Towards Health Smart Sustainable City UHCRC Learning

Dr. Vikas DesaiTechnical Director UHCRC

Surat

Urban Health And Climate Resilience Centre

Approach:Research, Documentation, Advocacy ,Training, Consultation.

Jurisdiction:Surat – Gujarat- IndiaGovernance:Executed by Health department of SMCGoverned by SCCT in which SMC is a major stakeholderTARU – Knowledge partnerACCCRN- Rockefeller Foundation - Funding support

UHCRC Smart City 2

Goal: Healthier Citizens in Healthier CitiesAim: To develop a Knowledge Hub for “Urban Health And Climate Resilience

3

Urban health• UH is a new Arena , Policy is awaited• UH is an out come of complex interaction between several factors beyond Health service domain• Is still predominant Medical care services• Have predominant presence of private actors• Disease control implementation differently • UH in Transition Curative to preventive service Double burden of diseases Environment & Climate change risk to health Traditional to Technology enabled services Conventional to mission mode action Affording to Insurance/ cash benefit approach• Access to academic institutions support

UHCRC Smart City

Impact factors Analysis

Health service networkIntegrated urban planning

Community participation

Urban sanitation

Intersectoral convergenceIntegrated surveillance

Health information and education

Public private partnership

Involvement of academic institutions

Cross learning and skill buillding

UHCRC Smart City4

Factor influencing Urban health system Preference score

Network Analysis for Urban health Planning

City planning, Built EnvironmentBasic infrastructure, Health services,

Migration

Health service network, Integrated urban planning, community participation and inter

sectroral convergence

Governance

Finance

What makes a city resilient? It helps assess whether their development trajectory is likely to make the city more or less resilient.

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Resilience of cities four key dimensions.

People: The health and well-being of everyoneOrganization: The economic and social systemsPlace: The quality of infrastructure and ecosystemsKnowledge: The capacity to learn from the past and take appropriate action based on informed, inclusive, integrated, and iterative decision making in our cities.

ARUP

SMC Health service networkUHCs 43

Maternity homes 11

Immunization centres 185

AWCs 1004

Malaria control units 13

Malaria workers 465TB control unit 5

Designated microscopy centers 27

TI projects 23

Counselling centres 41

Medical college SMIMER 1

Maskati Hospital 1

Public health laboratory 1

Central pathology laboratory 1

UHCRC Smart City6

Commissioner SMC, IAS

Dy. Com. Health & Hospital , DPH

Medical Officer Health

MO FP

MO RCH

MO ICDS

MORNTCP

IO

ZoneDy.

MOH

Zone Asst.

IO

UHCMO

Pharma.ANMASHA

Health Data management - SMC

IPD

13 Hospital

63 Hospital (Sentinel Centre )

UHCRC Smart City7

OPD

41 UHC

375 Private practitioner

(Sentinel Unit)

Data Sourcewww

http://ursms.ne

On line dissemination

Actionat

Zone /Ward office

UHC

ActionFeedback

Daily

With in 24 Hrs

Data Use

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Health Management Network - WHO

Surat Census Population and Population Growth

41 51 61 71 81 91 2001 110

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

5000000

0

10

20

30

40

50

60

70

80

90

100

171443 223182 2880

26

4716

56

7765

83 1498

817

2433835

4466

82630 29

63 65

93 92

55

Population Growth rate

Cens

us p

opul

ation

% g

row

th

UHCRC Smart City9

Filaria Malaria Plague Leptospirosis

Surat Intra city population and Health Service trend

Central South West

South South East

East North West

49971(-1.2%)

3105 (43.3%)

11253 (70.4%)

38390 (88.4%)

30303 (59.8%)

19392 (69.4%)

8288 (48.0%)

Trend of Population dens-ity 2011

Dens

ity/S

q.Km

.

