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Impact of Urbanisation on Mental Health: A Critical Appraisal

Dr. Sumanth S. Hiremath

Correspondence Address :

Dr. Sumanth S. Hiremath
Department of Sociology
Rani Channamma University
Belagavi, Karnataka State, India
Tel: +91- 9844774431
Email: sumanthiremath@gmail.com

Received on: May 8, 2020, Accepted on: May 21, 2021, Published on: May 28, 2021

Citation: Sumanth S. Hiremath (2021). Impact of Urbanisation on Mental Health: A Critical Appraisal

Copyright: 2021 Sumanth S. Hiremath. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Urbanisation is seen as a natural outcome of growth. The rapid increase of population in urban areas worldwide is one of the significant global-health issues in the 21st century. Urbanisation carries with it a unique set of merits but at the same time challenges on health surely outweigh its positives by miles! So it is even followed by demerits. Presently, about 31 per cent of the Indian population dwells in cities and the percentage is expected to increase to about 41 – 45 per cent by the year 2021. There is a strong indication that urban people were expected to report mental illness and depressive symptoms more likely than rural, mainly because of the cultural factors resulted from fast pace of life. The series of chaos and social deviance related to urbanisation is enormous. Some of them are: severe mental disorders, anxiety, depression, alienation, family disintegration etc. These mental health problems of urbanisation affect whole of the population, especially the so-called vulnerable section: children, women and elderly. There is a need to spread awareness about the mental illnesses across all the sections of society. This will serve as a facilitator of change in a fast transforming Indian society.

Keywords: Mental Disorders; Social Deviance, Urbanisation; Vulnerable Section; Awareness


Urbanisation plays an important role in the social structure of a country and in the national and regional economy worldwide. Though in reality, the opportunities for education, services, employment and cultural enrichment, and the expectation of better health may not be as uniformly promising as hoped, but in theory and popular opinion, urban areas offer these opportunities better. To claim these opportunities, people migrate and adapt themselves to the urban living; but the practicality of urban lifestyle has a greater impact on the lives of many people. The so-called vulnerable sections suffer the most. The urbanisation has given rise to major health issues among almost all the people linked with this process. Due to urbanization, there is huge ecological imbalance in the nature and society. Physically and mentally the urbanites are becoming the sufferers due to various environmental degradation, pollution, fast-living culture, food habits, etc. This paper highlights the impact of urbanization on the psychological perspectives and well-being of the population.

Objectives and Methodology of the Study
The rapid increase in urbanization globally may lead to a worldwide health and social issue [1]. The paper endeavours to illuminate on the impact of urbanisation in India with emphasis on health. It tries to trace pattern of urbanisation, urban health problems and related policy issues. The paper also highlights some principles that should inform India’s approach to counter it. Researcher has used both primary and secondary sources for data collection. Primarily, through observation method, the impact of urbanisation on mental health of urbanites was explored by the researcher. The paper is also designed with rich secondary sources, and selected academic articles to comprehend and analyse the new wave of urbanisation buffeting the mental health. The secondary sources were selected based on the quality of research work articulated using the field work, case studies, analysis, etc. An attempt is also made by the researcher to discuss ‘how does urbanisation threaten mental health’ in the past, present and future.

Urban Health Hazards and Causes
The impact of urbanisation has made a huge impact on the environment. Other major trends like industrialisation, megacities etc. have polluted the society with diseases like cholera and typhoid borne from polluted water, ‘summer diarrhea’ - flies feeding on horse manure and human waste, typhus - spread by fleas/lice, contaminated food, tuberculosis and various other respiratory diseases. The main causes for the aforesaid diseases are crowded and pitiable housing conditions, poor sanitation infrastructure, scarce drinking water, child labour, improper hygiene, etc.

The health data among urban residents should be available and accessible. Urban areas are not necessarily the islands of healthy living as traditionally assumed, and the health status within those is not necessarily distributed evenly. This can be stated based on what is known about the current urban lifestyle and the urbanisation patterns. Therefore, the health data presumably would be most useful for understanding urban health problems and targeting the interventions efficiently. A wide range of urban health disorders and associated risks are due to substandard housing, crowding, air pollution, scarce or contaminated drinking water, poor sanitation and solid waste disposal services, vectorborne diseases, industrial waste, increased vehicle traffic, stress associated with poverty and unemployment, among others [2].
They have negative impact on the development of children and even effect the brain.

Mental Health of Urban Community
Mental diseases and mental instability are a typical urban phenomenon as instability and insecurity of life and mental isolation are features of the urban community. Mental disorders result due to the lack of emotional satisfaction of a person. The main feature of problem is tension, anxiety, isolation and insecurity. Some of the following cultural factors representative of urban life affect the mental health of an urbanite:
• Urban Tension: Urban life is characterised by mainly physical irritations like high frequency audios, the continuous disharmony or machinery sounds, strain caused by daily commuting, continual visual attacks on the eyes by glaring multi-coloured lights, crowd congestion in public conveyances, restaurants, departmental stores and amusement places. All these factors produce unnecessary anxiety and extra tension on the urbanite's mind, which is beyond his/her mental capacity to endure and thus affect their mental health.

