Anita Patil - Urban Design & Health of the City

Aim of Urban DesignUrban planning, design and formrecognize the role of built environmentas a model for minds, intellect, creativityand health of its occupants and inturn must mirror their imagination,capability and aspirations. Thereforeurban development is not a mere growthbut an up-gradation of the physical,social, cultural and economic health ofthe citizens. The role of urban form hasbecome critical in the rapidly urbanizingworld where the lens of urbanization initself becomes a determinant of health.This paper seeks to illustratevarious aspects of structural design ofthe urban settings, and how it can helpcreate healthy and inclusive cities.of invigorating planning’s ability tounderstand and enhance the vitalityof both places and the people” 4The Healthy Cities movementinitiated in 1980s highlighted therelationship between urban environmentand health and the role of localgovernment in promoting health at a cityscale. (Hancock & Duhl 1986,) 5 ,. WHORegional office in Europe launched itshealthy urban planning initiative in 1997that led to Healthy Urban Planning- aWHO Guide to planning for People. 6 Ithas set of guidelines that provide 12key objectives for the practioners.cities in the coming years will have aglobal impact on the economic, political,environmental, cultural and social fabricof our planet. In the year 2008, the humanrace entered a new Urban Millenniumwhere, for the first time in human history,more than half its human population, 3.3Billion people were urban inhabitants. 7Urban Design& Health ofthe CityPaper presented at the UDRI Conference NegotiatingUrban Form in Mumbai held on 25th Febuary 2011Anita PatilExecutive Director, PUKARHistorical Perspective &Current PracticesHistorically the disciplines ofurban planning and public health bothoriginated out of the need to resolve theproblems of sanitation and disease in the19th century cities of Europe. The firsturban planning university course wasintroduced at the university of Liverpoolin 1907.(UN Habitat-2009) 1 Despite thiscommon origin, in the current timesthere is minimal cross over betweenthe two disciplines (Corbun, 2004,Sloane, 2006). 2,3 But there is increasingrecognition in the world of developmentfor the need of overlap between the two.The recent issue of Journalof American Planning Associationdevoted an entire issue (volume 72,Issue 1-2006) to urban planning rolein building healthy cities. The editor,Marlon G Boarnet writes “The growingpartnership with health bring the promiseThe Context: Urbanization:Today & Tomorrow:“The growth of the cities willbe the single largest influence on thedevelopment of the 21st century”1996- State of the WorldPopulation Report.This prophetic statement seemsto remind us that what will shape theUrbanization is inevitable, ishappening rapidly across the globe andhas both positive and negative impacts.This trend of urbanization is unavoidable.UNFPA predicts that almost all the world’sgrowth in population over the next2–3 decades will be in urban areas indeveloping countries (UNFPA, 2007) 8 . Thepopulation in these areas is expected toSource: UNDESA, WorldUrbanization Prospects,2007 revision-WB-WorldDevelopment Indicators.120 / 04 health04 / 121

Share of national gdp andpopulation of selected citiesSources: Van Dijk, 2007.Johannesburg, Cape Town:Naude & Krugell, 2004.grow from 2 billion in 2000 to 3.9 billionin 2030, while the total world populationmay grow from 6 to 8 billion, with themost rapid pace of growth expectedin Asia and Africa.(UN Habitat, 2006) 9While North America, Latin America andEurope are currently the most urbanizedregions, the number of urban dwellersin the least urbanized region, Asia (1.8billion), is already greater than that inNorth America, South America, Japanand Europe combined (1.3 billion).An outstanding feature of theurban population growth in 21st centuryis that it will be composed of poor people.One out of every three, city dwellersnearlyone billion people - lives in aslum. Most of the slum dwellers in SouthAsia, 63% or almost 170 Million people,reside in India. (UN Habitat-2009) 10Role of CitiesCities have traditionallybeen the engines of growth since theindustrialization began. The prosperityof nation is intimately linked to theprosperity of their cities. (UN Habitat2010-2011). 