Urban Green Space, Health Economics and Air Pollution in Delhi 9780367352691, 9780367710217, 9780429340581

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Urban Green Space, Health Economics and Air Pollution in Delhi

This book looks at the ecological stress on cities and engages with challenges of reducing vulnerabilities and risks of pollution on the health, wellbeing and livelihoods of people living in developing countries. Cities are the world’s highest energy consumers and the biggest producers of toxic wastes and pollutants. With an emphasis on the environmental issues facing the city of Delhi, the volume focuses on steps to preserve and manage the city’s urban green spaces. It explores the concept of urban green spaces and their economic, social, health, and psychological significance in cities. Drawing from their fieldwork and research in Delhi, the authors identify the sources of pollution in the city and assess the role of urban green spaces in countering adverse effects. They further examine the relationship between green spaces and social and economic development, urban health, and urban governance. They highlight the good practices followed by other global cities. The volume also offers suggestions and policy recommendations to reverse and recover ecological balance in cities. This book will be of interest to students and researchers of environment and ecology, public health, urban planning and governance, development studies, urban geography, urban sociology, resource management and health economics. It will also be useful for policymakers, and NGOs working in the areas of sustainability, urban planning and management and environmental preservation. Swati Rajput is a faculty member in the Department of Geography, Shaheed Bhagat Singh College, University of Delhi. She has 20 years of experience teaching geography in Delhi University. Her subject expertise includes environment, agriculture, urban and tourism geography. She is the editor of the book, Sustainable Smart Cities: Challenges and Future Perspective. She was awarded as the National Resource Person in Social Sciences by the Ministry of Human Resource Development and United Nations FPA. She has contributed to various national and international books and peer-reviewed journals. She has also recorded various modules for e-PG Pathshala and Massive Open Online Courses (MOOC) (National Institute of Open School

[NIOS]) under a Ministry of Human Resource Development (MHRD) initiative. She is a Gold medallist (Delhi University) and rank holder throughout academics. Kavita Arora is the author of a book Indigenous Forest Management in Andaman & Nicobar Islands, India. She has published her research in many reputed journals. She earned her Ph.D. in Political Geography from Jawaharlal Nehru University, New Delhi. She got Post -Doctoral Fellowship from Indian Council of Social Science Research (ICSSR), New Delhi and Rajeev Gandhi Institute of Contemporary Studies (RGICS), Rajeev Gandhi Foundation, New Delhi. She is currently working as an assistant professor of Geography at Shaheed Bhagat Singh College, University of Delhi, India. A political geographer with interests in development and environmental issues, her research focuses on forests, gender, indigenous knowledge, transborder conservation and the socio-political dimensions of development. Rachna Mathur is an assistant professor in the University of Delhi. She has been teaching economics for the last 13 years. She did her Ph.D. in Health Economics. Her areas of interest are health economics, money and financial markets and financial economics. She has published many research papers and presented papers in national and international conferences.

Urban Green Space, Health Economics and Air Pollution in Delhi

Swati Rajput, Kavita Arora and Rachna Mathur

First published 2021 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2021 Swati Rajput, Kavita Arora and Rachna Mathur The right of Swati Rajput, Kavita Arora and Rachna Mathur to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this book ISBN: 978-0-367-35269-1 (hbk) ISBN: 978-0-367-71021-7 (pbk) ISBN: 978-0-429-34058-1 (ebk) Typeset in Sabon by SPi Global, India

Contents

List of Figures vi List of Tables viii Preface x Acknowledgements xiv Introduction 1 Urban green spaces: Concept and significance

1 8

2 Green spaces of Delhi: A journey from past to present

35

3 Level and extent of air pollution in Delhi

59

4 Health challenges in Delhi

89

5 Healthcare management: Investment and expenditure

107

6 Green health insurance for urban areas: Willingness to pay

139

7 Conclusion and suggestions

159

Index 175

Figures

I.1

Simplified model of linkage between green space, air pollution and health economics 2 1.1 Green spaces in world cities 22 1.2 Vertical green pillars along metro lines 26 1.3 Exhibition of kitchen garden practices 27 1.4 Migratory birds in Yamuna Bio-diversity Park in Delhi 28 1.5 Green cities and their remarkable features, as per the Economist Intelligence Unit 28 2.1 Green spaces in Delhi, 2002 49 2.2 Green spaces in Delhi, 2015 50 2.3 Green spaces in Delhi, 2018 50 2.4 Spatiotemporal change in agricultural land, parks and vegetation (including TOF) in 2002 and 2015 52 2.5 Location of selected parks in Delhi 53 2.6 NDVI for Delhi, 2016 54 2.7 NDVI for Delhi, 2018 55 2.8 Potential green spaces in Delhi, as proposed by several authorities 56 3.1 Registered private vehicles in million-plus cities, 2017 66 3.2 Registered vehicles in Delhi 67 3.3 Fuel utilisation in Delhi 68 3.4 Types of industries in Delhi 70 3.5 Distribution of factories 71 3.6 Industrial fuel consumption 71 3.7 Road length in Delhi 74 3.8 Delhi heat stress May 2000–2016 79 3.9 Temperature distribution in Delhi, 2016 80 3.10 Concentration of PM2.5 in Delhi 81 3.11 Concentration of PM10 in Delhi 82 3.12 Distribution of carbon dioxide in Delhi 83 4.1 Life expectancy in megacities of the world 91 4.2 Infant mortality rate in world megacities 92 4.3 Diseases in Delhi (zonewise) in per cent 97

Figures vii

4.4 4.5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 6.1 6.2 6.3 7.1

Preference for environment friendly products 100 Preference of ecofriendly products and educational level 101 Vicious circle of health investment and management 108 Virtuous circle of health investment and management 109 Healthcare providers in India 111 Healthcare providers in urban and rural India 111 Investment on health in different plan periods (percentage of total plan investment) 114 Government expenditure on health as percentage of GDP in 12th Five-Year Plan 114 Health expenditure by healthcare providers in India 115 BRIC countries health expenditure per capita (US$, 2015) 117 Government and voluntary health expenditure as percentage of GDP, 2017 118 OOP expenditure (as percentage of total current health expenditure) of major regions of the world, 2015 121 Percentage of OOP expenditure and percentage of government expenditure on health, 2015 122 Choice of hospitals for healthcare service by the people in Delhi 130 Income levels and choice of hospitals (percentage of respondents) 130 Number of earning members and choice of hospital 131 Level of education and choice of hospital 132 Monthly expenditure on preventive healthcare (rupees) 133 Willingness to pay for health insurance 133 Number of family members and WTP for health insurance 134 Frequency of occurrence of disease and WTP for health insurance 135 Level of education and WTP for health insurance 136 Family income and WTP for health insurance 136 Individuals’ WTP for an improvement in health status from U0 to U1 while still maintaining the same level of well-being 141 Demand curve showing WTP for green insurance for given BIDS 153 Demand curve for amount respondents are willing to pay for green insurance 156 Green infrastructure, health economics and development 173

Tables

3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 4.1

Impact of pollutants on trees and plants Gases emitted by different types of industries in Delhi Sources of PM10 and PM2.5 Health impacts of construction material Selected heat stress indices temperature limits Heat stress in Delhi, 2016 Temperature and pollution (PM2.5) regions of Delhi Temperature and pollution (carbon dioxide) regions of Delhi Report on National Air Quality Index and Health Impact, Central Pollution Control Board 4.2 Details of vector-borne diseases in Delhi, 2010–2018 4.3 Major cause of death in Delhi, 2018 4.4 Major environment problems in your area 4.5 Disease that family members suffer from 4.6 Types of preventive healthcare 4.7 Ecosystem services derived from green spaces 4.8 Test statistics for the regression model for the preference for EFP 4.9 Test statistics of the regression model of choice for EFP 4.10 Assessing the health satisfaction level (percentage of respondents) 5.1 Trends in centre–state share (Per cent) in total public expenditure on health 5.2 Public expenditure on health as percentage of GDP across World Bank income groups (2015) 5.3 Current health expenditure per capita (USD), 2015 5.4 Public expenditure on health as percentage of GDP for South East Asia Region (SEAR) Countries, 2015 5.5 Government and voluntary health expenditure as percentage of GDP, 2017 5.6 Breakdown of out-of-pocket payments by Indian households on healthcare (in percentage) 5.7 OOP expenditure (as percentage of current health expenditure in different countries) in 2017

