In 2016 alone, there were over 800,000 deaths attributable to non-communicable diseases in Pakistan. Led by cardiovascular diseases, non-communicable diseases — including cancer, diabetes and chronic obstructive pulmonary disease — accounted for 58 per cent of all deaths in the country.
Cardiovascular disease is generally a product of a combination of diseases resulting from sedentary behaviour, poor dietary choices and smoking, brewing against a background of genetic susceptibility.
The cities we live in, our work and residential neighbourhoods and their in-built opportunities for physical activity, as well as our food choices motivated by commercials, accessibility and pricing deeply influence our health and health-seeking behaviours.
Our environment drives our behaviour. And our environment, as it is today, sits at the heart of the present non-communicable disease crisis.
During my hour-long commute after a long day at work, I witness the staggering mass of humanity on the roads. As cars honk and loud motorbikes weave expertly in between other vehicles, the traffic inches slowly along the road.
Motor vehicles are mostly privately owned and spotting public transport and pedestrians is a rarity. There is then the gray, gray sky, roadside trash burning and the perpetual scent of smoke.
Karachi is a sprawling megacity of over 20 million. Its population has doubled over the last two decades. Almost five million vehicles are registered in the city with the Sindh Excise and Taxation Department.
According to Gallup Pakistan, the total number of registered motor vehicles has increased by 268pc, and while two-wheeled motorcycles and private transport vehicles increased by 439pc and 327pc respectively, public transport increased only by 167pc through the period 2000-2015.
This disparity is evident on the roads.
Concomitant and largely consequent to rising motor vehicle use, Karachi and other cities in Pakistan have seen an alarming increase in air pollution.
According to the World Health Organization (WHO), in 2016, outdoor air pollution was estimated to cause 4.2 million premature deaths worldwide.
This is through exposure to small particulate matter of 2.5 microns or less in diameter (PM2.5), which leads to cardiovascular and respiratory disease, and cancers.
The WHO has set limits for PM2.5 exposure at mean value of less than 25ug/m3 per 24 hours. Many Pakistani cities record a PM2.5 level far higher than this acceptable limit.
For example, Lahore ranks worst among major cities globally with air quality index (AQI) of 318 and PM2.5 level of 267.8 µg/m3 and Karachi with an AQI of 152 and PMI2.5 of 57.3 ug/m3.
The math is simple. No opportunities for walking or bicycling to work = a large number of vehicles on the road = rising air pollution, road traffic accidents and poor health indicators in the city population.
And none of these diseases are the kind you can get over with a seven day Z-pack. They are lifelong illnesses requiring lifelong medications, doctor and hospital visits and the consequent toll on the patient’s pocket and life potential.
All major global agencies have highlighted the critical role of city design and management decisions in ensuring the health and well-being of city residents.
Indeed all countries of the world are signatories to the United Nations Sustainable Development Goals where Goal 11 is to "make cities and human settlements inclusive, safe, resilient and sustainable."
In a study published as a part of a Lancet series on urban design, transport and health, the researchers used a health impact assessment framework to estimate the population-level health effects of alternative land use and transport policy initiatives in six cities.
They modelled land use changes to represent a compact city in which density and diversity were increased and distances to public transport were decreased to generate low-motorised mobility.
Essentially, this scenario, which involved a shift from using private motor vehicles to walking, cycling or public transport, provided health gains for all cities — mainly, a reduction in diabetes, cardiovascular disease and respiratory diseases.
An observational study of 6,855 adults done across 14 cities in 10 countries across five continents evaluated factors associated with physical activity. They found that increased residential density, intersection density, number of public transport stops and number of parks within walking distance were all factors positively and strongly associated with increasing physical activity.
In addition, they found that compared with those who lived in the least activity-friendly neighbourhoods, people who lived in the most activity-supportive neighbourhoods performed up to 89 minutes more of physical activity per week.
Policy changes guided by multiple stakeholders (i.e. city governance, city planners and city residents) are needed in the urban planning, transport and parks and recreation sectors.
The guiding principles for policy changes that will affect both human and environmental health include: high residential density with safe, walkable and shaded streets; walkable distances to shops and services; a mode-of-travel shift to public transport; and multiple green spaces and parks to encourage leisurely physical activity.
Making cities more activity friendly is an important long-term solution to curbing the non-communicable disease epidemic while saving our environment.
Our lives and the planet’s life depends on it.
Are you a medical or planning professional? Share your insights on the intersection of the public space and health at firstname.lastname@example.org