11 In this sense, urbanization,in a way similar to globalization, can beseen as a structural social determinant ofhealth that can challenge the aspirationsof equity due to the tendency foraccumulation of wealth and power amongthe urban elite (Vlahov et al., 2007) 12On one hand cities have becomethe engines of growth, encompassinga large pool of talent, finance, labourand knowledge creation opportunitiesin concentrated areas, thus producingeconomies of scale. On the otherhand they have also become places ofincreasing poverty, disparity, squalor andsocial disruption. Inequalities in the intracityaccess to services, housing, healthand health care, education & employmenthave socio-economic, environmentaland political repercussions. The realchallenge lies in recognizing flaws of theprocess and find solutions that will makethe positive impacts more pronounced,the growth more inclusive and equitableand prevent and / or reduce the negativeimpact of this unprecedented growth.Urbanization of Poverty& Planet of SlumsIndustrialization, urbanizationand associated migration have influencedthe land use patterns in all cities andland has become the most precious andcontested commodity. This is especiallytrue in an island city of Mumbai, thusmaking Mumbai one of the mostexpensive real estate markets in theworld. This has resulted in the growthof slums due to rapid growth of thepopulation and the failure of the citiesto provide the necessary infrastructure,land and low cost housing to themarginalized sector. Cities as diverse asNairobi, Johannesburg, Mexico, Rio andMumbai have large number of residentsliving in slums. The slum populationof Rio is almost the same as the totalpopulation of Helsinki (State of the WorldCities 2007) 13 Mumbai’s more than 6million slum dwellers exceed the totalpopulation of Nairobi. These 6 millionoccupy a total of 8% land of Mumbaithus creating a density of 29,650 peopleper square kilometer compared to 2050per square kilometer of New York.Definition of slums differsfrom country to country and city-to-citytherefore the exact number of peopleliving in the slums in any country isdifficult to estimate. The operationaldefinition of slum as per the UN Habitatis as follows: A slum is a group ofindividual living under a same roof inan urban area who LACK one or moreof the following five conditions1. Durable Housing2. Sufficient Living Area3. Access to Improved water4. Access to sanitation5. Secure TenureVarious Dimensions of Urban Poverty• Poor quality, hazardous, overcrowdedand often insecure housing• Inadequate provision of basicservices which increases the healthburden and the work burden• Inadequate, unstableor risky asset base• Inadequate public infrastructuresuch as schools, and hospitals• Limited or No safety nets• Inadequate protection of rightsthrough the operation of the law• Voiceless-ness and powerlessnesswithin the non-responsive politicalsystem and bureaucratic structure.(Adopted from Satterthwaite 2004)The annual growth rateof cities and slumssource: UN-HAbitat, GLobalUrban Observatory 2004.122 / 04 health04 / 123

Urban Design & Health“The urban setting is a lensthat magnifies or diminishes othersocial determinants of health. Urbanenvironments have a number ofcontextual and compositional attributessuch as size, density, complexity andverticality that affects health equity inboth positive and negative ways.” KNUS14While social and economic conditionsare vitally important, there is a growingbody of work across the disciplines thatrecognize the role of physical urbanenvironment in shaping health anddiseases and thus in contributing tohealth equities (Galea & Vlaho 2005 ) 15Visible and invisible spatialborders that transpire into segregationof the society according to socioeconomicconditions often divide cities.According to UN Habitat 2010‐2011,‘Closer assessment of theurban space in many cities of thedeveloping world unambiguouslyexposes the fragmentation of thesociety with clear differences in the wayspace and opportunities are produced,appropriated, transformed and used’.Some areas features significantinfrastructure, well kept parks, gardensand clean well built residential areas. Incontrast, other areas are characterizedby sever deprivation, inadequate housingdeficient