MEDS 042: Block-3 (Unit 01) – Urban Health Care

-

 UNIT 1: URBAN HEALTH CARE

1.1 Introduction

Urbanization has brought rapid transformation in infrastructure, economy, and lifestyle. However, it has also created significant challenges for public health systems. With a growing urban population—often residing in slums or underserved areas—urban health care systems face enormous pressure. Access, quality, and affordability of health services are major concerns. Urban health, therefore, is not just a medical issue but a critical development concern linked to housing, sanitation, environment, and governance.

1.2 Health: Concept and Relationship with Development

Concept of Health

According to WHO, health is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

Relationship with Development

  • Economic Development: Healthy individuals are more productive. Poor health leads to economic loss and poverty.
  • Social Development: Health is linked with education, gender equality, and social stability.
  • Environmental Sustainability: Pollution, waste, and inadequate infrastructure impact urban health.

In cities, public health is influenced by environmental conditions, socio-economic disparities, and availability of health services. Thus, health is both an outcome and a driver of sustainable urban development.

1.3 Components of Health Care

Urban health care includes preventive, promotive, curative, rehabilitative, and palliative care. The main components are:

  1. Primary Health Care
    • First contact services (e.g., immunization, maternal care).
    • Urban Primary Health Centres (UPHCs) serve this function.
  2. Secondary Health Care
    • Specialist care through district hospitals or community health centers.
  3. Tertiary Health Care
    • Advanced diagnostic, therapeutic, and surgical services in urban hospitals.
  4. Preventive Health Care
    • Health education, vaccination, disease surveillance.
  5. Public Health Infrastructure
    • Sanitation, waste disposal, drinking water, and air quality.
  6. Human Resources
    • Doctors, nurses, ASHAs, and health volunteers.
  7. Health Information System
    • Data management and disease reporting.

1.4 Urban Health Care: Situation and Issues

Urban Health Scenario

While urban areas have better health infrastructure than rural areas, accessibility and equity are major issues.

  • Urban Poor: Live in slums, with limited access to health care.
  • Overcrowding: Leads to infectious diseases, especially in children.
  • Non-communicable Diseases (NCDs): Like diabetes, hypertension due to sedentary lifestyle.
  • Environmental Health Issues: Air pollution, waterborne diseases.
  • Mental Health: Rising due to stress, unemployment, and urban isolation.

Key Issues

  • Inadequate coverage and outreach.
  • High out-of-pocket expenditure.
  • Weak referral systems.
  • Lack of gender-sensitive services.
  • Inadequate data and planning in urban health sectors.

1.5 Urban Health Delivery System

Urban health care is delivered by:

  • Government sector: Under municipal bodies or state governments (UPHCs, hospitals).
  • Private sector: Dominant in tertiary care; however, services are expensive and often unregulated.
  • NGOs and Charitable Trusts: Fill service gaps in slum and low-income areas.
  • Informal Providers: Quacks and untrained practitioners common in slums.

Public-Private Partnership (PPP)

Increasingly promoted to improve service delivery efficiency and reach.

Referral System

Ideally should move patients from primary to tertiary level. In practice, this system is often weak, leading to overcrowding in tertiary hospitals.

1.6 National Urban Health Mission (NUHM): Framework for Implementation

NUHM, launched in 2013 under the National Health Mission (NHM), addresses the health needs of the urban poor.

Goals

  • Equitable access to quality primary health care for the urban poor.
  • Strengthen public health infrastructure and governance.

Key Components

  1. Urban Primary Health Centres (UPHCs): For every 50,000 urban population.
  2. Urban Community Health Centres (UCHCs): Serve as secondary care units.
  3. Outreach Services: Urban Health & Nutrition Days, Mobile Medical Units.
  4. Accredited Social Health Activists (ASHAs): Recruited from slum communities.
  5. Urban Local Bodies (ULBs): Empowered to plan and implement health strategies.

Implementation Partners

  • State governments
  • Municipal bodies
  • NGOs
  • Community-Based Organizations (CBOs)

1.7 Problems of Urban Health Care System

Despite initiatives like NUHM, several problems persist:

  1. Inequitable Access: Marginalized groups (migrants, slum dwellers, homeless) face exclusion.
  2. Unregulated Private Sector: Leads to expensive and inconsistent quality of care.
  3. Overburdened Public Facilities: Inadequate infrastructure and staffing.
  4. Poor Urban Health Governance: Fragmented responsibilities among agencies.
  5. Data Gaps: Lack of disaggregated health data hampers planning.
  6. Environmental Risks: Poor sanitation, air pollution, and climate-related health issues.
  7. Health Emergencies: Urban systems struggled during COVID-19 due to poor preparedness.

1.8 Let Us Sum Up

Urban health care is a critical development issue linked with urbanization, poverty, and governance. Although cities offer better facilities, access remains unequal, especially for the poor. NUHM provides a framework to address urban health challenges, but implementation issues, weak governance, and inadequate infrastructure remain obstacles. A comprehensive and inclusive approach involving public, private, and community sectors is essential to build a healthy urban future.

