As seen from the table, a robust program to build the public health
foundation and scientific research on determinants of health has been
absent in national efforts. Urban health has been neglected till the
launch of the National Urban Health Mission (NUHM). Municipalities have
not been empowered as custodians of public health. In developed
countries, urban areas with widespread respiratory diseases invested in
improving ambient air quality. Cities subject to waterborne diseases
have built state-of-the-art water-sewer-drainage systems. Protection
from diseases created by vectors (such as mosquitos, fleas, and rats)
led to measures to prevent or control vector-borne transmission by
establishing underground drainage, managing trash collection and
disposal, and modifying construction materials and methods to decrease
vector-human interaction. Unfortunately, these systems have not been
universalized in cities of developing countries, including India. They
have not built the foundation for public health needed for
disease-resistant urban life, productivity of labor, and economic
growth. A key reason for this is the absence of empowered local
self-government. The agenda for democratic decentralization and transfer
of power from state to urban local governments, initiated by India
through the 74th Amendment Act, has not been
implemented in the spirit of the Constitution.
The urban planning model followed by most developing countries,
including India, is based on the older town planning laws in the United
Kingdom, especially the Town and Country Planning Act of 1947. This law
regards spatial planning as a technical activity connected with land use
detailing and designing of settlements based on a master plan. The
master plan, based on the ‘command and control’ approach, presents a
long-term vision of the built environment of the planning area. While
the urban planning system in the UK has undergone drastic changes with
increasing focus on decentralization to local government, it continues
to remain centralized in developing countries. While the stated
objectives of master plans are to promote public health, public safety,
and welfare, in practice, they have been confined to land use mapping at
multiple levels. Unrealistic norms for plots, housing, streets, and
amenities have driven the urban poor out of formal land markets.
Exclusionary planning has forced these sections to occupy
environmentally fragile and degraded lands in a bid to be close to
employment opportunities. This has led to slums and serious health
hazards for the poor and the community at large. Paradoxically, while
urban planning functions in most states in India are discharged by
development authorities, basic public health functions are left to
municipalities. The lack of coordination between the two authorities is
conspicuous. Lessons from the history of pandemics emphasize the need to
restore the lost links between urban planning and public health in
developing countries.