services, poor recreationaland cultural facilities, urban decay andscarce capital expenditure. This kindof spatial injustice has tremendousimpact on the health of the residents.It is in this context that the urbandesign has a critical role to play.Urban planning and design orlack of it can create very different urbanenvironments that can impact health in apositive or negative way. In all countriespoor end up living in unhealthy places…down stream, down wind, in low layinglands, in flood plains, in landslides, overgarbage dumps, near polluting factories.In the city of New York all the bus depotsare located in Harlem, where the AfricanAmerican people are concentrated.Most slum dwellers inMumbai are located along the railwaytracks, over the dumping grounds,or near flooding areas. It has beennoted that ‘Disparities in health areincreasingly linked to the physical andsocial environment that fall under thedomain of planning (Corburn 2004)The issue that can be moderatedthrough urban design and planning:Land use patters, designingof infrastructures, both soft and hard,density and location of facilities and safeneighbourhoods. Availability or lack ofthis has severe impact on the physicaland mental health of the residents.Urban planning and theregulatory framework it provides on landuse, land development, housing andbuilding standards and infrastructurestandards should reduce inequities inliving conditions. Their core purpose is toensure health and safety, including landuseregulations that prevent buildingson unsuitable sites (for instance, floodplains), and ensure that land is availablefor infrastructure and services and open/public space (Barton & Tsouros, 2000) 16 .Six pathways for designinghealthy cities1. Equitable Access toBenefits of Urban life:Assess to livelihood opportunitiesare critical to people’s health. Longand expensive commute to workingplace and lack of easy access totransportation impact both the physicaland the economic conditions of thefamily and makes urban poor vulnerableto unemployment. Spatial mismatchbetween job location and place ofresidence can leave more remote slumdwellers little alternative but to spenda night in public space, squat in thetemporary unit devoid of services. In Riosome workers sleep on benches duringweek saving commuting time as wellas transportation costs that consume20% of their earnings. In Mexico city20 % of workers spend more than 3hours commuting to and from workeveryday. (State of World cities 2010/11)In an affluent country like US,traffic congestion cost $ 4.27 Billion inextra fuel and person hours in Chicagoin 2003 (Urban Mobility Report, TexasTransportation Institute). On the otherhand Victoria Transport Policy in Australiastates that public transit in cities cansave $279 per capita in congestions costsavings. This identifies the importanceof infrastructure. (GRNUHE) 17Traffic accidents are also onthe rise in the cities. Between 1975-1998 traffic fatalities increased by237.1 % in Columbia, 243 % in Chinaand 338% in Botswana. Many who diein traffic accidents are pedestrians.In Mumbai where 6.5 million workerstravel on the commuter trains, 19persons are killed each day in trainrelated accidents (Uncovering theMyth of Urban Development inMumbai’ by Dr. S. Parasuraman) 18 .Better urban infrastructure,pedestrian friendly streets and wellplanned transport system that providesafe options for getting around thecity are needed to curb the rise inthe traffic Deaths (UN Habitat, Stateof the World’s Cities, 2006/7).Other critical access is for thehealth care services and facilities. In poorareas there are no health care facilitiesavailable. In Kaula Bandar, a 40 years oldunregistered slum in Mumbai PUKAR hasfound out that there is no primary schoolin this community of 15000-18000 peopleand the nearest health service deliveryfacility is 1.5 kms away with no publictransportation available to reach thatfacility. (June 2010 Report to RockefellerFoundation, Unpublished data). Researchin higher income countries has revealedthat in densely populated cities the124 / 04 health04 / 125

