skip to content

(Mega)Urban Health: Health Disparities and Access to Health Care Services in Pune/India

Title: „(Mega)Urban Health: Health Disparities and Access to Health Care Services in Pune/India"

Project leader: Prof. Dr. Frauke Kraas, University of Cologne

Contact persons: Carsten Butsch, Mareike Kroll (University of Cologne)

Research partner: Prof. Dr. Erach Bharucha, Institute of Environment Education and Research, Bharati Vidyapeeth University, Pune

Project duration: 01.03.2007 – 31.12.2012

Keywords: Health system / health status / access to healt care / megacities / health governance

Research discipline: Urban Geography, Geography of Health and Health Care, Development Studies


The increasing interest in urban health is primarily related to the "urban turn" our global society is currently witnessing. This leads to a situation in which urban habitats – with their specific influencing factors on human health – are the living environment for half of our plant’s population. The manifold and complex effects of urbanisation on health range from extremely positive (e.g. availability of health infrastructure and special medical services, societal plurality) to extremely negative (e.g. environmental degradation, lack of hygiene, overstress of the health system) ones. Due to the high urbanisation dynamics, congestion of infrastructures and the physical environment today is the norm of megacities in newly industrialising countries. This is mainly associated with a loss of governance that can be observed in these fast growing agglomerations. The effects of these dynamics on human health and the access to health care facilities are in the focus of the project.


The broad field of human health, consisting of the complexes “health status”, “health system” and “access to health services”, is mostly addressed from a strongly polarising point of view. Often a dichotomy of “urban” (good supply/ better health status) versus “rural” (undersupplied/worth health status) health is – at least implicitly – postulated. This assumption often hinders a differentiating reflection on the provision of health care services in urban areas or the analysis of epidemiological profiles of different population groups. Taking the example of Pune as a fast growing metropolis, the goal of the research project is to analyse megaurban health from two different perspectives (i.e. from the perspective of "demand" and "supply"): (A) from a public health perspective the project strives to identify health disparities between different socioeconomic groups and (B) from a health system perspective to explain why differences in access to health care services exist and in which way certain barriers and facilitators influence the access behaviour.


Butsch, C., Kroll, M., Kraas, F., Bharucha, E., 2015. How does rapid urbanization in India affect human health? Findings from a case study in Pune. Asien 134: 73-93.

Kroll, M., Bharucha, E., Kraas, F., 2014. Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India. Global Health Action 7: 23447.

Butsch, C., Bork-Hüffer, T., Kroll, M., 2014. Menschliche Gesundheit in den Megastädten Indiens und Chinas. In: Universitas 69 (815), 40-58.

Butsch, C., Kroll, M., Bork-Hüffer, T., 2014. Megaurban Health in Developing and Newly Industrializing Countries. In: Michalos AC (Ed.), Encyclopedia of Quality of Life and Well-Being Research. Springer, Dordrecht, Netherlands, 3981-3985.

Kroll, M., 2013. Gesundheitliche Disparitäten im urbanen Indien. Auswirkungen des sozioökonomischen Status auf die Gesundheit in Pune. Stuttgart.

Butsch, C., Kraas, F., Kroll, M., 2012. Gesundheit für alle? MDGs am Beispiel von Mumbai. Geographische Rundschau 11, 36-42.

Butsch, C. 2011. Zugang zu Gesundheitsdienstleistungen. Barrieren und Anreize in Pune, Indien. Stuttgart.

Kroll, M., Butsch, C., Kraas, F., 2011. Health inequities in the City of Pune, India. In: Krämer, A, Khan, M, Kraas, F. (Eds.), Health in Megacities and Urban Areas. Springer, Heidelberg, 263-277.

Butsch, C., Kroll, M., Bork, T., 2010. Health Challenges in Megacities - Examples from India and China. Geographische Rundschau International Edition 6 (2), 20-25.

Bork, T., Butsch, C., Kraas, F. und M. Kroll (2009): Megastädte. Neue Risiken für die Gesundheit. In: Deutsches Ärzteblatt 106 (39): 1877-1881.

Butsch, C. (2008): Access to healthcare in the fragmented setting of India’s fast growing agglomerations – a case study of Pune. In: Bohle, H.G. und K. Warner (Hrsg.): Megacities. Resilience and Social Vulnerability. Source No. 10: 62-72.