Tackling The Diabetes Explosion In India
““Focusing on increasing the physical activity levels of individuals is unlikely to counter this epidemic. Interventions at the population level are required, and this means an Indian way of imagining, building, and running our cities.””
A 2023 ICMR-led study has found that over 100 million (11.4%) Indian have diabetes. Another 136 million are living with pre-diabetes (15.3%).
In a little over a decade, the numbers have doubled, leading to a diabetes explosion.
One major reason for this is a lack of physical activity in the daily lives of Indians. Therefore, inducing physical activity in the lives of Indians, particularly the pre-diabetics, is one quick way of immediately tackling the impending diabetes explosion.
The problem? To make populations active.
Typically, we view this as a problem of making individual humans more active. There is, however, another side to this: people can be induced to become physically active by creating an environment that encourages activity in their leisure time. The environment can do this by giving them choices to plan an exercise regimen, or just include in their daily routines.
What are some specific ways to make our cities more walking-friendly?
1. Construct parks or walking pathways within reach of all localities in the city, meaning that residents should be able to reach them within 10 minutes (1/3 mile distance)
2. In order to increase park/walking path usage, ensure the safety of visitors, provide water bodies and play equipment for children in parks, and landscape the walking paths. It has been found that children play more in parks with play structures, as compared to open fields. Parents bring children to parks if they are safe, toilets and drinking water is available, the park is well-lit, and shade-providing trees are present.
3. For people who have a preference for vigorous physical activity, create courts and playgrounds for two or more localities, and sports complexes for five or more localities. Walking pathways should always skirt these as well.
4. Ensure that footpaths in all localities are wide, easy to get onto, unobstructed to pedestrian movement by trees or transformers, street lights burn in the night and are seamlessly connected to shops and bus stops/metro stations. Well-maintained street crossings encourage children to walk.
5. Encourage the development of social ties in the locality, as these play a crucial role in encouraging physical activity in the elderly, children, and women.
Creating social zones
A sixth way to make Indian cities more walking-friendly is to divide all roads into two - traffic zones and social zones. In practice, this would mean:
• The traffic zones would continue to be planned on the 3Es model: enforcement, education, and engineering. The underlying assumption is that traffic will flow smoothly if traffic rules are enforced, the public is educated, and roads are upgraded to standards in transport engineering/planning.
• In the social zones, vehicle movement, and walking would be combined.
• The combination would be based on Woonerf principles developed by Niek de Boer and Joost Vahl in the Netherlands. Concretely, this means that in social zones, street traffic would flow with pedestrian movements, children’s play activities, and social activities.
• The guiding principle of social zones would be “ambiguity and urban legibility” in street design. There would not be any warning signs, road markings, and traffic signals. Surface treatment, lightning columns, and junction corners would be squared-up. The purpose is to make the intersection resemble the center of the Indian town or to create a public realm.
• Shared space is another fundamental Woonerf principle that would be applied to transform busy traffic intersections. No mode of transport is given priority and pedestrians, buses, cars, and trucks used eye contact to negotiate the junction. Despite giving the impression of chaos and disorder, this is untrue, because different types of traffic mingle using eye contact and care for other types of transport. No police regulation or control is visible and traffic movement depends on informal convention and legibility.
The Woonerf principles were applied in Christiansfeld, Denmark, and the Friesland market town of Oosterwolde, as well as the “Home Zones” programme in the UK. Expectedly, the number of killed or seriously injured (KSI) during the last three years was reduced to zero. Moreover, traffic backups were reduced. Compared to junctions that have traffic signals, ambiguous junctions prevent accidents, reduce delays, and are cheaper to construct and maintain. In the city of Christiansfeld, the number of deaths or serious injuries during a three-year period was reduced to zero.
Denting the diabetes epidemic
The problem of diabetes is so huge and increasing so quickly that it can be labeled as an epidemic whose effects are felt in the long run, especially in terms of increasing costs of diagnostics, medicines, loss of productive days, and income. Focusing on increasing the physical activity levels of individuals is unlikely to counter this epidemic. Interventions at the population level are required, and this means an Indian way of imagining, building, and running our cities.
Making Indian cities more walkable with the creation of social zones would be a unique contextual way of inducing physical activity into the daily life of large populations of India and making a dent in the diabetes epidemic.