• Strain from Competition: Large scale and greater extents of competitions are standard features of urban living process. Competition for jobs, for seats in educational institutions, for business orders, for customers, for patronage, for membership in clubs, for a cinema ticket etc. in short to secure anything and everything in life. As such, the loser in the competitions may put the blame on his own inability and thus develop an inferiority complex or become frustrated. Moreover, excessive competition itself puts an extra amount of strain on a person’s mentality.
• Conflicts: Conflicts are one of the innate features of urban living which is heterogeneous and complex in people’s interests, attitudes, outlooks, numerous daily contacts and variety of economic, political and social interests. Hence, a slight misunderstanding between two persons may result in a conflict. This further saps the mental energy of a human being. The equal importance given to conflicting interests and opposing points of view may create confusions in the urbanite’s mind and complicate it.
• Insecurity: A sense of loneliness and isolation are the typical features of urbanising, which breaks up cohesive community life by its very nature and leaves the individual puzzled. Individual admits a conglomeration of value systems and belief patterns without proper guidance as to their merit. The constant competition and conflict of urban life may eliminate a person at a time if he/ she show signs of weakness.

• Rapid growth of urban areas because of immigration leads too Increase in the population with poor standards of life, o Poverty, unemployment, child labour, crime, o Isolation, cultural change, estrangement, conflict,

o Poor home environment, disintegration of families, decay of aesthetic structure,
o Pollution, anxiety, depression and uncertainty of future. Hence, negatively affecting mental health of individuals, all of these factors mentioned above give rise to mental illnesses; homicide; suicide, drug abuse, accidents, coronary heart diseases,violence, etc [3].

Old Age and Urbanisation
Urbanisation alters the dynamics of society at large and family in particular. Swift urbanisation has led to a huge population of older people left behind in the rural areas to fend for themselves while the younger ones make their living in the urban areas. It means lesser availability of caretakers when old people fall sick. Generally, the rural health care services are not that well-equipped to meet the needs of older community. Even at the primary care level, the health care is clinic-based. The older people need to attend the clinic. It often involves a long journey and a longer waiting time. Comprehensive health and social care systems in the cities have made people overlook the vital caring role of families, and their need for support. Conversely, the reliability and universality of the family care system is often overestimated in developing nations. Due to the myths that persist in the society, older people are among the most vulnerable groups. Therefore, taking care of old age people has become a big social problem due to urbanisation, nuclearisation of family, migration, and dual career [4].

Women and Mental Well-Being
Women are vulnerable and often tolerate the burden of changes related to urbanization. The nuclear setup of urban areas and sheer economics has forced women to venture out. Domestic violence is also known to be prevailing highly in the cities. Women living in urban set ups of both the developed as well as developing countries are at highest risk to be assaulted by their intimates [5]. An analysis of thirteen (13) epidemiological studies in different regions of India revealed a prevalence rate of psychological disorders among the women of 64.8 per 1000 [6]. Significantly, women had higher overall prevalence rates for organic psychoses, neuroses and affective disorders than men. The working women in India have a high rate of psychological distress and the cultural factors have their contribution. Usually the mental distress among the women is unacknowledged [7,8].

Psychological Impact
‘World Health Organisation’ (WHO) investigators studied cross-country comparisons of the prevalence and correlates of mental distress using a composite analytical interview. It was found that there was a consistent pattern of mental distress prevailing in urban areas than in the rural set up. The cultural determinants play an important role in the society. The attitude towards people with mental sickness may be hindrance to the probability of reintegration. The relationship with social rank is also an essential determinant of physical and mental health and is closely influenced by cultural dynamics [9].

The rise in the probability of geographic mobility has produced an extraordinary multinational influx to urban living. The complexities of cultural aspects that impact mental wellbeing are posing both challenges and benefits to the practice of psychiatry. The pessimistic aspects of multinational immigration may however, include the deficiency in the familiarity of illness management, belief systems and unwillingness to rely on medical systems; all of these aspects may cause delay in proper evaluation and treatment [9].

Urban Design and Mood Disorder
Mood disorders are highly common and signify a leading cause of global disability. Urbanisation grasps a great civic health implication across various associated environmental, socioeconomic domains, lifestyle behavioural risks for mood disorders, especially depression [10]. According to the center for ‘Urban Design and Mental Health’ (UD/MH), compared to villages, higher rates of most mental health issues are found in the cities, as over 20 percent more of anxiety, almost 40 percent higher risks of depression, and double the risk of schizophrenia, in addition to stress, seclusion and loneliness. In the Indian scenario, we can experience to observe the impact of urban design on physical well-being, and only few scholars/ experts recognize how the poorly designed cities contribute towards poor mental health. The COVID-19 pandemic has emphasised on relevance of public sphere for our well-being, both in terms of maintenance of people’s health and reducing the risk of infection with friendly urban design (infrastructure), having wider pedestrian paths in maintaining proper social distancing. (UD/MH). The urban planning can support mental well-being. The view of scenic beauty from above the buildings and apartments seem to have many positive changes in reducing loneliness and promote social interaction because of increased access to quality, and well maintained green spaces with plant and animal life diversity. The architects must consider mental health as one of the prime objective in urban planning and also to consider integration of physical activity into people’s routines by safe walkways, street connectivity and good public transport.
(Layla McCay. Director, UD/MH-London).