63 69 72 73 78 81 85 86 93 94 94 96 97 98 99 102 103 105 113 116 116 117 119 120 123

Tables ix

5.8 Healthcare financing schemes, 2014–2015 (percentage of total) 124 5.9 Expenditure on health with reference to GSDP 127 5.10 Percentage of plan expenditure on health sector by Government of Delhi 128 6.1 Descriptions of variables for the study of WTP for green insurance 145 6.2 Classification table for binary logistic in Step 0 (initial step) 148 6.3 Variables in the equation 148 6.4 Variables not in the equation 148 6.5 Omnibus tests of model coefficients 149 6.6 Classification table for binary logistic WTP for green insurance 149 6.7 Model summary of binary logistic regression 150 6.8 Variables in the equation showing the determinants for participating in the green insurance scheme 151 6.9 Percentage of respondents willing to pay the proposed BID amount for green insurance in Delhi 152 6.10 Willingness to pay for green insurance for proposed BIDs 152 6.11 The amount respondents are willing to pay for green insurance, using the regression model 154 6.12 Test statistics of the amount respondents are willing to pay for green insurance, using the regression model 155 6.13 Amount respondents are willing to pay for green insurance, using the open-ended question 156

Preface

The human species has marked its presence on the Earth by reshaping the landscapes with numerous social and economic activities. Urbanisation is inevitable in the modern world. Cities have become symbols of human dominance and triumph. Agriculture and industry are two strong pillars of human establishment. Industrial development led to massive urbanisation worldwide. After the 1990s, tertiarisation shaped the emancipated megacities. The reckless behaviour of man has hampered the urban ecosystem by misusing and abusing the natural resources, especially in cities. Growth in number of cities and population residing in them has shown a drastic increase in the last century. Cities occupy nearly 3 per cent of the world’s land and accommodate around 55 per cent of its population. The increase in concentration of population in limited areas has pressurised the natural biomes. Asia has some 48 per cent of its population residing in urban areas. India, China and Nigeria contribute to 37 per cent of urban population in Asia and Africa together. Tokyo is the world’s largest city with an agglomeration of 38 million inhabitants, followed by Delhi with 25 million, Shanghai with 23 million, and Mexico City, Mumbai and São Paulo, each with around 21 million inhabitants. By 2030, the world is projected to have 41 megacities with more than 10 million inhabitants (UN, 2014). The huge increase of population in cities has led to contraction of agricultural land, forest land and other open spaces. Green spaces are imperative for healthy growth of cities and its residents. Green spaces in cities have social, psychological and health impacts. These spaces are essential for the residents to breathe fresh and clean air. Trees are very important elements of the sustainable urban ecosystem. Due to various developmental activities like building of roads, rails, housing and commercial complexes etc, green spaces are reducing in the city and have become last in the priority list of the planners and policymakers. Cities are considered to be the engine of economic growth, but now they are turning into symbols of unsustainable growth, especially in the developing nations of Asia and Africa. The Greenpeace Report, 2018, says that India has 22 of the 30 most polluted cities of the world, and Gurugram is reported to have the most

Preface xi

polluted air of the world. Coal burning and vehicular emissions are the most common and major contributors to air pollution in the Asian cities of India, Pakistan and China. The report adds that around seven million people die every year in the world due to air pollution. According to Sandifer et al. in 2015, ‘The roles of Urban Green Spaces in supporting biodiversity and the linkages among biodiversity, human health and ecosystem function have so far received insufficient attention’. This book tries to explore several aspects of the linkages between green spaces, air pollution and health in Delhi. Nearly 97 per cent of Delhi’s population lives in its urban areas. Delhi has a population density of 11,297 persons per sq. km. It is considered to be among the most polluted yet greenest capital cities of the world. Twenty per cent of its area is vegetated, but even with the availability of 21 square metres of green area per person (Forest Survey of India, 2016), it has miserably bad air. Green spaces in Delhi have not been planned properly. Air pollution has become a major issue of concern. The residents of Delhi are breathing the worst quality air. The city lacks an effective plan to curb the issue. Numerous saplings were planted before the 2010 Common Wealth Games in South and South West Delhi, brought from different countries like China, Sri Lanka and Malaysia. Biodiversity parks and the city forest are also being created and maintained; yet, the citizens of Delhi suffer from numerous health ailments. Vehicular pollution, industrial pollution, pollution due to waste disposal and power generation are among the major culprits. The book begins with introducing the concept of green spaces and their significance. By focusing primarily on Delhi, the book covers a past-to-present journey of green spaces in it. It later discusses the challenge of depleting green spaces and increasing air pollution, by explaining the link between the two. The book also emphasises upon the financial and economic aspects linked to the human health level in Delhi. The solution lies in adopting a holistic approach. The government is generally forming short-term policies and attempting to just bandage the wounds. It should rather focus on a pragmatic approach to build the policies and urban designs with an eco-friendly perspective. Residents are careless and authorities are not willing to invest in something which does not generate direct financial profit but rather demands investment. Sadly, we fail to understand that ‘health is wealth’. A healthy nation can generate profits at much accelerated speed than an unhealthy nation. Delhi is the asthmatic capital of the world; the number of asthma patients has shown a nearly 300 per cent rise in the last few years. Residents have been paying a heavy cost of staying in a polluted and unhealthy environment. As a quick short-term measure, odd–even cars are supposed to ply on roads on odd–even dates, respectively. On high pollution alert days, residents are advised to stay indoors. A pollution holiday is declared by the government by shutting down the schools. Children are more vulnerable to such hazards. The health expenditure for both curative and preventive care is increasing day by day.

xii Preface

Delhi needs a huge health investment plan, where on the one hand, the focus should be on creating a sustainable environment and on the other hand, the government should sensitise and subsidise the adoption of green health insurance policies. The problem of air pollution, which is turning out to be more dangerous day by day, has to be addressed by making both short-term and long-term policies. There is a need to invest in establishing institutes that can impart training in urban and environmental engineering. The book clearly restricts itself to a spatial and economic approach by incorporating various parameters of the issue of shrinking green spaces, air pollution and health. While writing this book, the authors came across several documents, reports, news coverage, media discussions, etc., all pinpointing the felling of trees, problem of air pollution and rising asthma cases in Delhi. Although it was very difficult to include all sources and related data, the book tries to include the authentic sources and impactful studies. The book is based upon both secondary sources and primary surveys. It is written in a systematic manner; it moves from a spatial approach to a historical journey, then the economic perspective and later it gives a technological insight. It focuses upon the concept and need of green spaces and the quantity of green spaces needed in urban areas. The book figures out the temporal changes in urban green areas from the early historical period to the present modern period. It includes both planned and natural green spaces and their interface with empires, planners, policymakers and the public. The book analyses and maps the level of air pollution in Delhi, based on data collection at various green and non-green spaces. It discusses the causes and consequences of depletion of green spaces and increasing air pollution. The hotspots in relation to temperature and pollution have been identified, tabulated and mapped by using the data collected by air quality monitors. The book also focuses on the extent of health issues and related health economics. Prevalence of pollution leads to the frequent occurrence of seasonal diseases like dengue, chikungunya, fever, common cold and cough, asthma, bronchitis, eye infections, and skin diseases, which have been causing a heavy burden of healthcare cost on an individual or a household. People are spending a huge amount of money on both preventive and curative costs. They pay a high cost for every single episode of hospitalisation or visit to the doctor. Heavy out-of-pocket expenditure on health is one of the important causes of poverty, which adversely affects access to healthcare. It is catastrophic to poor households and further impoverishes them. This study aims at converting this out-of-pocket expenditure into prepayment schemes through health insurance on the basis of willingness to pay, which will lower the financial burden of medical expenses, enabling access and protecting them from the economic ruin caused by high health expenditure. The study suggests the importance of insurance for health in the form of ‘Green Health Insurance’. Green insurance products with a low