esponse time of the emergencyambulances and fire services is very long,leading to lower survival rates. (Campbellet al. 1993,) 19 , In Mumbai, there is nofacility for a special ambulance lane andno traffic system existent for making wayfor an ambulance. (personal observations).Access to schools,community places and parks arealso important for communitycohesions and physical activities.2. Access to adequate housingThe link between health andhousing has been known for centuries.Vast body of literature has explored theconnections between housing and healthimpacts. (Thomson, Petticrew 2002). 20Most of the major cities in theworld have been facing the constantcrisis of lack of affordable housingfor the urban poor and increasinghealth inequities created by thelack of shelter in the urban poor.The Health Evidence Network,Europe produced a report in Feb. 2005‘Is Housing Improvements apotential health improvement strategy?’The summery of that reportssays- “The well-established links betweenpoor health, poor housing and povertysuggest that housing improvements indisadvantaged areas or social housingmay provide a population-based strategyto improve health and reduce healthinequalities. Housing improvements thatreduce exposure to specific hazardsmay lead to health improvements forcurrent residents and prevent harmfulexposure by future generations”Smith’s study in 1989 21delineated specific health conditions thatarise from poor housing structures, anarea deeply related to urban design:Each of these factorscan be addressed by changing thestructural design even within therestrains of the costs, material andland use by creative means.The world Health Organizationhas identified nine critical featuresof housing conditions that canhave direct impact on health.1. The house as structure that protectsoccupants from natural elements likeheat, cold, rains flood, pests, noise, etc.2. The extent to which thereis adequate water supply, bothquantitative and qualitative3. The effectiveness of the provision forexcreta, sewage and solid waste disposaland management of that disposal4. The quality of housing site, theextent to which it is structurally safefor the housing and the extent towhich provision is made to protectit from contamination.(provision fordrainage being the most important)5. Effects associated with overcrowdingincluding household accidents, increasedamount of air‐born infectious diseasesincluding pneumonia and TB.6. Indoor air pollution associated withfuels used for cooking and heating7. Food safety including the extent towhich the shelter had adequate provision8. Vectors and hosts of other diseasesassociated with the domestic andperidomestic environment.9. Home as a workplace‐ whereoccupational health questions suchKaula Bandar: Anunregistered slumin Mumbai- Lack ofwater, sanitation &garbage disposal:- PUKAR-HSPH-NYU Project.Housing DefectsInadequate heatingInadequate ventilationLack of Hygiene FacilityInadequate kitchen facilityDisrepairStructural instabilityInadequate lightingUse of hazardous materialsOvercrowdingInadequate means of escapesource: UN-HABITAT, Global Urban Observatory 2004.Health RisksBronchitis, PneumoniaHeart disease, hypothermia,Accidents, Dampness with growth of mouldsRespiratory diseases, CO poisingInfectious diseasesAccidents, food poisoningAccidents, Fires, InfectionsAccidentsAccidentsCancer and respiratory diseasesInfections, stress, Intra‐family violenceInjury or death by fireKaula Bandar: Anunregistered slumin Mumbai- homeas a work place11 child labourers workingand living - PUKAR-HSPH-NYU Project126 / 04 health04 / 127

Provision of toiletsby socio-economicgroup, BangaloreSource: (SinclairKnight Merz and EgisConsulting 2002)as storage of toxic or hazardouschemicals and health safety aspects ofequipment used needs consideration.A critical component of housingthat has one of the largest impact onhealth, especially morbidity and mortalityin children under five years is access tobasic sanitation and water. Only 17 % ofurban poor have individual toilets at home.In Kaula Bandar, an unregisteredslum in Mumbai where PUKAR has beenresearching on social determinants ofurban health we found that only 3.0%of households had access to a toilet intheir home. Of the 97.0% of householdsnot having a toilet facility in their home,households made recourse to a varietyof methods, including defecating ina pay toilet (59.0%), in a public toilet(39.6%), and outside in the openalongside the sea (13.7%). Given thesensitive nature of the question, it