How India can improve urban public health with lessons from COVID-19

(Credit: Unsplash)

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Suchi Kedia, Community Specialist, Regional Agenda – India and South Asia, World Economic Forum & Harshita Agrawal, Associate, IDFC Institute

  • During COVID-19, platforms were developed to track case numbers, fatalities and hospital bed availability, but this technology is sorely lacking for other diseases.
  • Healthcare data needs to become a policy focus for urban public health in India, where cholera, tuberculosis, dengue and Ebola are still prevalent.
  • Infrastructure investment, increased budgets and more health personnel will also be necessary to build a more robust healthcare system going forward.

Almost exactly a year ago, India recorded its first COVID-19 case. While the pandemic can arguably be considered a black swan event, it has exposed deeper cracks in its cities public health sector. COVID-19 is already projected to roll back progress on a number of socio-economic indicators; unaddressed, poor public health will exacerbate existing challenges.

Going forward, we need to take a closer look at the COVID-19 and non-COVID-19 disease progression in India’s cities, the lack of data, inadequate infrastructure and insufficient budgets.

The disease burden in cities differs compared to rural regions and is continuing to change. Pathologies such as cholera, tuberculosis, dengue, H1N1 and Ebola are still prevalent in urban India. A 2018 survey in Delhi revealed that40% of its population has had dengue at least once in their lifetime owing to a certain mosquito found in urban areas.

The study also reveals that, while the spread of dengue depends on temperature and rainfall, the degree of urbanization is also a contributing factor. Specifically, poor housing conditions can lead to diseases being carried by insects and rodents, as well as respiratory infections from poor ventilation and low-grade cooking material. SARS and the novel coronavirus have also added to the disease burden, especially because of their spread in megacities and travel between them or rural-urban and urban-urban migration.

Going forward, healthcare data needs to become a policy focus for India. With the COVID-19 pandemic, there emerged a number of platforms to track case numbers, fatalities, hospital bed availability and so on. State governments such as that ofTamil Nadu built GIS platforms to track containment zones and hotspots of infection, thereby deploying the necessary resources to the areas that required them.

Similarly,, a volunteer-based, private platform on state-wise contagion rates and testing has been an important source of COVID-19-related information. However, such data is grossly lacking when it comes to other healthcare problems. Healthcare data in India is largely unavailable or fragmented.

This stems from the nature of delivery of health services in the country: citizens in urban and rural areas interact with the healthcare infrastructure through a number of private and public delivery points with no single system integrating and acting on the information, as has been done for COVID-19. Moreover, with allied issues such as rising pollution and inadequate sanitation leading to other illnesses, data on healthcare concerns, coupled with other city-level data, needs to be significantly ramped up and utilized for better policymaking.

COVID-19 has also laid bare several fissures in India’s public health infrastructure and investment, particularly in cities. During the last decade, less than 2% of India’s GDP has been invested in healthcare; China and the US’s healthcare investment hovers at around5% and 17% of GDP, respectively.

At the local level, budgets have increased. Between 2015-16 and 2017-18, the healthcare budget in Mumbai and Delhi has gone up, each by41% and 26%. However, the focus is unevenly on secondary and tertiary care, rather than primary care. While expenditure on hospitals was 74% of Mumbai’s health budget, only 26% was spent on dispensaries. Cities deserve specific attention: 75% of India’s current healthcare infrastructure can be found in cities, and every minute, 25-30 people migrate to urban areas from rural ones. If city-level healthcare services are not adequately scaled, the current disease burden will only be exacerbated.

We recommend improvements in data collection, infrastructure investment, budget alterations and personnel training in healthcare. Using big data in healthcare with electronic health records, government records, laboratories and insurance companies can provide a rich source of information to healthcare providers to assess clinical risk and genetic susceptibilities. Combining healthcare data with other parameters related to transport and housing, for instance, could be used to generate healthcare plans and deploy healthcare services in real time to those who need it the most.

Simultaneously, however, while framing healthcare data collection and usage, it is important tobalance individual privacy and data protection with institutional transparency and accountability. Government documents were being shared on WhatsApp that outlined details of COVID-19 positive patients, including their names and home addresses. This practice began to discourage people from getting tested even if they exhibited symptoms to avoid stigmatization by their neighbours. The new National Health Stack will create extensive health profiles of individuals, but the health data management policy of the National Digital Health Mission must be followed.

As we rebuild from the pandemic, it becomes important to create and monitor certain thresholds for public health infrastructure based on population. For example, regardless of whether an area is classified as rural or urban, if it has a certain population level, it would benefit from having a hospital rather than a single physician clinic. Establishing such benchmarks (in terms of physical infrastructure, specialization of personnel, relevant support staff) and reworking them as necessary, can go a long way in building a population with a healthy life expectancy in India where low state capacity falls short of the demands of secondary or tertiary care.

