The overarching goal of this thesis is to explore and assess infrastructure-environment-health interactions in Indian cities, addressing social factors such as wealth and literacy, as well as the provision of multiple infrastructures.
Five main studies are conducted. First, exploration of Delhi all-cause mortality data and survey of local experts on associations between infrastructures, environment, and health outcomes. Key findings include: a) that 50% of deaths in Delhi are reported with cause not classified (demonstrating the need for bottom-up study to supplement hospital data) and b) that ~19% of classified deaths by cause in Delhi, India could be related to infrastructure or infrastructure-related environmental factors.
Second, review of epidemiology studies relating health outcomes to infrastructure and pollution exposure in Indian and Asian cities is conducted to help identify initial evidence and gaps for infrastructure-related health effects and quantification of differential risk based on social factors (e.g. low socio-economic status (SES)).
Third, top-down analyses using national survey of under age-five mortality rates (U5MR) by multiple infrastructure conditions are studied while addressing confounding social factors. A key finding is that the relative risk for under-five mortality rates are 860% higher in Urban India for those lacking multiple basic infrastructure provisions relative to improved conditions for low SES condition and limited literacy households. These analyses demonstrates limited literacy household sensitivity and importance of considering multiple infrastructures together over single infrastructure improvements.
Fourth, bottom-up comparative community study helps characterize infrastructure, environment, extreme weather conditions and local sustainability priorities. A key finding was that households deprived of infrastructure provisions would prioritize that first over pollution or extreme weather conditions. In addition, both low SES communities studied were different in their coverage of all infrastructures except cooking fuels. In the high SES area, infrastructure conditions were ranked as a highest priority (e.g. drainage) with pollution and climate-related extreme weather events still higher priorities than low SES areas, which selected water supply, parks and open space, and drainage as highest priorities. Multiple dimensions of access to healthcare conditions in the same neighborhoods were explored next with findings indicating the two low SES areas to have similar travel costs to reach care and different abilities to pay for care. The high SES area also had higher accessibility to care yet with quality of care less acceptable relative to low SES areas that had issues with wait times, affordability, and access- suggesting future study should address such factors and effects on health outcomes.
Finally, data availability, needs, and challenges are explored for computing health benefits of multiple infrastructure interventions, while also identifying preliminary intervention scenarios and who may benefit more or less by age, gender, and SES.
These efforts offer a preliminary approach to helping prioritize future decision-making in Asian cities by demonstrating initial methods that can be useful for modeling risks and interactions between infrastructure provisions, environment, and health.
|Advisor:||Ramasawami, Anu, Silverstein, JoAnn|
|Commitee:||Agarwal, Siddharth, Main, Debbi, Marshall, Wes, Ramaswami, Anu, Silverstein, JoAnn|
|School:||University of Colorado at Denver|
|School Location:||United States -- Colorado|
|Source:||DAI-B 75/10(E), Dissertation Abstracts International|
|Subjects:||Civil engineering, Public health, South Asian Studies, Sustainability, Urban planning|
|Keywords:||Health equity, India, Infrastructure, Sustainability, Urban environment|
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