Preface xiii

premium would help to finance seasonal diseases caused due to environment pollution, especially for the poor and workers from unorganised sectors in the urban areas. The book thus tries to make the readers think from various perspectives of green spaces, air pollution and health in Delhi. The authors have made a genuine effort to demonstrate the extent of the issue and highlighted the solutions to it. There can be many more perspectives and approaches to understand the interface of green spaces, air pollution and health, that cannot be undermined; therefore, the authors have taken due care to maintain the relevance of their approach and respectfully leave the further scope of the multifarious ways to handle the issue. The book, on the one hand, emphasises the need of having green spaces and curbing air pollution in cities, and on the other hand, analyses the financial and economic perspective of managing the grim situation. New Delhi, India

Acknowledgements

The authors are thankful to the University of Delhi for giving the opportunity and environment for conducting research under innovation project 2015. The authors extend special thanks to Dr. Bindhy Wasini Pandey, Associate Professor in Department of Geography, Delhi School of Economics, University of Delhi, for his mentorship. The authors are grateful to Dr. P. K. Khurana (former Principal) and Dr. Anil Sardana, the Principal, Shaheed Bhagat Singh College for their constant support and encouragement. The book is an outcome of sincere hard work put in by a group of undergraduate students, in the form of conducting field surveys and data collection, from Geography and Economics Department of the college namely, Shubham Saket, Sagar, Nupur Bhatia, Sachi Vohra, Tanvi Jindal, Pretty Pamei, Khuram Shabir, Prasun Bhowmik, Soumya Kumari, Mayank Garg, Shikhar Kumar, Sonali Chowdhury, Ngamgupou Thaimei, Shikha Barnwal, Sharad Yadav, Ankesh and Dr. Vijay Pandey (Assistant Professor). We are also thankful to the authorities and officials of Delhi for sharing the information and their views on concerned issues. The authors are indebted to the residents of Delhi for sharing their opinions on the issues examined. The authorities of Indian Agriculture Research Institute, PUSA; Yamuna Biodiversity Park; Aravalli Biodiversity Park; Association of Kitchen Gardens, Defence colony; etc also deserve heartfelt acknowledgment for their support. We are also grateful for the technical help extended by Dr. Rashmi Rani Anand (Assistant Professor) and Ms. Arifa Begum (Research fellow IIRS and ISRO). The authors are also thankful to Mr. Rahul Celly, research editor in print media and education, for his help in proofreading the work. The authors extend their gratitude to the reviewers for giving positive reports about the manuscript. The authors are thankful to Prof. Gunnar Magnus Johannesson, Professor at the Stockholm School of Economics, for giving his approval for using the figure of willingness to pay in the study. Last but not least, the authors are deeply thankful to their respective parents and families for their continuous support and encouragement.

Introduction

Cities in the world are struggling from various complex and diverse challenges. Megasettlements with serpentine transport and communication networks, inexorable construction work, industrial townships, etc., have on the one hand, ensured convenience and on the other hand, created spheres of bio-geo-chemical modified landscapes. Among the many challenges is the challenge of air pollution. In the cities, trees are being cleared and chemicals are penetrating the air from various sources every second. Removal of these chemicals from the air is a challenging task, which means that people in the cities breathe in this polluted air making them vulnerable to many health risks. These health issues besides having an impact on the body also have a financial cost. The cost of increasing air pollution and being unhealthy has to be borne by people living in these cities. It is therefore important to analyse and understand the relationship between green spaces and air pollution to manage health economics in urban areas (Figure I.1). According to UNDP, cities of the world occupy 3 per cent of land but consume around 70 per cent of energy and are responsible for 70 per cent of carbon emissions. They contribute to around 90 per cent of the world’s GDP. Sustainable growth and environment conservation have to be the ultimate goals for the survival of mankind on the Earth. Natural vegetation cover is the only saviour for sustainability, considering the fact that the process and pace of production cannot come to a standstill. Vegetation cover has to be planned smartly and has to be considered as an integral part of the development process. Air pollution does not follow manmade national and international boundaries. Pollutants can be carried away by the air current to faraway places. The area which is the source of air pollution is the worst affected and its effect diminishes as we move away from its source. The land use changes of the city causes a slow and steady change in its microclimate. Excessive vehicular traffic, industrial and domestic effluents enter the air. The vapour, chemical and smog accumulates in the air just above the surface it becomes heavier, therefore, hindering the speed and process of air circulation thereby choking the cities. The horizontal movement of air and the development of

2 Introduction Building Cies

Expanding infrastructure/ houses/ markets/ offices etc

Shrinking green spaces

Air Polluon

Health Economics or The cost of survival

Health Challenges

Figure I.1  S implified model of linkage between green space, air pollution and health economics. Source: Authors

surface ozone is also common in the core of the city. The cities thus experience a phenomenon called ‘heat island’, especially in summers. The harmful impact of various pollutants in the air is unequivocal. The United States Environmental Protection Agency has categorically mentioned that long-term or short-term exposure to fine particle pollution, also known as PM2.5 (Particulate Matter), can cause premature death, harmful effects on the cardiovascular system and asthma. Moreover, long-lived greenhouse gases which trap heat in the atmosphere including carbon dioxide, methane, nitrous oxide and fluorinated gases are released due to various diverse human activities (https://epa.gov/). According to USGC global monthly, average concentrations of carbon dioxide have risen steadily from 330 parts per million in 1980 to 407 ppm in 2018, an increase of more than 20 per cent in less than 40 years. According to National Center of Biotechnology Information (NCBI), excessive breathing of CO2 can lead to breathing troubles, increased heart rate, elevated blood pressure, etc. Nitrous oxide concentration in the air has also drastically risen in last 50 years. Presently, it is 329.9 parts per billion. According to NCBI, excessive exposure of nitrous oxide leads to high blood pressure, nausea, headache and breathing disorders. India has nine out of the ten most polluted cities in the world. Researchers estimate that smog pollution killed around 1.24 million people in 2017. According to the American Thoracic Society, 2019, reductions in air pollution yield fast and dramatic impacts on health outcomes as well as decreasing morbidities. Reducing air pollution and establishing sustainable cities can be achieved by building green spaces. Green spaces are semi-natural areas that not only have the environmental function of blocking noise, reducing carbon emissions and air pollution, conserving water and soil, adjusting the microclimate

Introduction 3

and moderating temperatures, but also have the ecological functions of recovering fertility, preserving ecologically sensitive areas, providing the habitat and feeding spaces for various species and stabilising ecological systems. Moreover, it enhances environmental beauty and visual aesthetics. It  also strengthens social cohesion and place identity within communities by  providing environmental awareness, recreation and cultural exchange. Additionally, green spaces improve people’s sense of satisfaction and happiness and reduce stress. The United Nations Conference on Sustainable Development (UNCSD), Organization for Economic Co-operation and Development (OECD), UK government sustainable development framework indicator (UKSDI) and Towards Sustainable Europe all use green space as an important indicator for evaluating the sustainable development (Liu and Shen, 2014). A city devoid of quantity and quality of urban green spaces (UGS) becomes a concrete jungle or a polluted city vulnerable to calamities, with low liveability index. UGS provide benefits to the city that helps mitigate these negative effects (Ridder et al., 2004), and are valuable amenity–recreation venues, wildlife refuge and essential liveable-city ingredients (Jim & Chen, 2003).