CZ SWZ SEZ SZ NZ Wz EZ21

.9

9.7

17.1

14.6

14.6

7.3

14.6

9.1

7.7

16.7

15.5

15.8

9.6

25.4

Zonewise UPHCs compared to Popula-

tion

UPHCs Population

% o

f tot

al

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Surat Intra city Birth Registration Trend

Central

west

South w

estEast

North

South+So

uth East

9 9 8

26

16

32

9.2

8.2

6

23.7

16.3

36.6

Distribution of population and Registered births (2011)

Population Births

% d

istr

ibuti

on

West zone

Central zone

North Zone

East Zone

South+SE

South West Zone

93.6

7

93.7

0

92.5

6

97.5

7

83.5

2

97.3

1

Zone wise-Institutional Delivery (2011)

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Surat Mortality trend (2001-2011)

<1yr. 1-5yrs. 6-14yrs.

15-45yrs.

46-64 yrs.

>65yrs.

9.70

%

1.60

%

2.20

%

28.1

0%

26.1

0% 32.3

0%

6.30

%

1.00

%

1.40

%

23.7

0% 27.5

0%

40.1

0%

Age specific mortality trend

2001 2011

0.3 1.

10.

414

.7

0.0 0.4

0.2 1.

80.

2 2.2

0.3

3.2

0.8

3.4

0.3

0.1

2.5

0.9

10.4

0.3

5.1

Cause specific mortality trend

1989 2008

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Surat Vector-borne Disease trend19

88

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

-(upt

o Ju

ly)

2215

5

4100

7 5383

8

4342

1

4600

3

3349

3

2154

0

1221

1

1587

3

9744

8218 11

461

8511 1136

3

8274

6984

8227

8292 12

617

9765

1014

1

1036

3

1359

3

1236

9

1125

6

8794

3242

Malaria (Total No. of cases)

UHCRC Smart City 132000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

6 4

9954

1678

138102

157

475426

69

166

344 363Dengue cases

Climate And Vector born Disease - Correlation (1988-2014)

Climate Factors Rho

Malaria Dengue

Average Temp and Positive cases 0.151 0.213

Maximum Temp and Positive cases -0.148 -0.311

Minimum Temp and Positive cases 0.304 0.756

Average Humidity and Positive cases

0.284 0.305

Heat Index and positive cases 0.031 0.715

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Surat City Floods and All cause mortality

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Floods and Disease Trend

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

102

136.

5

189.

5

260.

5

408

301

474.

5

255

149.

5

209.

5

242.

5

181.

5

112 120 164 145 133 217 482

1011

312 127 237 470

Average cases of 2005 and 2007 Vs in 2006 due to Gastroenteritis

average no. of GE cases of 2005 and 2007 Cases of GE in year 2006

No.

of d

eath

s

Post Floods infection – lessons learnt

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Floods 2006 2013

City Area affected

90% 30%

People affected 30,00,000 33206

Clinically Suspected

379 64

Sero positivity %

47 36

Deaths 43 4

CFR 11.3 6.2

14%

37%

2.9%6.5% 16%

15%7.3%

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Surat Heat19

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

57

59

14

4 42

5 58

6

1

17 16

9 10 97

15

9

4

9

3

13

22

2 26 5

Number of days with Maximum Temperature ≥ 40 0 C

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

46

30 25 31

42

53

42 42

53 48 45

58

46

32

58

35

59 57 60 57 52

62

42

76 68

46

67 59 67 60

1

8

3

8

9

8

14 1

13

11 11

9

5 34

18

4

12 13

18 15

8

7

14

4

7

34

12

15

9

15

Number of days with HI Danger and Extreme DangerDanger 41-54°C Extreme Danger (>54°C)

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Kosad (NZ)

Sarthana – industrial area(EZ)

Bhesan-peri urban (WZ)

Hope bridge- Central old city area (CZ)

Bamroli – Near sea (SZ)

Intra City Variation (Highest record in Summer 2014)

Dumas40.8o

C98.3%

Scienc

e.cent

er42.2o

C 92.9

Bhes

an42

.8o C

97%

Bridge 42.3oC90.8%

Kosad 42.8 oC92.2% Sarthana 43oC96.1%

Karanj44oC 94.8%

Bamroli

42 oC 97.1%

Higher Heat comfort

in zones at Sea shore

and riverbank Poor Heat

comfort in zones

towards East and South

With Industries and

Slums

All Cause Mortality and Heat- Surat

25-30 30-35 35-40 40-45

38

36.6

38

41.7

Average No. Of All Cause Deaths / Day And Temperature

Temperature (Celsius)

