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 74^th 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.