Sustainable development goals and cities According to World Health Statistics 2016, achieving a sustainable and healthy future for all requires action on air pollution, which is a major cause of morbidity and mortality globally. The new Sustainable Development Goals (SDGs) provide a massive opportunity for addressing air pollution and the related burden of increased health risks and diseases. The list of targets related to health, air pollution and sustainability includes: SDG target 3.9, which calls for a substantial reduction in deaths and illnesses from air pollution SDG target 7.1, which aims to ensure access to clean energy in homes SDG target 11.2, which aims to provide access to safe, affordable, accessible and sustainable transport systems for all SDG target 11.6, which aims to reduce the environmental impact of cities by improving air quality WHO is currently involved in the development and monitoring of the following SDG indicators: Air pollution-related mortality (SDG 3.9.1); Access to clean energy in homes (SDG 7.1.2) and air quality in cities (SDG 11.6.2) (World Health Statistics 2017). More than half of the world’s people now live in urban areas and the proportion will rise to two-thirds by 2050; the urban population will reach 6.4 billion people by 2050, driven by high rates of urbanisation and population growth (United Nations, 2014). Understanding how health is affected by urban environments is therefore of the upmost importance.

4 Introduction

A growing body of evidence shows a relationship between urban green spaces and reductions in several diseases, as well as improving people’s health and well-being, especially for low-income and deprived urban populations (Mitchell and Popham, 2008; Maas et al., 2009; Mitchell et al., 2015). Lower exposure to green space has been associated with a number of lifestyle diseases such as obesity, Type II diabetes, osteoporosis and stress-related illnesses such as depression, heart diseases and mental fatigue (Ulrich et al., 1991; Mitchell and Popham, 2008). Evidence also shows that access to green space can promote physiological effects such as lower concentrations of cortisol, lower pulse rate and blood pressure, greater parasympathetic nerve activity and lower sympathetic nerve activity compared to urban environments (Park et al., 2007, 2010; Lee et al., 2011; Song et al., 2016). These studies suggest that green space may offer opportunities to buffer or mitigate health outcomes for urban populations (WHO, 2017). There is disparity in health expenditure worldwide. More than half of the population in the world does not have access to formal social protection schemes (WHO, 2010). In India, the disparity on health care cost and expenditure done by the state is pretty evident. The high cost of frequently prevalent diseases caused due to pollution has to be borne by the people. This increases their out-of-pocket expenditure. The heavy financial burden of diseases becomes unbearable for middle class and low economic class people. At times, people have to sell their property or land or precious belongings, take loans or even make compromises related to the health and survival of the sick or the elderly. Where cities face constant and frequent cases of air quality or lifestyle health challenges, special health insurance products need to be built for these areas to minimise the out-of-pocket expenditure of the people. Therefore, an analysis of linkages between air pollution, green spaces and health care cost is of great importance. Our health depends on our environment and we cannot ignore the environment while focussing solely on rapid urbanisation or the growth of our economies. The book presents the relationship between urban green spaces, air pollution and health. The first chapter of the book highlights the concept of urban green spaces and their significant role in cities. The next chapter discusses the green spaces present in Delhi from past to present. The third chapter gives an insight into the extent of air pollution in Delhi by highlighting various causes. Lack of green spaces and high pollution levels are linked to various health challenges. Chapter 4 discusses the extent of health challenges with the help of primary and secondary data. Chapters 5 and 6 talk about the health economics, out-of-pocket expenditure and financial burden on the city dwellers because of the persistent environmental challenges. Concluding chapter discusses various good practices followed by different countries. It also focuses on the present policies and scope of such good practices in Delhi.

Introduction 5

Research methodology and data analysis The study covered in this book is based on both primary and secondary sources of data. The secondary sources include published reports of the World Health Organization (WHO), Census of India, Central Pollution Control Board (CPCB), Planning Commission of India, and National Health Estimates. The study also takes into consideration the data and papers published in renowned national and international journals and newspapers. The book incorporates the mapping of green spaces using Global Positioning System (GPS), satellite images and Geographic Information System (GIS). To identify the green spaces, the study uses satellite images of Landsat (Landsat 7, October 2002 and Landsat 8, April 2016). Landsat 7 (2002) and Landsat 8 data (2016) with 30 metres of spatial resolution were taken into consideration. Landsat 7 bands: are Band 1 (Blue), Band 2 (Green), Band 3 (Red), Band 4 (NIR). Landsat 8 bands are Band 2 (Blue), Band 3 (Green), Band 4 (Red), Band 5 (NIR), Band 6 and Band 7, to make the bands composite. After getting the images geo-registered, a supervised classification technique was performed. After the Land Use and Land Cover (LULC) map preparation, Normalised Difference Vegetation Index (NDVI) was also calculated to understand the density of greenness. From the LULC map, the vegetation class was derived, coupled with Agricultural class and Park class. For validating the vegetation class, NDVI calculation was conducted, because NDVI is the most generalised index of plant ‘greenness’. Hence, the output maps show the classes of vegetation, agriculture and parks for the years 2002 and 2015. A land use and NDVI map of 2016 was also prepared. The study uses maps to show the variation in temperature and pollution level at different locations of Delhi. Besides maps, the study uses descriptive analysis by using relevant statistical diagrams like bar diagrams, pie diagrams and trend lines to represent the data. The spatial analysis of temperature variation and air pollutants (mainly PM2.5, PM10 and CO2) was done on the basis of data collected through manual air quality monitor (AQM). Data were collected at 35 different locations of the city. The sample was thus determined by keeping in view various sectors and green and non-green spaces of Delhi. Care was taken to identify the 35 locations in such a way that they covered various categories of land use like residential, commercial, market, traffic junctions, water bodies, and semi-natural areas like forest or ridge. The GPS instrument was also used in order to acquire the absolute location (cardinal points). Data were collected twice in the month of June, between 10th and 15th, 2016 (11:00 am to 3:00 pm). Data (temperature, PM2.5, PM10 and CO2) were recorded at 35 selected locations and then mapped to check the relevant role of green spaces and type of economic activities in the extent of pollution. Data were also collected for temperature and relative humidity

6 Introduction

to calculate heat stress by using the heat stress calculator (WBGT, UTCI). The data were then represented on the map using ARC GIS for better understanding. The AQM employed works with principle of light scattering (PM2.5 and PM10) and Non-Dispersive Infra-Red (NDIR) (CO2). NDIR means that when a beam of IR light is emitted from a light source, it does not disperse between the source of the light and the detector. An NDIR gas sensor specifically measures the abundance, or concentration, of gases. The employed AQM range is from 0 to 1,000 μg/m3 for PM10 and 0–500 μg/m3 for PM2.5 and 400 to 3,000 ppm for CO2. The accuracy level is +5 per cent FS for all parameters. To analyse the health economics, a primary survey was conducted for a total of 900 households. The survey was been conducted taking 100 households from each nine zones or administrative divisions (2011) of Delhi on the basis of random sampling, by taking into consideration different socio-economic backgrounds of the respondents. Since the sample size was not based upon any pre-hoc power calculations, this was a sample of convenience. One of the relevant sections of the questionnaire was based on healthcare cost, health insurance and willingness-to-pay study. All the answers have been kept confidential, processed statistically and used only for a scientific study. A pilot survey of 50 questionnaires was done using the random sample method, to understand the bidding amount for willingness to pay for health insurance. Thus, bids were introduced in the questionnaire after the responses. The health satisfaction level has been analysed by considering both physical health and mental health. The level of environmental awareness has also been evaluated, based on responses related to eco-friendly products and services. To analyse the health economics, especially the willingness to pay for health insurance, the method chosen for this study was a bidding game and open-ended questions. Valuations using the bidding format (BID) were elicited by face-to-face negotiation. All respondents were asked whether they would be prepared to pay at least some amount (payment principle question). Those who responded positively were asked to state the maximum amount they would be willing to pay (WTP) per month on the basis of the BIDS given to them. During the survey, five WTP BIDS – for Rs. 200, Rs. 500, Rs. 1,000, Rs. 2,000 and Rs. 2,500 – were given for providing green insurance. Respondents were given one bid value, to which they could respond with either a ‘Yes’ to accept that they were WTP the proposed amount, or a ‘No’ to refuse to pay the proposed amount. That is, each individual was given one bid chosen randomly. Responses were discrete for this dichotomous choice question; therefore, the Ordinary Least Square Method was unsuitable to estimate the valuation function. In this case, Logit Models have been used for computational ease. Later, Multiple Regression Analysis was conducted to find the relation between various socio-economic variables and willingness to pay for health insurance.

