. This figure reveals the urgency in which the cities have to act.
The National Urban Survey conducted across the metropolitan cities of India
reported a high incidence of diabetes: 11.7% in Kolkata (Eastern India), 6.1%
in Kashmir Valley (Northern India), 11.6% in New Delhi (Northern India),
and 9.3% in Bombay (West India) compared with 13.5% in Chennai (South India),
16.6% in Hyderabad (South India), and 12.4% in Bangalore (South India).
The vulnerability of the urban
poor is higher as this group is more likely to consume sugary drinks and other
The moot question in the Indian
context is that even if the city government and the city think like other
cities of the world, do they have the ability to implement even an iota of what
they think. The hard fact remains that governance in Indian cities and, for
that matter, in South Asia is very limited in the hands of city governments.
In India, the cities are more
like adjuncts of the state (province) governments. The ability of the city
council to tax has been completely shed after the new sovereign tax -- the
Goods and Services Tax (GST). The city governments are limited to the functions
of solid waste management and such other smaller responsibilities. The city's
ability to intervene has shrunk dramatically over the last few decades. Public
health is not even in the domain of the city government. Parastatals in various
state governments are responsible for public health in cities.
However, the response of
Philadelphia is a sweet reminder of what a city government can do to ensure
quality life for its citizens. It is also a reminder of the role that the city
governments must perform in the future. And, that role is not just limited to
providing basic utilities to its citizens, which of course it is, but also to
ensuring a livable city.
The writer is former
Deputy Mayor of Shimla, Himachal Pradesh. The views are personal.