1.9 Keywords

  • Health-Complete physical, mental, and social well-being.
  • Urban Health-Health status and services specific to urban populations.
  • Primary Health Care-Basic, first-contact health services for all.
  • Tertiary Care-Specialized medical treatment typically in large hospitals.
  • NUHM-National Urban Health Mission for urban poor health care access.
  • UPHC (Urban PHC)-Urban Primary Health Centre serving 50,000 people.
  • UCHC-Urban Community Health Centre for secondary health care.
  • ASHAs-Community health workers, often recruited from slum populations.
  • Public Health Infrastructure-Systems ensuring clean water, sanitation, and disease control.
  • Out-of-pocket expenditure-Direct payment made by patients for health services.
  • Public-Private Partnership-Collaboration between government and private sector in service delivery.
  • Referral System-Stepwise care from primary to tertiary health levels.
  • Urban Poor-Low-income city dwellers, often in slums or informal settlements.
  • Health Governance-Institutional arrangements and policy for managing health systems.

 

Comments

Post a Comment

Popular Posts

Jcert Class 8 Daffodil Chapter 1a: The Naive Friends Solutions

-
Chapter 1a : The Naive Friends Answer the following questions: 1. Which questions made Keshav and Shyama curious about the egg? Ans.         How did the chick come out? How big would the eggs? How many? What colours would they? What did they eat? Such types of questions made Keshav and Shyama curious about the egg. 2. What three things did the children do to protect the eggs? Ans.         The children done three things are: (i)          Adjustment of food. (ii)        Adjustment of water. (iii)      Adjustment of roof. 3. Why did Keshav think of making a cushion for the eggs? Ans.         When Keshav saw the egg on direct sun light, he thaught making a cushion for the eggs. 4. What excuse did Keshav give for not showing the eggs to Shyama? Ans.     ...
Read more

Jcert Class 8 भाषा मंजरी Chapter 3 मित्रता Solutions

-
अध्याय - 3 : मित्रता 1. आप किस प्रकार कह सकते हैं कि मित्रों के चुनाव की उपयुक्तता पर हमारे जीवन की सफलता निर्भर करती है? उ. मित्रों के चुनाव की उपयुक्तता पर हमारे जीवन की सफलता निर्भर करती है क्योंकि संगति का गुप्त प्रभाव हमारे आचरण पर पड़ता है और यदि हमें अच्छी संगति, अच्छे मित्र मिलते हैं तो वे हमें सफलता की ओर ले जाते हैं जबकि बुरी संगति हमारे जीवन को खाक में मिला देती है।  2. 'विश्वासपात्र मित्र जीवन की एक औषध है।' आशय स्पष्ट कीजिए। उ. 'विश्वासपात्र मित्र जीवन की एक औषध है'- ऐसा इसलिए कहा गया है कि यदि हमें विश्वासी मित्र मिल गया तो हम अपने जीवन में चाहे जैसा भी कदम उठाएँ, उस कदम की आलोचना करके वह हमें सही दिशा की ओर उन्मुख करेगा। हम अपनी गलती रूपी बीमारी को उसकी आलोचना रूपी औषधि से दूर कर सकेंगे।  3. मित्र का चुनाव करते समय हमें किन बातों का ध्यान रखना चाहिए? उ. मित्र का चुनाव करते समय हमें निम्नलिखित बातों का ध्यान रखना चाहिए हमारे अच्छे विचारों (संकल्पों) को दृढ़ करने वाला हो। हमें दोषों और त्रुटियों से बचाए। हमारे सत्य, पवित्रता ...
Read more

Jcert Class 8 भाषा मंजरी Chapter 8 अमरूद का पेड Solutions

-
अध्याय - 8 : अमरूद का पेड 1. लेखक को क्यों लगता है कि इन सब पिछड़े खयालातों का हमारे घर में गुजर नहीं हो सकेगा। उ. अमरूद के पेड़ को देखकर सबसे पहले बाबू कन्हैयालाल की बूढ़ी पत्नी ने एक दिन टोका कि पश्चिम की तरफ अगर मकान का मुखड़ा हो और सामने ही अमरूद का पेड़ तो 'राम-राम बड़ा अशुभ होता है और माँ के चेहरे पर थोड़ा-सा भय दिखा पर लेखक को विश्वास था कि इन सब पिछड़े खयालातों का हमारे घर में गुजर नहीं हो सकेगा क्योंकि उसके घर के लोग आधुनिक विचारधारा के थे उसकी माँ सत्याग्रह के दिनों में अजमेर में लम्बा जेल कर चुकी है। पिताजी खुद राजनैतिक सामाजिक उदारता वाले आदमी थे। बुआ ने विवाह नहीं किया था, पढ़ने-लिखने में ही अपनी सम्पूर्ण जिन्दगी लगा दी और समाज कोई चुनौती देने का साहस नहीं कर सका। साथ ही परिवार के सभी लोगों में पिछड़ेपन के प्रति भर्त्सना का भाव था। 2. अमरूद के पेड़ की छाया किस प्रकार लेखक को उनके भाई-बहनों के साथ जोड़ती है ? उ. अमरूद के पेड़ की छाया लेखक को उसके भाई-बहनों के साथ जोड़ती है। वे सभी अमरूद की छाया में बेंत की कुर्सियों पर बैठ चर्चाएँ करते थे जिससे उनके बीच...
Read more