The Role City Govts Can Play in the Health of Citizens

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 India’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 high-calorie products.

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.