br India is rapidly becoming urbanised By around
India is rapidly becoming urbanised. By 2030, around 40% of the country\'s population will live in urban areas. The extent to which India\'s health system can provide for this large and growing city-based population will determine the country\'s success in achieving universal health coverage and improved national health indices. In , Sundeep Salvi and colleagues offer a glimpse into India\'s urban health situation by reporting on the medical symptoms and diagnoses and the characteristics of patients who sought treatment from qualified primary health-care practitioners across 880 cities and towns on one day in 2011. This study provides a national perspective on the state of both population health and health systems in the context of an increasingly urban India. The distribution of illness and diagnosed conditions reported in the POSEIDON study furthers understanding of the urban disease burden. Hypertension, an important risk factor for cardiovascular disease, was the most commonly diagnosed medical condition at urban primary care practices. Alarmingly, the researchers noted that one in five patients diagnosed with hypertension was younger than 40 years. These data accord with 2013 Global Burden of Disease findings that high blood pressure is the leading risk factor in attributable disability-adjusted life-years (DALYs) in India. That there are such high rates of hypertension in younger people has important implications for premature death and disability in the most productive years of life, with economic effects that would extend to the dopamine antagonist drugs supported by these people. Furthermore, there are national economic losses to consider with the premature death of people in the middle of their working lives. Urban India has a high concentration of health-care providers, yet, as the POSEIDON researchers explain, not everyone has easy access to health care. The data on patients\' characteristics highlight two urban health system issues that have received inadequate attention. First, more than half of patients visiting a doctor were male, despite the expectation that women would represent most of the patient load. There are several possible explanations for why there were fewer female patients than male patients reported. That gynaecologists were not included in the study sample meant that visits by women to this kind of practitioner were not captured by researchers. Second, issues such as lack of empowerment and financial barriers to accessing health care will affect women more than men. And third, the difficulty in accessing care from a female doctor might limit the willingness of women to seek care: one study estimated that only 17% of doctors in India are women. Issues of access to health care also affect older people. Although national surveys show that reports of ailments increase with age, only 7–9% of the visits recorded by Salvi and colleagues were made by patients older than 60 years, suggesting that older people are under-represented in the study. Given the abundance of health-care providers in urban India, the reasons behind the low proportion of older patients reported might be because of physical impairments that make a visit to a health provider difficult, or the lack of financial resources to pay for health care. With life expectancy increasing across India, the issues of access and affordability of health care for older people will only become more important.
Family planning programmes in low-resource countries have notably expanded access to modern contraception. The modern method contraceptive prevalence rate (MCPR) is now 56% in UN-designated least developing regions (61% in developed regions). In least developed countries, the rate has risen from negligible proportions in the 1970s to 30% in 2011. A bedrock principle of family planning programmes is to ensure individuals and couples seeking contraception are able to make a voluntary and informed choice from a wide range of methods to meet their reproductive goals. This principle was endorsed by 179 countries in the Programme of Action of the 1994 Cairo International Conference on Population and Development, and has been reiterated often. There is also longstanding international consensus on the importance of gender equity. From the standpoint of vasectomy (male sterilisation), however, there has been a disconnect between stated commitments to choice and equity and programme realities.