isprobable that households underreporteddefecation in the open “wherever ahiding space can be found” (0.6%)and in the open alongside the sea. 22An urban planning strategy thatfacilitates access to clean water, toiletscan reduce prevalence and minimizethe impact of water born diseases. Itis estimated that providing adequatesanitation and water can reduce thediarrhea morbidity up to 46%.While talking about urban slumsof kinetic city of Mumbai Professor RahulMehrotra, Chair of the department ofUrban Planning and Design at HarvardGraduate School of Design says:“Perhaps the only standardthat should be applied for the evolutionof these settlements are laws andinfrastructure interventions that dealwith HEALTH & SANITATION, and notdeal with the form of the housesor dwelling unite per se” (www.timeoutmumbai.net, October 15, 2010)There is plethora of literature,elucidating association between lackof toilets, lack of adequate waterand diarrheal diseases. In developingcountries, in an average two weekperiod, an estimated 82 million childrenaged 0-5 years old have diarrheaand estimated 24,000 children dieEACH DAY due to diarrheal illnessthat are related to lack of access towater and sanitation. (WHO 2008) 23The following diagramshows the prevalence of diarrhealin various parts of the world.3. Safe Living Environment:The nature of urban planningleading to creating urban environmenthas major impact on the health throughbehaviour modifications and safety. Urbandesign has an important role to play interms of physical activity, accessibilityto open spaces, wailkability around theneighbourhoods, and availability of easyfast foods, connectivity and finally safety.When talking about safety, it revolvesaround many issues again related tourban form and design. Safety on theroads for the pedestrians and elderly,children’s safety on the playgrounds,safety from violence and abuse forwomen, occupational safety and safetyfrom natural and man-made disasters.Road traffic accidents lead to 1.2 milliondeaths in the world annually and 50million more are injured or disabled.(WHO,2002) 25 In India, road traffic accidentsare almost always underreported and anaddition to the pedestrians, the pavementdwellers often are the easiest victimsof road injuries in city like Mumbai.4. Physical Activity:Well thought‐out urban planningand design certainly has the potentialto reduce the health impacts of newlife style enhanced by the urbanizationprocesses, increased physical activityand in doing so lead to increased socialcohesion and community gatherings.Two most famous examples ofthis spatial and distributive justice areCurtiba in Brazil and Bogota in Columbia.Bogata’s visionary mayor Enrique Penlosaexecuted one of the most ambitionsplan of reducing the private automobiletraffic, expanding and improving byclespaths, increasing the easy accessibilityof affordable bus rapid transit system(TransMilenio) and increase the opnepublic spaces for people to connect.Bogata’s TransMilenio systems averages1600 passengers per day by bus,reducing travelling time by 32%, reducinggas emission by 40% and decreasingaccidents by 90%. The CicloRuta, thebicycle path of Bogata is one of theChildhood Diarrhea : Howthe world looks 24128 / 04health 05 / 129

Cicloruta, BogataPrevalence of under andover-weight amongwomen aged 20-49 yearsin urban areas in selectdeveloping countriesSource: AmericanJournal of ClinicalNutrition 81: 714 –21,American Society forNutrition, with permissionlongest bicycle network in the world,stretching 340 KM of bicycle only lanes.This has increased the physical activity forthe rich, the connectivity for the poor anddecreased of GHG emission of 36.6 tonesof Co2 in Bogata. ( www.c40cities.org/bestpractices/transport/bogata_bus.jsp) 265. Food Security:The large participation ofwomen in the labour force combinedwith pervasive globalization has led todramatic alterations of food habits acrossthe globe. In many parts of the world thetraditional diets of grains, pulses, fruits& vegetables have given way to meatintensive diets combined with excessof processed food. In US the availabilityof instant foods are easily available inpoorer neighbourhoods where coke andhamburgers are cheaper than waterand salads. This nutritional transitioncoupled with urban planning that is