Health Impact Assessment

Long back, I visited Law School, opposite Supreme Court, New Delhi to meet Prof. Furqan Ahmed. During the meeting, I got a chance to go through a judicial magazine/journal wherein a special chapter on “Judicial response to problems of urban planning” caught my eye. I requested for a photocopy of the said article. However, the professor gave the magazine in original. I lost that magazine in 2014 floods along with other almost 2000 books.

The article was about certain urban planning issues/problems dealt by courts. The one specific issue related to public health stuck in my mind till date. This is very important for understanding health of the city and its citizens.

“Bangalore Development Authority (BDA) had allotted a piece of land to a philanthropic organization for construction of a hospital. The hospital would serve poor people for various types of diseases. This was stated by the NGO/Trust in their demand for allotment and the project would be charitable in nature. However, the piece of land was earmarked as a public park in the city’s Master Plan. The NGO through its influence and charitable goals managed to get the land allotted after motivating the Chairman/CEO of BDA. So far so good. Someone filed a PIL in the court against the land allotment and pleaded that it is wrong to give land to an NGO/Trust that is reserved for a public park in the master plan.  The case ultimately reached Supreme Court. The NGO side put their arguments based on the plea that the hospital would serve common people and mostly poor people, who have least access to health care facilities. The other side would keep on arguing that a reserved public park cannot be given to NGO for construction of a private hospital. The final arguments were heard and the judgment came against the NGO/Trust for cancellation of the allotment of land for hospital based on the fact that a public park is better than a hospital. It is because of less open public space for socialisation, reduction in open space for free air flow/ cross ventilation, reduction in green spaces, reduction in community/neighbourhood open spaces where children would play, elders would gossip and socialise to reduce boredom, depressed/stressed and lonely people would come and relax, couples who have congested and cramped spaces at their homes would throng  to spare time together. The public parks are spaces which reduce the burden on hospitals indirectly. These open spaces put together in a city provide congenial environment and allow people to live fuller lives. If we start reducing these open, green and community spaces, the city would get cramped. Such spaces act as relief  parks and relieve people of stress, tension and depression. These open parks act as lung spaces and have huge environmental and health benefits. When such spaces are lost to development, people end up as patients in the hospital. In this background, the allotment must have got cancelled and the park was restored as a public park as envisaged in the Master Plan.”

We mostly depend on doctors for healthcare, who prescribe medicines. Medicines have side effects. We believe that medical is a noble and best profession. Doctors too are under the same impression. We try to fix the problem through doctors in hospitals. And if they cannot, then blame them only and even beat them up whenever possible. We keep on saying that we have less doctors and least healthcare. True. But we fail to understand the dynamics of human life and its functioning.  Take for example a car. The automobile mechanic is like a doctor and the workshop is like a hospital. What we forget is that if we have good scientific roads, there will be less wear and tear of the vehicle and less accidents. I am specifically leaving driver aside who acts as a mind to the car. Intelligent cars are yet to come on roads and mind you, those would not be driven on bad & bumpy roads like ours. Similarly clean petrol/diesel, gear/engine oil, filters also help in keeping the car healthy and safe. In case of bad quality of roads and oil, the car lands up in workshop for service more often. It is the external factors (roads/oil) that impact health of the car. Similarly, the health of human being is directly related to its surrounding environment. So, if the environment is degraded, it has negative consequences and impact on human health. Human body does not function in isolation. The environment is a dynamic and comprehensive phenomenon, integrated with symbiotic relations  between living and non-living, tangible and intangible. The full context /canvass  of environment is the universe itself. We are yet to fully understand the impact of stars/galaxies and satellites  on earth and its constituents. We are limited to the earth in terms of  air/aerospace, water/waterbodies, food/forests, land/limited natural resources. We neglect the role of sun, moon and stars.  We inhale oxygen, release carbon dioxide, eat food and drink water, feel warmth in summer & cold in winter, wear clothes for protection from weather and hostile environment. We work and sleep. We fall sick because of bad quality of air, contaminated water and bad quality of food. These may be of direct tangible consequences. However, human being has indirect and intangible impacts due to socialization, mental health, psychological impact, likes and dislikes, emotional consequences, allergies to various food types, dust and pollution etc. Therefore, technically speaking, the outside impact on human health is far more serious than of its own or within a building. Air has no borders, which means diseases due to air/dust pollution need collective efforts to curb it. Water quality – both piped water supply and natural water through springs, streams, rivers, ponds/lakes needs to be taken care of and good quality water for drinking/cooking/bathing be made easily accessible to curb water born-diseases. So is true of food quality- the food has to be clean and healthy to reduce food related diseases.