Further, given the burden on urban healthcare systems, budgets need to be expanded to improve healthcare infrastructure supply aligned with the disease progression in cities. This must result from greater decentralization of finances and responsibilities, as well as revenue from health tourism.

Moreover, along with an increase in the budget, there needs to be capacity to manage that spending. With the increasing use of technology and healthcare analytics to treat diseases, healthcare professionals will have to acquire skills to harness data and interpret it to provide decision-making support to medical practitioners. Over and above this, as COVID-19 has highlighted the need for management of epidemics and pandemics, there must be a mandate for public health professionals in government.

These steps are not exhaustive and are not sufficient to tackle the current pandemic. However, with adequate planning, they can guarantee a more robust system to deal with the next one, and build a more healthy population and productive economy – along with resilient cities in the process.

(Kadambari Shah, Senior Associate, IDFC Institute, contributed to this article.)

the sting Milestones

Featured Stings

Can we feed everyone without unleashing disaster? Read on

These campaigners want to give a quarter of the UK back to nature

How to build a more resilient and inclusive global system

Stopping antimicrobial resistance would cost just USD 2 per person a year

Everybody against Germany over the expensive euro

EU-U.S. Trade Talks: European Commission presents draft negotiating mandates

How do we go about improving mental health in the community and reducing suicide rates in the 15-29 age group?

African economies sustain progress in domestic resource mobilisation

UN updates guidelines to ensure successful return to civilian life for former combatants

The new North America trade deal USMCA punishes German cars

Lebanon: UN rights office calls for de-escalation of protest violence

Guterres welcomes conduct of Afghan elections, commends ‘all who braved security concerns to uphold their right to vote’

This is why we should test everyone for COVID-19

Hope for ‘long-elusive progress’ in negotiating peace in eastern Ukraine

Eurozone: There is a remedy for regional convergence

Refugee crisis update: EU lacks solidarity as migration figures drop

Criminals thrive on data abundance – here’s how we’ll catch them

4 crazy things that are happening in the Arctic right now

Counting unemployment in the EU: The real rate comes to anything between 16.1% and 20.6%

Mental Health Policy, a significant driver for growth

MEPs strengthen EU financial watchdogs

Time to be welcome: Youth work and integration of young refugees

These LGBTQI Davos leaders shared their advice on coming out

Pharmaceuticals spend millions to push TTIP while consumer groups spend peanuts

European Youth Forum welcomes establishment of new Youth Intergroup in the European Parliament

Under fire, UN refugee agency evacuates 135 detained in Libya to Niger

Secure 5G networks: Commission endorses EU toolbox and sets out next steps

Telemedicine can be a COVID-19 game-changer. Here’s how

Fighting against the Public Health System dismantling means guaranteeing assistance to all

UN blue helmets in South Sudan use Sustainable Development Goals to help build peace

What makes America the world’s most competitive economy?

Is Germany yielding to pressures for more relaxed economic policies?

In polarized America, a new divide looms

Humans aren’t made for repetition – it’s time AI took over manufacturing

This is what you need to know about the Iran nuclear deal

Where do health literacy and health policy meet?

Why we need to start a new pro-vaccine movement

Parliament seals 2014 EU budget and the spending ceiling until 2020

Electronic or conventional cigarettes – which is safer?

The EU cuts roaming charges further while the UK weighs Brexit impact

Fashion has a huge waste problem. Here’s how it can change

Young people are key to defusing unrest and restoring public trust

Early detection of chronic kidney disease can save lives and cut costs

In post-COVID Latin America, investment in infrastructure can bring back tourism – and rebuild the economy

Renewed pressures on Berlin to adopt growth policies

Worth going ‘extra mile’ for a new Syrian constitution, UN envoy urges

How can batteries become more sustainable? This young scientist might have the answer

In Bahrain, Global Forum for Entrepreneurs and Investment examines empowerment of women, youth through innovation

Thousands returning to Nigeria’s restive Borno state ‘at risk’; UN ‘gravely concerned’

We can end TB right now. Here’s how

Why today’s leaders need to know about the power of narratives

WHO supports measles campaign targeting millions of children in northern Nigeria

Deutsche Bank chased away from US, threatened with more fines

Climate change is speeding up. Our response needs to be even faster

First-ever EU defence industry fund to finance joint development of capabilities

Tax revenues continue increasing as the tax mix shifts further towards corporate and consumption taxes

Manufacturing reimagined: from improved productivity to profitable growth

Will Turkey abandon the refugee deal and risk losing a bonanza of money?

VW diesel scandal and climate change: can increased independent car checks lead to cleaner mobility?

Humanitarian migration falls while labour and family migration rises

Thursday’s Daily Brief: Climate crisis and food risks, fresh violence threat for millions of Syrians, calls for calm in Kashmir

Boris to end up in jail if he loses the next elections?

Social enterprises can change entire industries. This is how

Here are three technology trends changing the way you travel

More Stings?


  1. Yes. It can do wonders if it learns from Covid-19. Thank you 😊

Speak your Mind Here

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s