builtaround the automobile industry whichdiscourages physical activity has led tothe epidemic of obesity and diabeteswith approximately 2 Billion peoplewho are either obese or overweight.Physical activity is stronglyinfluenced by the design of the citiesthrough the density of the residences,mix of the land uses, the degree to whichthe streets are connected, the abilityto walk from place to place and theprovision of and access to local publicfacilities and space for recreation andplay. (Report of Commission on SocialDeterminants of Health, WHO, 2008) 27There has been no specificattention paid to the walkability partin the context of urban planning inIndia. A study commissioned by theministry of Urban Development inIndia assessed footpaths and overallinfrastructure and including pedestrian’srating of the facility. The nationalaverage walkability index was 0.52.By comparison largeinternational cities like Londonscore 1.5 to 1.7. Even though mostIndians walk, absence of footpathsand constant negotiation withtraffic makes walking a hazardousexperience in major cities in India.It is important that urbanplanning gives priority to walkingpathways, bicycling pathways and createdaffordable and easily accessible masstransport infrastructures in every city.Planning that focuses on open spaces,parks for recreations and playgroudsconstitute a major contribution towardsencouraging physical activities. All thethe above mentioned planning startegiescontribute towards making a city healthy.Access to Natural EnvironmentThe natural environment inwhich people live and interact havelarge impact on both physical andmental health. This is where soundurban planning can play a large part.Environmental pollutions, includingwater, air, noise pollution has increasedconsiderably due to rapid industrializationand automobile dependent life styles,increased need for energy anddependence on many chemical orientedproducts used in our daily lives. Somerelationships between these factors andhealth are well studied. Noxious factoryfumes and motor vehicles exhaustcausing increased asthma and upperrespiratory infections. Polluted drinkingwater causes gastrointestinal diseasesand heavy metal poisoning. Staying inolder home with lead paint has causedsevere lead poisoning in young childrenin US. As per WHO (2010) indoor andoutdoor pollution is a major healthproblem and is estimated to causeapproximately two million prematuredeaths worldwide per year with most ofthe burden of diseases being in LMIC. 28In Kaula Bandar a small roomof 100 square feet without ventilationhosts 10-15 people at a time who workwith chemicals, (Tannery & Leatherbelt making) weaving, (carpets, zariembroidery),tailoring etc. There is largeamount of suspended air particles,cotton fibers, threads, other fumes, inthese congested spaces. This may leadto increased incidence of respiratoryelements, asthma, allergic cough, otherchronic lung diseases, Tuberculosisand other air-born infections (personalobservation). There are handfulsof studies coming out of India andWalkability index,select Indian citiesSource: (WWF 2008)130 / 05 health05 / 131

Pakistan that has looked at these butmore empirical research is needed toestablish the causal pathways in a morerigorous manner. In addition in KB wehave observed continuous flooding of thehomes during monsoons, thus giving riseto large number of vector born diseases.Another critical part of urbandesign related to the Urban Heat Islandeffect secondary to climate change.The absorption of heat by the concretesurfaces results in urban areas havinghigher temperatures than surroundingnon-urban areas (GRNUHE 2010). Thisindeed has a negative impact on thehealth. Therefore ensuring trees, openparks, greenery as a part of urbanplanning will provide both cool shade andcarbon sinking capacity to the citiesHealthy by DesignA planners’ guide toenvironments for active living wasreleased by the National Heart Foundationof Australia (Victorian Division) in 2004.The development of Healthy by Designwas assisted by key stakeholdersrepresenting planning, recreation, health,transport and community buildingsectors and with support from thePlanning Institute, Australia - VictoriaDivision. This design tool has beenwidely adopted by local governmentand developers in Victoria, Australia.