Findings and Discussion
The 2018 Revision of World Urbanization Prospects produced by the Population Division, United Nation, Department of Economic and Social Affairs, highlights that, future increase in the size of the world’s urban population are expected to be highly concentrated in India, China and Nigeria, that will account for 35 percent of the projected growth of the world’s urban population between 2018 and 2050. By 2050, it is projected that India will have added 416 million urban dwellers [11]. Developing nations have many concerns, including hygiene and sanitation that are of more significant focus in the world of public health. Much of the mental health problem that coincides with urbanization has been exacerbated throughout the region by little government spending on aid and resources [12]. Living in urban setup is a complex and difficult to define phenomenon. The findings based on the qualitative research method, reveal that; urbanisation has affected the entire gamut of population, especially the socalled vulnerable section (children, women and elderly) [13]. It has brought profound changes in the pattern of family life and social organisation. Critically, there is higher risk of developing mental illness in adulthood, especially at old age if we spend in longer in an urban environment from birth to adolescence. In accordance of this view, when people have admittance to high quality housing, the frequency of despair contained by urban areas is found to be lesser. The rise of nuclear families makes especially urbanites vulnerable to psychological trauma and to mental disorder. ‘The Mental Health Context’ report by WHO has specified that, mental disorders account for nearly 12 percent of the global burden of disease. It is estimated that about 150 million Indians are in need of active psychiatric intervention. Consequentially, for the urbanites many following factors are considered for the disturbance of peaceful life with- poverty, fluctuating socio-economic status, crimes, sexual violence, pandemics, etc. are all associated with depression, psychological disorder, aggression, dementia, family disintegration, etc [14]. As a result, with such a scenario, urban India is likely to share global health challenge in the upcoming years and the odds of some of the health disorders/pandemics that have merely an urban profile, need to be addressed separately as urban health issues.

Implications and Recommendations of Policies

The study highlights the direct and indirect effects of urbanization on mental health of various populations and emphasizes the need to develop individual level and policy level strategies to manage problems arising out of the same [15]. Before health care providers can design effective programmes to improve mental health among general populations, they need to identify relevant factors that are related to good and/or poor mental health [16].
‘Mental Health Care Act, 2017’ of India mandates that, every person with mental illness shall be treated as equal to persons with physical illness in the provisions of all health care [17]. The ‘Ayushman Bharat’ (Healthy India) initiative launched in 2018 aims to provide comprehensive primary health care and health insurance coverage for non-communicable diseases including mental disorders, which could contribute to reducing the adverse effect of mental disorders at the population level [18].
‘Human Health Care’ (HHC) is said to be the supreme for various sectors addressing urbanisation. Two main areas that need greater attention are listed below:
• The availability, accessibility and relevance of health data and its usage to inform policy, target and evaluate the involvement and implication. Further exploration for the description and quantification of connection between environmental hazards and human health effects.
• Secondly, in effective partnering across wide range of sectors, there is need for attention and action to look after urban health. Since there is a significant health inference, the planning and actions taken in vast range, the health sector needs to be integrated in urbanization process
which includes planning in association with urban zoning authorities, environmental regulators, housing board officials, energy and transportation sectors, corporation service providers, etc.
As suggested by ‘National Commission on Labour’, there should be a regular periodical medical check-up of all the employees from time to time. Moreover, malnutrition and the insanitary conditions of living are the main causes of bad health and thereof, efforts should be made towards improving the diet and housing conditions first, rather than concentrating mainly on the improvement of medical facilities.

To Sum Up
Critically, the longer you spend in an urban environment during childhood and adolescence, the higher your risk of developing mental illness in adulthood. This ‘dose-response’ association provides indirect support for a causal relationship between urban living and mental illness [19]. The health of population dwelling in cities needs urgent interest and consideration. To enable the local authorities to offer the most basic setting for healthiness such as safe environmental conditions, housing, employment and security, the urbanisation should not progress with improper planning. The health and hygiene aspects of any city are of utmost importance to keep it clean as well. Mental distress is new challenging issue and is the one that requires urgent attention. For this issue to be successfully tackled, a broad understanding of societal classes, including the individual and related factors is essential. Hence, such an approach is sequential with the contemporary thoughts of urban health study suggesting that an integrated approach and acknowledging the intricacy of urban health issues is termed to be the futuristic need.

I am overwhelmed in all gratefulness to acknowledge my depth to all those who have helped me to put these ideas, well above the level of simplicity and into something concrete. Thank you all.
Funding Acknowledgment
I have not availed any financial support in preparation of this research paper from any sources.

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Conflict of Interest
I (The author) declare that there is no conflict of interest.


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