Introduction 7

References Jim, C.Y., & Chen, S.S., 2003, Comprehensive greenspace planning based on landscape ecology principles in compact Nanjing City, China. Landscape and Urban Planning, 65, 95–116. Lee, Andrew C.K., & Maheswaran, Ravi, 2010, The health benefits of urban green spaces: a review of the evidence, Journal of Public Health (Oxf) 33(2), 212–222. doi: 10.1093/pubmed/fdq068. Liu, H.L., & Shen, Y.S., 2014, The impact of green space changes on air pollution and microclimates: A case study of the Taipei metropolitan area. Sustainability 2014(6), 8827–8855. www.mdpi.com/journal/sustainability. Maas, J., Verheij, R.A., De Vries, S., Spreeuwenberg, P., Schellevis, F.G., & Groenewegen, P.P., 2009, Morbidity is related to a green living environment. Journal of Epidemiology and Community Health 63, 967–973 Mitchell, R., & Popham, F. 2008, Effect of exposure to natural environment on health inequalities: an observational population study. Lancet 372, 1655–1660. Mitchell, R.J., Richardson, E.A., Shortt, N.K., & Pearce, J.R., 2015, Neighborhood environments and socioeconomic inequalities in mental well-being. American Journal of Preventive Medicine 49, 80–84. Park, B.J., et al. 2007, Physiological effects of Shinrin-yoku (taking in the atmosphere of the forest): using salivary cortisol and cerebral activity as indicators. Journal of Physiological Anthropology 26(2), 123–128. Ridder, K., et al., 2004, An integrated methodology to assess the benefits of urban green space. Science of the Total Environment, 334–335, 489–497. http://www. globalchange.gov/browse/indicators/indicator-atmospheric-carbon-dioxide Song, C., et.al. 2016, Physiological effects of nature therapy: a review of the research in Japan. International Journal of Environmental Research and Public Health, 13(E781). doi:10.3390/ijerph13080781 Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., Miles, M.A., & Zelson, M., 1991, Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11, 201–230. UN, 2014, World Urbanization Prospect, Published by the United Nations ISBN 978-92-1-151517-6 Copyright © United Nations, 2014. WHO, 2010, Health system financing: the path to Universal coverage, The World Health Report, 1–128. WHO, 2017, Urban Green Space Interventions and Health A review of impacts and effectiveness, Denmark: WHO publication.

Chapter 1

Urban green spaces Concept and significance

I ntroduction Cities are the engines of economic growth and opportunities for a nation. They offer significant employment opportunities, educational facilities, housing facilities and medical facilities. Robust spaces required for infrastructures, markets, commercial complexes, residential and industrial areas become zones of preferential land use in a city. The balance between development and environment protection will always remain an issue of concern for experts and planners. Concrete expansion swallows green spaces, or the so-called lungs of the cities. And, while the importance of cities has increased significantly over the centuries, the transition from rural to urban life has had complex social and environmental impacts (Woolley, 2003). The urban landscape has been in a constant state of change and transformation. Roger et al. (1999) elaborated on the key factors which influence changes in the urban landscape (cited in Thompson, 2002): 1) Technical revolution, focused on information technology and changes moving from global networks connecting people to local networks; 2) the ecological threat, with its implications on sustainable development; and 3) social transformation where life patterns reflect increasing life expectancy and new lifestyle choices. This chapter tries to answer and elaborate upon some important aspects related to urban green spaces. It also maps the concept with the reality in Delhi by discussing the following questions: What are urban green spaces? Why are green spaces necessary in cities and urban areas? Where should these green spaces be located and made available? How much is the minimum requirement or threshold for green spaces?

U rban green spaces Green spaces such as parks, community gardens, trees, terrace gardens and cemeteries play an inevitable and important role in urban environment protection and have their own relevance in the urban ecosystem. Simply

Urban green spaces  9

defined, they are open spaces or natural spaces within a city. According to the United Nations Environmental Protection Agency, a green space is land that is partly or completely covered with grass, trees, shrubs or other vegetation. These do not necessarily have to be urban parks, but can include spaces like kitchen gardens to bio-diversity parks. Developing green spaces in cities involves innovations, research and planning to make the most of the spaces available. The real and indigenous nature of green spaces can also change over time due to construction of transport networks, residential, commercial and industrial complexes. These can result in the loss of inherited species of flora and fauna and changes in the characteristics of soil in the natural green spaces in cities. It is important to study and minimise this loss as much as possible since these spaces can play a key role in sustainable urban growth. In ‘GreenKeys – Urban Green as a Key for Sustainable Cities’, a manual published by the European Union, an urban green space is defined as a public open space in an urban area which is predominantly characterised by a high percentage of vegetation and non-paved surfaces. An urban green space is directly used for active or passive recreation; or indirectly used by virtue of its positive influence on the urban environment, serving the diverse needs of citizens and thus offering a good quality of life in cities. It can assume different characteristics, for example, parks, gardens, squares, cemeteries and allotment gardens, as well as woodlands and areas for nature and landscape conservation (Carlos et al., 2008).

Typology of urban green area Dunnett et al. (2002) provides a typology of green spaces in the cities as: amenity green areas, functional green areas, semi-natural habitats and linear green areas. He further classifies them in subcategories as below. Main types of green areas by Dunnett et al., 2002: Amenity green areas 1 Recreation green areas 1.1. Parks and gardens 1.2. Informal recreation areas 1.3. Outdoor sports areas 1.4. Play areas 2 Incidental green areas 2.1. Spaces 2.2. Housing green spaces 2.3. Other incidental spaces 3 Private green area domestic gardens

10  Urban green spaces

Functional green areas 4 Productive green areas 4.1. Remnant farmland 4.2. City farms 4.3. Allotments 5 Burial grounds 5.1. Cemeteries 5.2. Churchyards 6 Institutional grounds 6.1. School grounds 6.2. Other institutional grounds Semi-natural habitats 7 Wetlands (open/running water) 7.1. Marshes and fens 8 Woodlands 8.1. Deciduous woodlands 8.2. Coniferous woodlands 8.3. Mixed woodlands 9 Other habitats 9.1. Moors and heathlands 9.2. Grasslands 9.3. Disturbed grounds Linear green areas 10 River and canal banks 11 Transport corridors (road, rail, cycleways and walking routes) 12 Other linear features (e.g., cliffs) Dunnett shows a classic work of identifying several classes of urban green spaces. These spaces are sometimes demarcated and can be easily categorised, while sometimes, there can be an overlap due to lack of space in the city, especially in developing countries. For example, linear green areas are also used as parks, gardens and play areas in Delhi. Children in cities do not have huge areas to play or indulge in sports activities, so they play in any accessible open space. G reen spaces of Delhi Delhi, the capital city of India, is one of the greenest capitals in the world in terms of green cover. This has been possible due its historical heritage of parks and the ridge, as well as continual plantation drives in some parts of the city. At present, about 20 per cent of Delhi’s geographical area is under green cover, making per capita green space availability to around 22 m2. Besides the Department of Environment and Forests of the National