In a city or a town where huge population is collectively at the receiving end due to scarce natural resources, the urban planning comes into play. At individual level, everyone is greedy to exploit/misuse the scarce natural resources whether land or water, rather misuse/abuse both natural as well as man-made facilities/amenities. The fundamentals of urban planning is to have spatial but fair, equal but equitable and balanced distribution of natural and man-made resources, infrastructural facilities/amenities, land ownership, affordable housing, healthy living, water supply, electricity, sewerage & drainage,  accessible good roads, transport & communication, educational and healthcare facilities, food security, safety from natural/man-made hazards, open spaces/public parks for leisure, entertainment and socialization, sports/stadia complexes, trekking  facilities, science & art museums, zoos,  religious/community facilities, graveyards/cremation amenities etc. The protection & conservation of waterbodies, wetlands, natural vistas and mountains is a fundamental duty of the government in order to stop natural imbalance in a city. The idea is to reach out to the last person in the city, without neglecting and ignoring the marginal and vulnerable communities/groups or individuals. The male/female population consists of children, youth, elders with subgroups as pregnant women, lactating women, physically challenged and specially-abled persons, etc. all need services for better quality of life, which has to be made available through physical, socio-cultural, economic & environmental aspects. The quality of physical infrastructure (like roads/mobility, water supply, electricity, drainage/sanitation, waste management), social infrastructure (educational & health facilities, community/marriage halls, religious facilities, sports facilities, fire services etc), leisure, tourism and entertainment infrastructure, natural & cultural heritage, ecology & environment when provided without ambiguity & hindrance makes people to enjoy and live a healthy, happy and fuller life. There are mechanisms placed to measure and evaluate environmental standards through Environmental Impact Assessment (EIA). Also Social Impact Assessment (SIA) is used to evaluate the social standards/cultural upliftment through economic enhancement.  What is required as of now is the Health Impact Assessment (HIA) of the city/district/village, because it all boils down to health of an individual and health of the community in general. In any case, health is wealth. The idea here is to bridge the gap between public health and urban planning as the later has tremendous impact on health of citizens because of its consequences. The better urban planning (not just paper exercise but providing fair distribution of infrastructural amenities in a sustainable manner with due care to parks & leisure vistas etc)  leads to better health. In our part of the world, there is a huge gap between the two and it is because of less knowledge and least importance about urban planning. As is explained in the beginning, how arguments in favour of a  public park succeeded against a hospital under judicial scrutiny. This means that park is better than a hospital as in the absence of open spaces, people will end up in hospitals for treatment. Therefore a direct relationship between planning and public health. This also means that Town & Country planners are required more in number. The sorry state of affairs is that on urgent basis, peons are given preference for recruitment than planners, despite the fact that modern government is trying to be more in corporate style where you need to do work on your own than depend on an orderly or a peon. But as is seen, our preferences are totally opposite to what is required. The lower class fulfils vote bank politics and food for appeasement policy. The government needs to recruit urban, regional & country planners, architects, Housing specialists, Transport planners, land use experts/habitat planners, Environmental Planners, Environmentalists/ecologists, sustainable development experts, human settlement specialists, health & hygiene administration specialists, hazard mitigation & disaster management specialists, climate change specialist, GIS/Remote sensing  analysts, land affairs and real estate experts,  Landscape architects, heritage & conservation architects, regional planners, sanitation and solid waste management experts, dairy & food technologists, quality control specialists, gender and anti-discrimination specialists, conflict & dispute resolution specialists, international relation  experts, media specialists (environment focussed), human right activists,  women development specialists, artists  etc.

Although we have adopted new academic courses in various fields in colleges and universities but not thought of providing jobs/employment at government level in these new fields. We need to come out of medical, engineering & bureaucratic phobia and instead seek employment for the fields I have stated above. The earlier we do and accomplish, the better it would be!

The writer is Joint Commissioner (Planning), Srinagar Municipal Corporation. The views expressed are author’s own and not of the organization he works for. He has been awarded internationally by i) Ford Foundation for urban planning & development studies in USA, ii)  ISOCARP/UN-Habitat for planning in Palestine  and iii) G20 Global Leadership Program  for  pursuing public policy development in South Korea.