Avg.

no.

of d

eath

s per

day

(27 to 31) Caution

(32 to 40) Extreme caution

(41 to 54) Danger

(> 54) Extreme danger

34

35.6

37.2

40

Average No. Of All Cause Deaths / Day And Heat Index

Heat Index (Celsius)

Avg.

no.

of d

eath

s per

day

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City Public Health Vulnerability Assessment

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Relative Public Health Vulnerability gradation of zones

Zone Relative vulnerability

West 78 LESS

South West 73

MODERATECentral 72

North 69

East 68 HIGH

South 60 VERY HIGHSouth East 56

Understanding Childhood Friendly resilient City

UHCRC Smart City 22

Understanding Urban Poor community-1VulnerabilityStressors

Price-hike, migration, crime, conflicts , sanitation , climate change

vulnerable groups

recent migrants, new extension area, slums, contractual employment, children, chronic illness

Rural – urban Migration

Poverty, Climate change

outreach services of SMC

Majority of community members shows awareness and sense of satisfaction

Top health challenges

Non communicable diseases and new infections

Preference of health care

Sickness- Private medical carePreventive- Public Health care

UHCRC Smart City23

Understanding Urban Poor community-1Families experience 2006 floods

familiar to risk and preparedness, SMC role for early flood warnings, post-flood cleanliness, medical healthcare is acknowledged.

Flood preparedness

storage of food, drinking water and valuables.

Demand Early warning system for extreme climate events climate change

heat stress, food shortage, local environmental problems.

Climate and Health

Understood as seasonal health problems

Strength Traditional knowledge of protection from climate change

Weakness Knowledge to Practice

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Urban development , climate and Health Resilience (Academic)

Surat Arogya Samwad(Citizens forum)

Healthy Surat Working Group (MSH PP Technical group)

Climate smart Healthy children

Surat Alliance for Urban Agriculture and Resilience

Woman and Child Friendly Resilient City(In process)

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Surat City Public Health Agenda 2015-2020

Overarching goals:1.Improve health status in priority areas to reduce health

disparities2.Promote attention to the health implications of policies and

actions that occur outside of the health sector, such as in transportation, community and economic development, housing, industrialisation, education , public safety and climate .

3. Create and strengthen public-private partnerships to achieve sustainable health improvement

4.Increase investment in prevention and public health to improve health, control health care costs and increase economic productivity.

5. Strengthen Community participation and inclusion in public health policy and programs

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Plan Globally act Locally

WHO Executive work board Work plan on climate change and health 2015

• Partnerships: to coordinate with partner agencies within the UN system, and ensure that health is properly represented in the climate change agenda.

• Awareness raising: to provide and disseminate information on the threats that climate change presents to human health, and opportunities to promote health while cutting carbon emissions.

• Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a global research agenda.

• Support for implementation of the public health response to climate change: to assist countries to build capacity to reduce health vulnerability to climate change, and promote health while reducing carbon emissions.

• Partnerships: to coordinate with partner agencies within the city, and ensure that health is properly represented in the climate change agenda.

• Awareness raising: to provide and disseminate information on the threats that climate change presents to human health, and opportunities to promote health while working on climate resilience.

• Science and evidence: to coordinate reviews of the scientific evidence on the links between climate change and health, and develop a local research agenda.

• Support for implementation of the public health response to climate change: to assist health departments to build capacity to reduce health vulnerability to climate change, and promote health

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Public Health Initiatives – Smart City

1 Health and Climate Observatory HCO2 Ward Public Health Quality Scoring WQS3 Health Promotion Centre HPC4 Health & Climate Resilience Skill

laboratoryHCRSL

5 Community participation consortiums CPC6 Childhood Friendly Resilient City CFRC7 Sustaining UHCRC-Academic partner for

support UHCRC

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Public Health Initiatives – Smart City

1 Non Communicable Disease Care Centres

NCDCC

2 Integrated Emergency Medical Care Network

IEMCN

3 Mission Poshan MP4 Accredited Urban Health Service QUHS5 Infectious Disease Diagnostic

LaboratoryIDDL

6 Hello Health Help Line HHH7 Mission Swachchhata

Thank You

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