When you consider that India spends only 1.4% of its gross domestic product (GDP) on health, the least among BRICS nations, the magnitude of its health problems are distressing, but not really surprising. Moreover, for five years till 2016, the National Health Mission (NHM) funds that were unspent by states even increased by 29%, according to a recently released audit by the Comptroller and Auditor General (CAG) of India.

Almost 61% of deaths in India are due to non-communicable diseases, especially cardiovascular, cancer and diabetes, according to the World Health Organisation. As these are the “most common diseases” in India’s cities, noone is really safe, not even you.

In the minds of urban citizens, the biggest disease bogeys seem to be all those illnesses with dreaded names – dengue, chikugunya, AIDS and the like. However, the reality is quite different, in the sense that what kills you may not really be any of these diseases, but something as simple as diarrhoea, which kills more people than AIDS, according to a report by the Registrar General of India and Center for Global Health Research. 

It is therefore both important and interesting to delve into what constitutes the key risks to physical health for people living in the cities.

1. Cardiovascular diseases

Heart disease and stroke are usually clubbed under the term ‘cardiovascular diseases’. Heart attacks, that target your heart as well as the arteries and veins, are the number one killers in the world and in India, and have been found to  be more prevalent in the cities.

A recent study found that adults in urban centres tend to be more at risk of cardiovascular diseases (CVDs). People who have more household wealth and those at higher education levels are more vulnerable. The study also shows that body mass index, high blood glucose, and systolic blood pressure, which are high risk factors for CVD, shoot up in richer houses in the cities.

The spike is largely due to changing diets, reduced physical activity and resulting obesity. They might hit you anytime, even early in life. The urban phenomenon of “large unorganised food retail and lack of implementation of policies” has failed to reduce dietary salt, according to a study by the Public Health Foundation of India (PHFI).

The city with the the largest number of CVDs is the capital! In a survey, Delhi showed the highest percentage energy contribution of fat, working out to 30%. It was followed by Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkata, Mumbai, and Pune.

According to some friendly tips from mayoclinic.org, here is what you can do. They may not sound too different from what your mother used to tell you, but better follow them and be safe than sorry:

• Avoid tobacco
• Exercise for about 30 minutes a day
• Eat healthy
• Maintain your weight
• Sleep well
• Manage your stress
• Check your blood pressure, diabetes, cholesterol and other parameters

2. Ill-defined/All other

Most of the deaths in India happen at home when medical attention is not given. So even death certificates might be given only on the basis of verbal accounts. The reason for death might be based only on the family’s description of the symptoms and illnesses. Would it be dengue then? Or chikugunya? Or acute encephalitis syndrome?

The reasons behind such deaths are rarely well-defined, and the diseases themselves are ill-defined. One man in 10 and one in seven women gets felled by this He Who Cannot Be Named.

3. Malignant and other neoplasms

Do not console yourself with the false notion that ‘Malignant and other Neoplasms’ is something that you have not heard about much, so it’s rare and might not affect you. This illness has another name that you are familiar with. It’s also called cancer.

There are more urban victims of cancer than before, mainly due to lifestyle changes, heavy urban pollution as well as use of pesticides, occupational chemicals and dusts, and frequent lower respiratory infections. Registries show that lung cancers affect more men in the cities, which has seen a distinct rise in the metros of Bengaluru and Delhi in particular. Breast cancer affects more urban women. The Indian Council of Medical Research (ICMR), says that in 2016, there were 14.5 lakh cancer cases, which is expected to shoot up to more than 17.3 lakh in 2020.

About one-third of deaths due to cancer in the cities is heavily impacted by the change in dietary and behavioural patterns — such as reduced intake of fruits and vegetables, low physical activity, excessive consumption of tobacco and alcohol — which lead to the most common lifestyle-related disorders, including obesity.

Although city-dwellers would find it tough to change their lifestyles, according to Indiancancersociety.org, natural foods can go a long way in acting as a preventive. Vegetable juices, probiotic foods, supplements and coffee can improve immunity. Eating beef liver is also shown to help. Eliminating processed oils and fats from the diet and consuming cottage cheese, flaxseed and flaxseed oil can make a difference. Treatments include chemotherapy sessions and alternative therapies.

If cancer is detected and treated early, about 80 per cent of the cases can be cured. 

4. Respiratory diseases

Respiratory illnesses attack your breathing apparatus. There has been an alarming rise in chest and throat diseases in the cities, due to plummeting levels of air quality, with 14 out of the 15 most polluted cities in the world situated in India.

Chronic respiratory diseases that push patients in India to the doctor most often include chronic obstructive pulmonary disease (COPD), asthma, tuberculosis and allergic rhinitis, according to the ERS journal. Pulmonary fibrosis (or scar tissue in the lungs), pulmonary hypertension, occupational lung disease, and interstitial lung disease damage the airways, lungs or lower breathing organs are also common. 

The cities are particularly vulnerable. One study showed that half of Delhi’s 4.4 million schoolchildren’s lungs are affected and would never recover complete capacity. About 89.6 per cent of slum-dwellers die due to respiratory diseases, according to a survey in Mumbai by the International Institute for Population Sciences (IIPS). A study by Practo, a healthcare platform, observes that there has been a steep rise in patients seeking appointments with pulmonologists in Delhi (50%) Mumbai (64%) and Bangalore (80%).

Smoking is among the top most cause of respiratory illnesses. But you can blame other kinds of smoke too. Apart from tobacco smoke, chemicals, dusts and frequent lower respiratory infections during childhood leads to such disease. The diseases, though they rarely have a cure, can be managed, if the air passages can be managed or dilated.

Pulmonary fibrosis (scar tissue in the lungs) cannot be cured. Lung transplantation might be the only option for this.

5. Digestive diseases

Disorders related to the digestive system account for 4.6 per cent of the total medically certified deaths, according to a government report. Urban citizens are the most affected. The primary reasons are, yet again, lifestyle change and negligence or ignorance of people about food habits. Substance abuse including alcoholism and tobacco addiction are also leading causes. 

Dietary neglect has led to stomach infections, indigestion, abdominal pain and chronic gastritis. Uniquely urban cuisine that is often spicy and rich in fat, medicines, tobacco, alcohol and chronic stress are the prime culprits. A gut-health survey shows that about 14 percent of India’s urban population is suffering from chronic constipation! 

Due to urbanisation, public infrastructure has not kept pace. Poor access to water and sanitation lead to high rates of diarrhoea in urban slums. To make a further case for building improved infrastructure in this respect, staying healthy also makes economic sense. A survey in Kaula Bandar slum in Mumbai showed that the cost of water and sanitation infrastructure can be surpassed by the total costs of diarrhoea for households.

The most common digestive disorders are peptic ulcer, primary malabsorption syndrome, dysentery, cirrhosis and abdominal tuberculosis. To stay free of digestive disorders, therefore, quit tobacco and alcohol, and be sure to consume balanced and healthy food. Avoid the use of medications such as aspirin, sulpha drugs, and steroids as far as possible.