(Sutherland & Carlisle,2004) 29Key Health Objective for Urban Planners:Urban Planning policies and proposalshould encourage the following:1. Healthy exercise2. Social cohesion3. Housing quality4. Access to employment opportunity5. Local low impact foodproduction and distribution6. Community and road safety7. Equity & reduction of poverty8. Good air quality andprotection from noise9. Good water & sanitation quality10. Conservation anddecontamination of land11. Climate stabilityConclusionsUrban planning and designhas a large and critical role to play increating healthy cities by providingcreative and equitable urban builtform. Through the medium of physicalenvironment the urban planners canenhance the physical, mental and socialhealth of the communities. This canbe achieved through various maens.From land use patterns, mixed zoningpatterns, good connectivity, affordableand effective transport mechanisms,low cost housing, and accessibility toall advantages of urbanization. Buildinghealth equity through design and thusbuilding healthy and wealthy citiesshould become a major goal of theurban planning and design processes.Bibliography1UN Habitat 2009, “Planning sustainable cities: Global report on human settlements 2009, Nairobi.2Corburn, J (2004): “Confronting the challenges in reconnecting the urbanplanning and public health” Am J Public Health 94 ($) 541‐5493Slone, D (2006) From congestion to sprawl: planning and health in historical context Jam Plann Assoc 72 (1) 10‐184Boarnet MG: Journal of American Planning Association. (2006) Volume 72, issue 15Hancock, T and Duhl L (1986): Healthy Cities: promoting Health in Urban Context.Copenhagen, WHO Regional Office for Europe6Healthy Urban Planning in practice: experince of European Cities. Report of the WHOCity Action Group on Healthy Urban Planning. Edited by Hugh Barton, ClaireMitcham, Catherine Tsouros.7UN Habitat 2008-2009: State of the World Cities, Harmonious Cities, Nairobi,United Nations Settlement Programme8UNFPA 2007: State of the world population: Unleashing the Urban Growth.9UN Habitat 2006: State of the world cities 2006/7. The Millennium development goalsand urban sustainability. Nairobi, United Nations Settlement Programme10UN Habitat 2009: Planning sustainable cities: Global report on humansettlements. Nairobi, United Nations Settlement Programme11UN Habitat 2010: State of the world cities 2010-2011. Cities for All: Bridging the Urban Divide. Nairobi, UN Habitat.12Vlahov et al (2007) “Urban as a Determinant of Health” Journal of Urban Health84 (0) 16-2613Satterthwaite D (2004): Under-estimation of Urban Poverty in Low and Middleincome Nations. HumanSettlements Working Paper Series. Poverty Reduction in Urban Areas No. 14. IIED, London.14KNUS: (www.who.int/social_determinants/resources/knus_final_report_052008.pdf15Galea, S, Freudenberg. N. and Vlahov, D (2005) “ Cities & population Health” Soc.sci. med. 60: 1017-103316Barton, H and Tsourou, C (2000) Healthy Urban Planning: A WHO Guide to planning for people. London, WHO.17S. Parasuraman, Urban India: Understanding the maximum city: Uncovering the myth ofurban development in Mumbai. Urban Age: India newspaper. November 2009 2118Campbell, et al. “ Ambulance arrival to pateinet contact: the hidden comonant ofprehospital respons time intervals” Ann Emerg. Med. 22: 1254-125719Thomson, H Petticrew, M (2007): “Housing & Health” British Medical Journal, Vol. 334, Number 7591, 334-434.20GRNUHE, “ Improving Urban Health Equity through action on the social and environmentaldeterminants of health” Final Report to Rockefeller Foundation, 201021Lesser, A. Sawant, K. March 2010. “ Urban Environmental Determinants of Health in Mumbai:A case study of Kaula Bandar slum”. PUKAR-HSPH-NYU Project: Unpublished data.23WHO 2008: The global burden of disease: 2004 update24www.worldmapper.org/25WHO 2002: World report on Voilence & Health.26(www.c40cities.org/bestpractices/transport/bogata_bus.jsp)27Closing the gap in a generation: Health equity through action on social determinants ofhealth. Report of Commission on Social Determinants of Health, WHO, 200828WHO 2010 “ Air Quality and Health” Kobe, WHO centre for Health development.29Sutherland, E. Carlisle R. NSW Public Health Bulletin, Vol. 18(12‐13) 228‐231132 / 05 healthAnita Patil 05 / 133