The urban burden of disease in India: modeling infrastructure, environmental and dietary risk factors associated with provisioning systems across forty cities (2022)

This study—for the first time—quantifies multiple health risks across 40 + Indian cities associated with seven key physical provisioning systems—energy (cooking fuels), mobility, housing, water and sanitation, food, and greenery—and compares them with national risk profiles. We harmonize diverse urban-scale datasets to estimate premature mortality per 100,000 population from diverse risk factors including inadequate infrastructure, environmental pollution/extremes (air pollution, noise, extreme heat/cold), sedentary lifestyles, and dietary risks. Such quantitative multi-risk assessment provides an essential baseline for transforming infrastructure and food systems toward health in rapidly urbanizing India. Results indicate that: (1) Urban health risks differed substantially from national averages, and varied widely across cities, thus motivating the need for the bottom-up approach developed herein; (2) Outdoor air pollution was the leading risk factor in both national (~ 70 premature deaths/100,000) and urban contexts (~ 37/100,000); cities reduced risks from indoor air pollution (to ~ 3/100,000) and unsafe water (to ~ 5/100,000) but revealed new significant risks from extreme heat/cold, low physical activity, and noise pollution, indicating emergence of urban environmental and lifestyle risks; (3) Urban–rural comparisons reveal urban advantage in clean cooking fuel, sanitation, water access, and certain dietary factors (milk, fruits), but disadvantage in overcrowding, sedentary lifestyles, and low whole grain and vegetable intake; (4) Inter-urban comparisons showed that city-average household income/expenditure was weakly associated with improved infrastructure services (indicating the importance of governance); (5) Intra-city inequality in infrastructure-and activity-related exposures finds the poorest homes disproportionately affected by inadequate infrastructure (cooking fuels, sanitation, water), while richest segments are most exposed to lifestyle- and dietary risks.