Analysis Health in South Asia

Mental illness and injuries: emerging health challenges of urbanisation in South Asia

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1126 (Published 11 April 2017) Cite this as: BMJ 2017;357:j1126
  1. Devaki Nambiar, senior research scientist1,
  2. Junaid Razzak, professor2 3,
  3. Kaosar Afsana, director4 5,
  4. Alayne M Adams, professor4 6,
  5. Arif Hasan, chair7,
  6. Dinesh Mohan, distinguished professor8,
  7. Vikram Patel, professor1 9 10 11
  1. 1Public Health Foundation of India, Gurgaon, India
  2. 2Department of Emergency Medicine, Johns Hopkins Medical School, Baltimore, USA
  3. 3Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
  4. 4James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  5. 5Health, Nutrition and Population Division, BRAC, Dhaka, Bangladesh
  6. 6Department of International Health, Georgetown University, Washington DC, USA
  7. 7Urban Resource Centre, Karachi, Pakistan
  8. 8School of Engineering, Shiv Nadar University, Gautam Buddha Nagar (UP), India
  9. 9Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
  10. 10Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
  11. 11Sangath, Goa, India
  1. Correspondence to: V Patel vikram_patel{at}hms.harvard.edu

Rapid unplanned urbanisation in South Asia has overlooked the health needs of poor and marginalised people. Devaki Nambiar and colleagues examine the problems of mental illness and injuries, and call for renewed political and financial commitment to urban health

The urban population of South Asia increased by over 130 million between 2000 and 2011, second in absolute terms only to the East Asia and Pacific region.1 In 2014, five of the world’s largest 15 urban agglomerations (or megacities) were in South Asia (fig 1).3 A characteristic feature of urbanisation is that cities have expanded spatially, merging with adjacent rural and urban settlements. For example, while the population increase in Dhaka’s core municipality was 45%, the growth in the conurbations of greater Dhaka was nearly twice as great.4 Expanding agglomerations around cities create increasing demands on infrastructure and services, which affects the quality of and access to healthcare, especially for poor people.5

Fig 1 Percentage of total population in urban agglomerations of more than 1 million in selected South Asian countries (1960-2015).2

In this article, we explore the determinants of health in the context of the uneven patterns of urbanisation in South Asia, with a focus on the emerging challenges and policy responses to mental health and injuries. We draw from examples of the megacities of Dhaka, Delhi, and Karachi to show the dynamic urban scenario of South Asia.

Urban context in South Asia

The urban context—and the living, working, and social conditions in towns and cities—is itself a determinant of health.67 Urbanisation reinforces growth and prosperity, and planned urbanisation has a positive effect on health, as seen in developed countries.8 However, urbanisation in South Asia is largely unplanned. Its messy and hidden1 character has led to a range of …

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