Urban green spaces  11

Capital Territory (NCT) Delhi, there are many agencies working for the ‘Green Capital’ mission, for example, the Municipal Corporation of Delhi (MCD), the New Delhi Municipal Corporation (NDMC) and the Delhi Development Authority (DDA). Recently, the Parks & Garden Society was set up to coordinate the greening activities in Delhi. The city has some well-maintained parks and gardens like Lodhi Garden, Mughal Garden, Deer Park, Buddha Jayanti Samarak Park, Indraprastha Park and The Garden of Five Sense. The Department of Environment and Forests of NCT Delhi has been mainly responsible for increasing the green cover of the city from 30 to 300 km2 during the past 10 years, despite acute biotic pressure (Chaudhary et al., 2011). According to the Town and Country Planning Organization, India, the types of urban greens include reserved forests, protected forests, national parks, district parks, neighbourhood parks, tot lots, playgrounds, green belts, green strips, tree cover and trees. Reserved forests: Reserved forests are duly notified under the provisions of the Indian Forest Act, 1927, or the State Forest Acts for having full protection. In reserved forests, all activities are prohibited unless specifically permitted. These forests are notified under Section 20 of the Indian Forest Act, 1927 [Act 16 of 1927] or under the reservation provisions of the Forest Acts of the state governments. Protected forests: Protected forests are found in urban and peri-urban areas generally secured by constructing a compound wall or a combination of half wall and wire mesh or by fencing the area. According to the Forest Act, no construction activity is allowed in such areas. National parks: National Parks are areas set aside for the protection and conservation of outstanding natural fauna, flora, geological formations and natural scenic areas. National parks prohibit hunting, killing or capturing of fauna or destruction and collection of flora and use of weapons except for the improvement and better management of wildlife. All these issues are handled by, or are under the supervision of, the park authorities. District parks: District parks are recreational parks developed to provide vital lung spaces. As per the 2021 Master Plan of Delhi, a district park has to be provided for a population of 250,000 and normally developed at the city level with an area of 40,000 sq. m. Neighbourhood parks: A park developed at the neighbourhood level for a population of 10,000 is identified as a neighbourhood park. The park has to be conveniently located within the developed residential areas at a walking distance with a planned area of 2,000–4,000 sq. m. Tot lots: Tot lots are the lowest level in the hierarchy of green areas, planned for a population of 2,500 as play-areas for children, with an area of 125 sq. m. Such parks are popular in high-density areas.

12  Urban green spaces

Playgrounds: Playgrounds are provided normally for sports purpose in educational institutions. They are also provided at the neighbourhood level for a population of 5,000. Green belts (buffers): Green belts include green girdles, park belts, rural belts, rural zones, agriculture belts, country belts and agriculture green belts. These areas are predominantly farm lands and they support agriculture and related functions at stretch of the country-side around and between towns separating one from the other. They may or may not be owned by the town/city/local body. A green belt is proposed in urbanisable limits of the urban centre (town/ city/) and legally established in order to: • • •

Check the further growth of built-up areas; Prevent neighbouring towns from merging into one another; or Preserve a special character of a town. Green strips: A green strip is developed on a vacant land, for example, the land under high-tension power supply lines. It is also developed along the arterial roads, separating residential areas from other uses. Tree cover: Tree cover is provided by trees planted along the roads within the right-of-way and on the central verge (median). Trees: The Delhi Preservation of Tree Act, 1994, defines a tree in its section 2(i) as ‘any woody plant whose branches spring from and are supported upon a trunk or body and whose trunk or body is not less than five centimetres in diameter at a height of 30 cm from the ground level and is not less than 1 m in height from the ground level.’

Terms associated with urban green spaces U rban forestry This refers to a careful management of forest cover in urban areas (Costello, 1993). Urban forestry is the management of trees for their contribution to the physiological, sociological and economic well-being of the urban society (Sinha, 2013). Urban forestry deals with woodlands, groups of trees and individual trees where people live. Urban forestry and urban greening concentrate on all tree-dominated as well as other green resources in and around urban areas, such as woodlands, public and private urban parks and gardens, urban nature areas, street tree and square plantations, botanical gardens and cemeteries. Urban forestry is the art, science and technology of managing trees and forest resources in and around urban community ecosystems for physiological, sociological, economic and aesthetic benefits that trees provide to society (Miller, 1997). The concept of urban forestry was first introduced by Jorgensen at the University of Toronto, Canada. The urban environment can present many arboricultural challenges, such as

Urban green spaces  13

limited root and canopy space, poor soil quality, deficiency or excess of water and light, heat, pollution, mechanical and chemical damage to trees and mitigation of tree-related hazards. Urban forestry also deals with challenges like lack of favourable policies, planning and design related to urban forests and other vegetation. It also needs experts to select and establish tree resources and other vegetation for urban environments. Delhi is already facing the problem of low green space; therefore, before the city expands further, a proper plan for greening in the city should be in place, especially with respect to land availability in the form of parks and gardens, forest patches and roadside plantations. Planning is important because trees are very often considered as an afterthought once development has taken place, rather than being incorporated in the original design phase. For effective, planned and systematic management of trees in cities, a measure of legal control is also necessary. Recently, the concept of social forestry and community forestry has also emerged. Social forestry means forestry catering to social needs and uses (Konijnendijk et al., 2013). Community forestry is considered when forestry is done by direct participation of local people. These two concepts originated for primarily rural areas but very recently, it has been applied in many urban areas too. According to Konijenendijk et al., the key strengths of a good approach for urban forestry are: 1. It is integrative, incorporating different elements of urban green structures into a whole. 2. It is strategic, aimed at developing longer-term policies and plans for urban tree resources, connecting to different sectors, agendas and programs. 3. It is aimed at delivering multiple benefits, stressing the economic, environmental and socio-cultural goods and services urban forests can provide. 4. It is multidisciplinary and aims to become interdisciplinary, involving experts from natural and social sciences. 5. It is participatory, targeted at developing partnerships between all stakeholders. Urban forestry should have indigenous and native plants and trees. Sufficient budget allocation with innovative techniques should be used to develop urban forestry. It is important to educate and involve the community and residents of the area with regard to plantation drives and management of trees. U rban agriculture The Habitat II conference recognises urban agriculture as a realistic and desirable land use option in urban areas and an integral part of the urban system. The World Summit (FAO, 1996) concluded that food and nutrition polices

