Urbanization and Health: Complementary or Contradictory?
By: Fatima Aamir
Date: 03/02/2022
What is the image that formats when the word ‘urban’ is mentioned? The common perception of urbanization is a heavily populated city with a fast-paced life, bright lights, constant noise, and endless movement. Like all things, such a lifestyle has repercussions on peoples’ socio-economic as well as personal lives, with mental well-being a direct and widely neglected area of concern.
Urbanization is often associated with improved economic prospects, delivery of public services, and access to amenities, including education and healthcare. While it is true that urban areas have more healthcare facilities available which can lead to higher levels of health among the public, it cannot be disputed that an urban lifestyle can in itself generate many health-related problems that would not exist otherwise. The pollution and sanitation deficiency common in urban regions deteriorate the physical health of its residents, but these issues are acknowledged and actively worked for. However, the problems associated with mental health are often overlooked.
Studies have shown that urbanization is associated with rising mental disorders, particularly anxiety and depression. The inadequacy of infrastructure resulting from a rapid rise in urban population and relatively slow increase of facilities creates a stressful environment for individuals, with longer working hours to keep up with rising prices and falling lifestyle as demand for amenities continually exceeds supply. This is positively related to urban poverty, putting financial constraints on individuals who are already overworked. Moreover, it leads to an increase in nuclear and smaller families, reducing social support and raising feelings of isolation and loneliness. The stress of urbanization spills on to the young generations as well who have to deal with ever-increasing academic pressures in addition to domestic ones. In 2003, World Health Organization (WHO) predicted developing countries to be disproportionately affected by mental health problems, owing to a variety of socio-economic factors; lack of facilities and trained staff, social stigmatization, financial strains, etc.
Pakistan passed a mental health ordinance in 2001 which emphasized granting access to mental health facilities, rights of patients, and overlooked the processes of admission, treatment, and caregiving. However, in practice, nothing of substance materialized. According to a report by WHO in 2003, there are only 5 mental hospitals in the country, which are organized alongside outpatient facilities. Only 1% of these treat children and adolescents, who make up 46% of users of outpatient facilities. Per 100,000 population, there are only 1.926 beds and 87 personnel available. This bleak situation is the product of the meager amount of 0.4% of healthcare expenditure spent on mental health.
Over the last two decades, Pakistan has shown no improvement in suicide mortality, not even for either gender. On the other hand, South Asia and the world have steadily declined in their statistics-so much so that the discrepancy between Pakistan and these averages has been eliminated. This is an alarming indication for the country; the world and the region are advancing by leaps while no measures of similar nature are undertaken or in consideration for Pakistan.
Despite these clear indicators raising concerns for future trends, there is a large discrepancy in data recording and collection. Suicide deaths are excluded from the annual mortality statistics, so most of the reporting is done by the media or private organizations. This exclusion relieves national institutions from facing the gravity of the situation and owning responsibility, further aggravating the situation.
Regardless of the lack of national data, clinical studies across provinces paint a grim picture. In the context of the data situation in Pakistan, it is not appropriate to make a comparison among rural and urban areas. Nonetheless, these studies highlight the problem prevalent in urban areas; depression is very common across Pakistan’s major cities and needs to be addressed promptly, starting with data collection and analysis.
SOUTH ASIA – A LOOK AT THE REGION
Pakistan is not the only country with a persistent suicide problem. It shares its borders with countries with similar social and economic attributes, that are also posing a similar case study on the topic as Pakistan. Unlike Pakistan, its neighbors have steadily decreased their suicide mortality rate, with China showing the most progression. For China, urbanization uplifted life standards drastically, and instead of contributing to the problem, it levitated the country out of it. This is owed largely to the recognition of the causes of mental distress, which in this case was poverty.
India has fared moderately, but it still maintains a two-figure suicide mortality rate. Its failure to crack down on this issue is attributed to a lack of systematic attention and state machinery, while studies show a high tendency of mental distress and suicide among the urban poor. Urbanization thus contributes heavily to drivers of suicide in India.
On the other hand, Bangladesh has only improved marginally. Its reasons for such a performance hit close to home; there is no suicide surveillance infrastructure to date and no such studies are carried out by the state. Despite that, there is abundant evidence that urbanization deeply correlates with the deterioration of mental health in Bangladesh, with financial and academic pressures being front-runners.
LESSONS FOR PAKISTAN
It is no surprise that South Asian countries have lagged in the development of infrastructure for mental health. Developing countries tend to prioritize economic growth over qualitative indicators of growth, but these factors can significantly affect economic growth itself. A country’s human resource is its defining force in achieving sustainability in development; if a country’s citizens are not healthy, the economy will not be healthy.
Keeping in mind the importance of its human resource, Pakistan needs to review its policies and lax approach towards their health, particularly mental health. The first step of any decision-making is the collection of data; Pakistan needs to address the issue by first acknowledging it. There should be a proper recording of persons seeking mental health facilities, so adequate provision of these facilities can be made possible. It is the state’s responsibility to provide psychiatric healthcare affordably; such a facility is globally perceived as a luxury while its afflictions are the worst for the poor.
There is also a pressing need to include deaths by suicide in national statistics; pretending a problem does not exist will not end it. Cases of suicides should use psychology experts in their investigation, so the cause of the action can be unearthed. Research bodies in the country should be supported by the state to carry out national-level studies to not only gauge the extent of the problem but also understand the underlying motivators and suggest viable solutions.
Unfortunately, a big aspect of the mental health problem in South Asian countries is the stigma attached to it. A social destigmatizing campaign is a dire need in Pakistan; an increased level of acceptance by individuals and institutions can help break from the invisible bonds of shame and denial regarding mental illnesses, which will ensure healthier citizens and increased welfare.
The world has moved past conventional measures of development and poverty and is now working by a multi-dimensional definition that takes the public’s happiness and satisfaction into account. Pakistan, as well as other developing countries, need to incorporate such an approach into their plans, to make sure that it complies with international standards and keeps up with the times.
