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Patel and Pradhan

equality in infrastructure and services (Riha, Karabarinde, Ssenyomo, et al., 2014), more so in less developed countries,
due to the inconsistent definitions of what constitutes an urban area and the lack of data (Montgomery, Stren, Cohen, et
al., 2003). Urban exposure is an immediate means of studying the unique features of urban areas, their association with
health, and their synergy with climate change (Allender, Foster, Hutchinson, et al., 2008; Novak, Allender, Scarborough,
et al., 2012; Angkurawaranon, Wisetborisut, Rerkasem, et al., 2015). Several studies have focused on the urbanicity scale
as a measure of urban exposure and its association with health (Novak, Allender, Scarborough, et al., 2012; Cyril, Oldroyd
and Renzaho, 2013; Riha, Karabarinde, Ssenyomo, et al., 2014; Sothmann, Krumkamp, Kreuels, et al., 2015).
There is no scientific study assessing the inequalities in urban exposure, especially the availability of infrastructure and
the provision of services in the million-plus cities of India. The present study aims to fill this research gap by estimating the
urban city-scale for the million-plus cities. Efforts are also there to assess selected child health status and its association with
available environmental indicators in some million-plus cities. The results are expected to be of use for urban planning and
for understanding the possible long-term impact of climate change in the studied cities. The results may also be of importance
in assessing the sustainability of these cities, providing real opportunities to mitigate and adapt to the effects of climate
change, which is accepted by the United Nations as a sustainable development goal (SDG-13) to be achieved by 2030.
2. Data and Methods

2.1. Data
The present study used data from the towns directory, household files, and the Primary Census Abstract of the Census
of India 2011 to construct the urbanicity scale. The Census of India is the primary official source of data on the urban
population. It provides statistics on state and town- or city-level estimates of the urban population and also estimates on the
availability of infrastructure and services in those localities. The 15 Indian National Census was conducted by the Office
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of the Registrar General, Government of India, in 2011 (ORGI, 2011). Census 2011 covered all the 28 states and seven
union territories, including 640 districts, 497 cities, 5767 tehsils, and 640,867 villages. The Census was conducted in two
phases – house listing and population enumeration. The house-listing and population census provide extensive information
on the status of the population settlements, the housing characteristics, and the primary assets and necessities of the
households. The Census of India provides information on a wide range of socioeconomic and demographic characteristics
at the community, household, and individual levels. In addition to the census data, the present study used indicators of
climate (mean temperature [maximum and minimum] and mean rainfall) for the selected cities as provided by the India
Meteorological Department. Pollution data from the Central Pollution Control Board and the World Health Organization
(WHO) Global Ambient Air Quality Database were also used to understand the climate conditions of some selected cities.
There were 53 million-plus cities in India in 2011, but only 40 of them had more than one million population, whereas the
rest had agglomeration population. The present analysis was restricted to the 40 million-plus cities.

2.2. Measurements of Exposure and Environments

2.2.1. Urbanicity scale measurement
The urbanicity scale was initially developed and used in the Philippines by Dahly and Adair (2007) and in India by Allender,
Lacey, Webster, et al. (2010). Urbanicity, also called urbanness or urbanism (Dahly and Adair, 2007; Allender, Lacey, Webster, et
al., 2010), is a broad concept that measures urban environments, health, and related issues. The urban exposure is influenced by
the population composition, physical environment, social environment, availability of, and access to health and social services
and all these are assessed through the urbanicity scale. The urbanicity scale helps highlight the differences and variations in the
levels of urban exposure among the large million-plus cities. Following a review of the literature, we selected an existing multi-
component urbanicity scale based on the availability of data. The scale used in the present analysis comprised of the following
seven components: Population size, economic activities, built environment, communication, educational facilities, health
facilities, and diversity. Specifically, information on population size; density; proportion of population involved in agricultural
activities; availability of paved roads, sewage system, flush latrines, electricity, television sets, mobile phones, theaters, public
phones, and public internet; literacy rate and availability of educational facilities; availability of health facilities, number of beds,
doctors, para-medical staff; and households having good quality houses and tap water was used to construct the urban city scale.
The selected domains and variables for calculating urban city-scale were based on the literature review and availability
of data from Indian Census. The scale scoring is modeled from Dahly and Adair (2007), Jones-Smith and Popkin (2010),
and Novak, Allender, Scarborough, et al. (2012). At the final stage adopted the Riha, Karabarinde, Ssenyomo et al., (2014)

International Journal of Population Studies | 2020, Volume 6, Issue 1 17