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Patel and Pradhan

Figure 2. Spatial distribution of urbanity level for million-plus cities of India, 2011.

defecation and promoting scientific management of municipal solid waste in statutory towns (Ministry of Housing and
Urban Affairs). The smart cities initiative aims to develop the necessary infrastructure and services based on a resilient
sustainable model. However, the findings of the study reveal that these cities are far from achieving the strategic goals
under SDG 13 (United Nations, 2017).
Environmental condition is directly associated with health. The study found that the temperature and rainfall of these
cities are changing over time and vary across cities. Inconsistent rainfall and increasing temperature will work adversely
for cities often known for high density and poor urban planning. Although this study found, the inconsistent association
between selected child health indicators and air pollution in selected million-plus cities, there is enough evidence
highlighting their significant inverse association (WHO, 2017; Christian, Zubrick, Foster, et al., 2015).
The strengths of this study are that it is the first attempt to estimate the urban exposure level in 40 million cities in
India. The urbanicity scale highlights the differences and variations in the levels of urban exposure among the large
million-plus cities. It is also helpful to understand; why and how urban settings are predisposed to health. The urban city
scale can be useful for a better understanding of the process of urbanization and its relationship/association with health
and development in urban areas. Results also highlight which indicators have a more significant impact on health and
sheds light on the potential policy interventions to improve urban infrastructure and programs for combating health issues
related to urbanization. The study findings may also help to develop resilient cities to mitigate or minimize the effects of
climate change.
One of the limitations of this study is that the urbanicity scale gives information only for a particular point of time,
whereas urbanization is a long-term process. Thus, the conclusions are based on the scale scores without a historical
perspective on the resilient development of the cities and climate change. Another limitation is that the Census data do
not provide information on health and climatic conditions, which would be useful to understand the association between
urban exposure and diseases. Finally, the variables used for the development of the urbanicity scale may have an internal
association.

International Journal of Population Studies | 2020, Volume 6, Issue 1 23