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  1. Sreejini Jaya
  1. SCTIMST – Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum (Kerala), India


Background Currently India's total urban population accounts to 32% and is expected to reach 600 million by 2031. Health of urban populations is largely a neglected issue and needs understanding of the role of the urban environment itself. A social determinants approach emphasizes the role of factors that operate at multiple levels. The proposed National Urban Health Mission (NUHM) activities have a high focus on urban poor population, public health thrust on sanitation, and clean drinking water. Presently the National Health Mission (NHM) is envisaged to incorporate the programmatic components of both National Rural and National Urban Health Mission.

Methods A conceptual framework on urban health determinants was developed, listing out the determinants at two levels: multi-dimensional determinants at the local level and multilevel determinants. Our framework is based on review of frameworks of urban health and environment (Galea and colleagues), of a web of interlinking determinants (Vlahov et al.), of measurement of key social determinants in urban settings (Ompad), and of multisectoral and multilevel determinants (Harpham). Our conceptual framework attempted to examine the National Urban Health Mission activities and to access the extent to which they have taken a determinants approach on board.

Findings The NHUM activities try to incorporate various schemes incorporating wider determinants of health in the backdrop of existing divergence among wider determinants of health. The NUHM activities address some of the key domains of physical and social environmental determinants, but drastically fail to acknowledge economic and occupation-related determinants. The activities emphasise the role of neighbourhood/household level elaborately, but translation into action is questionable. In the multilevel determinants, the NUHM activities fail to address any of the domains at the global/national level, while they try to address some determinants at the local/municipal level. The National Urban Health Mission activities recognise the role of governance, but fail to incorporate the role of market and civil society.

Discussion Urban health challenges are a result of multiple and complex intervening factors and a social determinants approach is needed to address urban health challenges. The purpose of the present study was to analyse how NUHM activities address the wider social determinants of urban health. Although NUHM activities propose to create a common platform to ensure that, they fail to incorporate how these determinants operationalize in the context of political, economic and social structures of local bodies. Understanding urban health needs a focus on the urban exposures as determinant of urban health. A comprehensive policy approach to urban development, where urban legislation should be prioritized for sustainable urban development, is needed to address the wider social determinants of urban health.

No competing interest.

  • India
  • National Urban Health Mission
  • urban health
  • determinants

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