14  Urban green spaces

should, among others, include a concept for enhancement of the urban agriculture production. Global initiative for urban agriculture was created in March 1996 at the third meeting of the Urban Agriculture Support Group. A definition of urban agriculture was presented in the Cities Feeding People (CFP) report series by Mougeot. It says urban agriculture is an industry located within (intra-urban) or on the fringe (peri-urban) of a town, an urban centre, a city or metropolis, which grows or raises, processes and distributes a diversity of food and non-food products, (re-)using mainly human and material resources, inputs and services found in and around that urban area, and in turn supplying human and material resources, outputs and services largely to that urban area. A drastically increasing number of civil and natural disasters disrupt food production and affect supply lines to cities, thereby resulting into wiping out crops or increasing food prices. Urban agriculture can prove to be of a great help in such situations. City-ward emigration of rural youths affects rural production in the longer term, which is still largely small-scaled and labour-intensive. It can help in sustaining a range of new industries and employment opportunities in and near cities. The Council of Agriculture, Science and Technology in 2013 defined urban agriculture as a complex system encompassing a spectrum of interests, from a traditional core of activities associated with the production, processing, marketing, distribution and consumption, to a multiplicity of other benefits and services that are less widely acknowledged and documented. These include recreation and leisure; economic vitality and business entrepreneurship, individual health and well-being; community health and well-being; landscape beautification; and environmental restoration and remediation (Butler, and Moronek, 2002). Urban agriculture should always be an integral part of the city system. It not only makes a city self-reliant to some extent, but also conditions and nourishes the urban nutrient system. Urban agriculture enables the continued production of rare varieties of fruit or vegetables that may be exquisitely adapted to local conditions. It adds to diversity of peri- or intra-urban crops and croplands. This can further attract a greater variety of bird and animal life that the same lands in more ‘normal’ urban use. Urban nutrient recycling programs may lower both operating costs for farmers and food prices for the consumers. Fossil fuel use for transportation generates about a third of global carbon dioxide emissions (a ‘forcing mechanism’ in climate change), and global trade alone accounts for 1/8 of world energy use (Goldsmith, 1996). Moreover, locally produced foods require less packaging and refrigeration and other preservation measures, thus reducing the packaging waste stream, energy use and the chemical load in foodstuffs. According to Russo et al. (2017), edible green infrastructure is a must for future compact cities to meet the challenge of food insecurity and hunger. Such cities would have potential to improve resilience and quality of life. Edible green infrastructure is a sustainable planned network of edible food

Urban green spaces  15

components and structures within the urban ecosystem which are managed and designed to provide primarily provisioning ecosystem services… Typologies are based upon one macro category (i.e., edible green infrastructure and urban agriculture) as well as eight sub-classifications: (1) edible urban forests and edible urban greening, (2) edible forest gardens, (3) historic gardens and parks and botanic gardens, (4) school gardens, (5) allotment gardens and community gardens, (6) domestic and home gardens, (7) edible green roofs and vegetable rain gardens and (8) edible green walls and facades (Russo et al., 2017). U rban parks Urban or public parks offer recreation and open green space to the residents of the cities. Urban parks are defined as delineated open space areas, mostly dominated by vegetation and water, and generally reserved for public use… Urban parks are mostly larger, but can also have the shape of smaller ‘pocket parks’ (IFPRA, 2013). Urban parks are usually locally defined (by authorities) as ‘parks’. Such spaces are generally owned or maintained by the local government. These spaces have grasses, trees, and small insects in their biome. These spaces are used for relaxing, fitness, playing or for picnic. Urban parks not only symbolise beauty but also play a very vital role in the health of residents living within their impact area. ‘Parks are about so much more than our aesthetics and beauty, as important as that is. Parks are about healthy neighbourhoods. They are intimately tied to the health of their neighbourhoods. Parks promote community building, social capital and even in ways we’re only just beginning to understand, our physical health’ (Shakarian, 2014). Parks refresh and rejuvenate mind and body. Morning and evening walks, yoga, recreational areas for kids, all keep people fit and healthy.

 hy green spaces are necessary in cities and W urban areas? Urban green spaces are critical to urban sustainability, yet receive little scientific or political attention (Budruk et al., 2009). Urban green spaces provide critical ecosystem services. Green spaces also promote physical activity, psychological well-being and the general public health of urban residents (Wolch et al., 2014). Urban green spaces are just usually added as an afterthought by planners. Urban green spaces have been considered to have significant effects on the health and lifestyles of people of all ages. Studies show that green spaces create healthy and economically successful communities and liveable places for humans and wildlife. Green spaces create landscapes for prosperity. The literature on urban green spaces broadly emphasises their role in the ecosystem and their health benefits. One such study by Gairola and Noresah

16  Urban green spaces

analyses the research in urban green spaces and their implications on biodiversity. The study highlights the need of green spaces for sustainability and to be considered as a part of the natural resource system. The report on ‘City of London Urban Forest Strategy’ discusses the benefits of urban forest strategy and benefits that trees are expected to provide. According to the report, trees provide a multitude of benefits like climate modification such as shade cooling or wind shelter, aesthetics, privacy screening, wildlife habitat, food production, and air quality enhancement. Tree species vary in their ability to provide these different benefits. Urban green spaces are crucial elements for all cities. They affect the townscape, provide ecological diversity, have relevance for healthy citizens and societal well-being, deliver important economic benefits and form essential structural and functional spaces that make cities more liveable places (URGE Team, 2004). Urban green spaces are increasingly acclaimed as central elements in the promotion of environmental sustainability and quality of life in cities, following a long history of gradual recognition of its various hygienist, social, cultural, aesthetic, functional, economic or ecological functions. Green spaces provide environmental benefits, such as the mitigation of heat island effects, the reduction of pollutants in the air, promotion of biodiversity and noise reduction. They are also important in cities due to social benefits, by providing ample recreational opportunities, by supporting social interaction and integration and by contributing to the improvement of mental and physical health (Madureira, 2018). E cological benefits Properly maintained green spaces provide significant benefits to the environment in terms of maintaining micro-level temperature and climate, water and air quality, erosion control and run-off prevention and maintaining biodiversity. 1. Maintaining temperature and micro-level climate: Climate of an area is a complex phenomenon to understand. The climate of any region is affected by numerous factors. It is an established fact that ecologically maintained green areas have suitable climatic conditions. Rather, it has been observed that scholars have time and again emphasised upon the need to plant more and more trees in and around cities to maintain the ecological balance. Green spaces in cities can also provide cooling through shading and enhanced evapotranspiration, thus reducing the heat island effect that occurs in many cities (EPA, 2017). It has been observed that in most of the cases, expansion and development of cities has led to the depletion of green areas. Mega-infrastructure development, transport networks, buildings, etc., threaten the ecological balance of the city and make it vulnerable to climate variability and change over a period of time.

Urban green spaces  17

In many cities worldwide, it has been observed that the temperature in their core remains nearly 1–2°C higher than in the peripheral areas. This happens because the city’s core becomes commercially and economically important over the years. Therefore, planners and the government sell the land to private builders or keep this land purely for infrastructural development. Due to conversion of green spaces to concrete and massive vehicular movement every day, the core of the city becomes heated and the varied temperature gradient within the city leads to heat stress and health problems related to it. According to the Charlottesville Council, heat islands form like a large bubble over the urban area as a result of the natural land cover being replaced by pavements, buildings, and other infrastructure. In the natural state, trees and other vegetation naturally cool the air through shade and the evaporation of water from soil and leaves. However, dark surfaces such as pavements and roads retain heat, which is exacerbated by waste heat from vehicles and machinery such as air conditioners. High temperatures also lead to ozone formation and smog formation. Ground level ozone is formed when volatile organic compounds (VOCs) from common household and commercial products, and nitrous oxides (NOx) from vehicle exhausts react, when exposed to sunlight in the presence of excessive heat. Ozone in the upper atmosphere helps to protect us from the more harmful radiation of the sun; however, at ground level, ozone can have many harmful health effects – including damage to the respiratory system, decrease in lung function and inflammation of airways (http://www.charlottesville. org). Studies show that with the increase in green cover in the city centre, the temperature may reduce from 1°C to 4°C due to the cooling effect. Green spaces can modify the micro-climatic conditions by changing the hydrological cycle of the region. More green spaces mean more evapotranspiration. With an increase in the evapotranspiration rate, there is a greater probability of an increase in the amount of rain and the number of rainy days. Rain helps in controlling the temperature, growth of the plants, and settling of dust and smog in and around the city. 2. Stabilising and shielding the soil against water and wind erosion: The trees and other vegetation cover hold the soil and protect it from depleting or degrading. The soil is protected against wind and water erosion. Studies show that green spaces prevent nutrient runoff and nitrogen runoff from the soil. Green spaces also help to decrease the impact of flood and heavy rainfall runoff, which is essential in cities where population is very dense. Trees and plants act as shelter belts around the parks and other open areas, preventing loose soil to erode. The root system and soil microbes purify the water by trapping and removing pollutants.

