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 non-communicable 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.

KEYWORDS:

• Non-communicable disease
• India
• equity
• urban

This article is related to:

Research for city practice

Acknowledgments

This study was conducted in partnership with Indore Smart City Development, Ltd. (ISCDL) and the All India Institute of Medical Science, New Delhi. We would like to thank the Government Nursing College, Indore, and the Indore School of Social Work for their help in the data collection effort, and to ISCDL for their continued support of this activity in Indore.

Data Availability Statement

The data that support the findings will be available in The USAID development data library at https://data.usaid.gov/following a 1 month embargo from the date of first publication to allow for commercialization of research findings.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The following variables recommended by DHS exhibited sufficient variance (<95% or >5% prevalence) and were included in a Principal Components Analysis: water source, type of toilet facility, cooking fuel, household assets, use of domestic help, number of household members, and housing type.

Additional information

Funding

Building Healthy Cities is a five-year cooperative agreement funded by the United States Agency for International Development (USAID) under Agreement No. AID-OAA-A-17-00028, beginning 30 September 2017. The contents of this paper are the responsibility of Building Healthy Cities and do not necessarily reflect the views of USAID or the United States Government.

Notes on contributors

Amanda Pomeroy-Stevens

Amanda Pomeroy-Stevens The USAID-funded Building Healthy Cities (BHC) project refocuses city policies, planning, and services with a multi-sectoral health equity lens while improving data-driven decision-making for three Smart Cities in Asia. BHC (2017-2022) is implemented by JSI Research & Training Institute, Inc. (JSI) with partners International Organization for Migration, Thrive Networks Global, and Urban Institute, and with support from Engaging Inquiry, LLC.