Exploring urban health inequities: the example of non-communicable disease prevention in Indore, India

Abstract

The dynamics of urban settings can increase health disparities. This paper explores techniques for examining urban health inequities of non-communicable disease risk, using data from the city of Indore, Madhya Pradesh, India as an example. We analyzed non-communicable disease indicators by gender, wealth, education, slum status, housing type, and location, using a 2018 city-level dataset collected in Indore with a final sample size of 3,070. Four techniques for equity analysis were used including bivariate ratios, concentration indices, geographic information system heat mapping, and multivariate regressions. We found that in Indore, behavioral risk factors such as tobacco, alcohol, and salt intake were more likely to be borne by those with low education and income, slum status and temporary housing type, while diseases such as hypertension were borne more equally over the population. This analysis has shown techniques that urban health researchers and planners can use to understand differentials of noncommunicable disease risk and where action can be taken to reduce inequities. Use by city planners will be limited by technical feasibility and production of understandable information. We discuss implications and next steps for Indore as an example for other cities.

Does Neighborhood Status Affect Access to a Healthy Built Environment?

“…This paper uses a recent NCD survey from Indore City, India to explore whether there is any disparity in these community-level elements of the built environment and access to goods and services that in uence NCD risk. This analysis complements two previous papers using this dataset, which explored individuallevel risk factors that contribute to NCD risk, including gender, wealth, education, and housing status (Bachani et al, 2021;Pomeroy-Stevens et al, 2020).…”

“…Prevalence of harmful use of alcohol (heavy episodic drinking) in Indore is low. The authors found a citywide prevalence rate of 2%, while in slums it was 3% (Pomeroy-Stevens et al, 2020). Overall tobacco use prevalence was 21%, and 31% in slums.…”

“…The research was conducted through the USAID-funded Building Healthy Cities project, a ve-year learning project focused on testing healthy urban planning approaches in four cities across Asia. The household survey (Pomeroy-Stevens et al, 2020;Bachani et al, 2021) was designed using the WHO STEPS tool (WHO, 2003). The household survey sample comprised 3,070 households from 30 wards and 90 colonies.…”

“…Non-communicable diseases, once thought to be "diseases of a uence," are now known to affect those with lower socio-economic status (SES) as well (Lumagbas et al, 2018); in India, an estimated 60% of all deaths can now be attributed to NCDs (Nethan et al, 2017;WHO, 2014). A growing body of evidence has shown disparities in NCD risk and outcomes for those living in slums or low-income areas within Indian cities (Anand et al, 2007;Mberu et al, 2016;Mohan et al, 2008;Pomeroy-Stevens et al, 2020;Yadav & Krishnan, 2008). However, the current state of evidence on effective NCD prevention and control suggests that simply addressing NCDs as an individual-level medical concern will not be effective at reducing population-level burden.…”

“…Figure 1 shows how this paper builds from this existing set of literature, using the socio-ecological model as a foundation but focusing within the community level on factors related to the built environment. The broader work that the BHC project has done at other levels of the socio-ecological framework helped to de ne key connections and variables at the community level to include in this analysis, but will not be further analyzed within this paper (Bachani et al, 2021;Pomeroy-Stevens et al, 2020).…”