In recent years, India has progressed tremendously and new states such as Uttarakhand have witnessed progress too. However, a noted increase in urbanization has been observed in the state of Uttarakhand. More and more people tend to move from hill regions into plains in the state in search of new opportunities and comfortable lifestyles.  As new cities develop or the current towns expand to accommodate to increasing population, it is essential to develop facilities at the city level to cater for the needs of a growing population in the region. Whether it is a provision of adequate housing, transport facilities, sanitation and waste management, clean water and health facilities in new upcoming towns and cities. Increasing urbanization also intensifies the need for strengthening health emergency preparedness at the city level, as part of improving national health security. COVID-19 and other health emergencies have highlighted the important role that cities play in health security preparedness.

At the 75th World Health Assembly in May 2022, WHO Member States adopted WHA Resolution 75.7 on Strengthening health emergency preparedness and response in cities and urban settings. The resolution outlines the importance of cities and urban settings to health security and emergency preparedness and focuses on the implementation of the global Framework to Strengthen Health Emergency Preparedness in Cities and Urban Settings. WHO’s work on urban health, including health security preparedness, is vital for proper development of the region and its incorporation in state development policies would be helpful to strengthen not only health systems but also improve other services in the state at the level of towns and cities.

According to WHO, around 40% of urban growth is in slums which lack proper clean water and sanitation and 90% of the people in urban areas breathe polluted air. In New Delhi alone, every year poor quality air irreversibly damages the lungs of around 2.2 million people. Despite repeated efforts of the government to reduce pollution the challenge still remains.  Similarly, access to healthy food remains a challenge in urban cities where there is an increased trend for fast foods which is a leading cause of high cholesterol, metabolic syndrome and diabetes.  The use of fossil fuels for transport, cooking and heating in urban cities accounts for the emission of around 60% of greenhouse gases. This is one of the reasons for the difference in temperature in urban cities by 2 to 3 degrees Celsius as compared to the surrounding rural areas.  According to studies, the health burden of infectious diseases like HIV/AIDS, tuberculosis, pneumonia, dengue and diarrhoea; noncommunicable diseases like heart disease, stroke, asthma, cancer, diabetes and depression; and violence and injuries, including road traffic injuries is much more in cities and is due to unplanned urbanization.

There is a need to develop each city, town and village to be self-sufficient when it comes to primary health care, proper sanitation, essential water and electricity supply and other resources when it comes to good living. Challenges are immense if we start thinking at the microscopic level of small towns and cities but the impact of measures taken at that level is also high. At the forum, we welcome this approach and would support the concept of urban health.