18  Urban green spaces

Green spaces can help maintain and enhance soil quality and function. Building and road construction can reduce soil pH and degrade native soils through removal, compaction or burial. Soil in green spaces provides important hydrological (e.g., filtering and slowing stormwater) and biogeochemical functions (e.g., decomposition) that are diminished under paved areas (Davern et al., 2017). The leaf litter enriches the soil fertility by forming humus. Seeds, twigs, leaves, etc., that drop on the soil floor contain a variety of tiny and microscopic creatures, insects and animals. These creatures, for example, earthworms, make tiny holes in the soil, enabling air to penetrate into the soil. This is healthy for plant growth. 3. Purification of air: We know that plants and trees absorb carbon dioxide to make their food by the process of photosynthesis. In the process of making food they release oxygen, which is the most important gas required by human beings and animals to survive. Due to industrialisation and vehicalisation of the urban areas, the air has become polluted. Impure air is a cause of various health diseases like asthma, bronchitis and eye and skin problems. A study suggests that green spaces purify and trap more than 12 million tons of dust, soil and other particulate matter. Trees also absorb ozone, nitrogen dioxide and sulphur dioxide. According to a study by the Arbor Environmental Alliance (AEA), a single tree can absorb CO2 at a rate of 48 lb per year. In other words, an acre of trees absorbs enough CO2 over 1 year to equal the amount produced by driving a car 26,000 miles. By absorbing the carbon dioxide and other harmful gases, trees reduce the effect of local and global temperature increase and climate change. Trees are the lungs of an area; therefore, it is important to have a minimum one-third of land under forest or tree cover. While the world has 31 per cent of total land as under forest, in India, it is 24.16 per cent. This makes India among the top-10 countries with maximum forest cover. Biello, in his study of gigalopolises, mentions that an estimated 1.38 billion metric tons of world’s carbon could be released as forests transforms into roads, buildings and homes by 2030. As it stands, the world's cities bear responsibility for at least 70 per cent of the global carbon dioxide emissions (Biello, 2012). This would affect the biodiversity hotspots of the world. Huge urban areas will engulf the green spaces, resulting into global climate change. 4. Maintaining biodiversity: Green spaces are just not green; infact, they are the most colourful spaces of the Earth. Tall trees, small trees, shrub layers, herb layers, vine layers and ground cover layers support a variety of organisms and creatures. Many creatures like birds, monkeys, snakes, squirrels and insects build their houses and stay in a symbiotic ecological way. Green spaces are responsible for increasing the biodiversity of an area. Urban green spaces comprise of habitat heterogeneity, resulting

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in assemblage of biodiversity. Urban planners should integrate green spaces within concrete structures and buildings. Planners should encourage building green roofs, gardens, green walls, trees along streets and roads, butterfly corridors and eco parks. All these green areas can attract various animal species. A study by Fernández-Juricic and Jokimäki suggests that 10–35 hectares of continuous green spaces are required to support urban species. Similarly, rich floral gardens can attract bees, insects and birds that feed on nectar. Many studies also highlight the need of heterogeneity in green spaces. A heterogeneous green space can attract a variety of fauna and bird species. It is important to build wildlife corridors, butterfly corridors, etc., in the city, as they support continuity of the ecosystem, restrict movement of wildlife and improve population viability. Wildlife corridors are, in fact, becoming a prominent feature of urban planning. S ocial and health benefits 5. Physical fitness and health benefits: Green spaces are a source of oxygen and fresh air. They are often considered to be the lungs of a city. Parks and forests provide opportunities to walk and play. Parks also provide spaces for morning and evening walks, play area for children and development of sports activities. Walking or playing improves the fitness of the body. Walking in parks and walking tracks help in cardiovascular and pulmonary fitness. Walks in the open can nourish one’s body with Vitamin D, which is an essential nutrient to absorb the calcium in the body. Walking in parks regularly helps to fight obesity and high blood pressure too. Yoga or morning exercise keeps us fit and healthy. Recent estimates show that physical inactivity, linked to poor walkability and lack of access to recreational areas, accounts for 3.3 per cent of total global deaths (WHO, 2016). 6. Mental health: Urban parks and forests rejuvenate our minds. They enhance our cognitive skills and abilities. Playing in open spaces makes the brain alert and conscious. It develops the ability to sustain concentration and activate sensory organs. Many studies focus on the fact that the natural environment helps to resolve mild depression and physiological stress. “…a turn or two I’ll walk, to still my beating mind.” Prospero, The Tempest. Shakespeare The woods make a difference; they add freshness and enthusiasm to one’s mind while walking. The theory of biophilia, introduced by Edward O. Wilson, suggests that individuals like to relate or connect with the nature. He considers that individuals have an urge to affiliate with other forms of life. Humans develop positive emotions during

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their interaction with the green spaces. The city life drags humans away from their natural affiliation to manmade worlds of concrete, machines and gadgets. Still, we see often that people try to find peace by moving to or in green spaces. This affiliation helps them to maintain mental and physical well-being. Psycho-physiological stress reduction theory suggests that contact with nature can lead to stress reduction. The fresh fragrance of leaves and flowers affects the nerves of the brain and gives a ‘feel good’ factor. 7. Educational and recreational benefit: Different variety of plants, trees and herbs grown in kitchen gardens, parks and open spaces, provide an environment to urban dwellers to learn about plants and the ecosystem. It helps us to observe the lifestyle and habitats of other organisms. It also helps children to understand the concepts of ecology and biology. Wildlife trails, green trails and green excursions give exceptional knowledge to students about the relationship between man and the environment. Open spaces can be maintained as golf courses, sports complexes and swimming pools. These places help children and elders to learn sports activities and provide them ideal facilities to challenge their abilities. S ocial benefits Parks are places to socialise and foster social interactions. One can see morning walkers wishing and talking to each other. Yoga clubs and open health gyms are also common in some parks. Old people can be spotted walking and sharing their views on political and social issues in parks. Homemakers also get an opportunity to move out of their houses and interact while they walk. In the mornings, the groups of people can be seen forming laughter clubs; these are becoming very common in cities. People gather together and laugh loudly for 4–5 minutes every day. These clubs are formed based on the famous phrase ‘Laughter is the best medicine’. Green places are also often used as picnic spots, especially in winters, due to abundance of sunshine and warmth. Accessibility to open spaces holds a great value in modern society. Moreover, urban green areas have personal and social implications. They provide a context for social interaction, serve as tangible reminders of childhood and memories of community life and offer ‘gateways’ or opportunities for people to escape for a while from the stress of urban life (Burgess et al., 1988). Harrison and Davies (2002) use the term urban biodiversity as ‘the biodiversity that matters’ to describe the places that urban residents value because of social concerns associated with green spaces and semi-natural areas, such as access to green space, aesthetics and opportunities for contact with nature. These values shape different habitats among people and spaces in cities that are often ignored by ecologists. Therefore, social concerns are equally an important perspective for urban green spaces.

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E conomic benefits The accessibility and proximity of any residential complex to a green area affects the cost of the land and real estate. Green spaces improve the aesthetic value of an area. A high property rate may benefit the seller, although it can become tough for investors and dwellers to buy property in that area. The development and maintenance of green spaces also provide jobs to many, like gardeners, caretakers, managers, guides, botanists and wildlife experts. It can also enhance the tourism activity of the place in terms of recreational and educational areas, which in turn can increase the economic opportunities and have a multiplier effect on the economy. Green spaces are also linked to economics of health. Green spaces absorb pollution and reduce the temperature by producing a cooling effect. This can reduce the cost of air conditioners and other coolants. It can also reduce curative and preventive cost of health issues and diseases linked to pollution. Walking and playing in parks and open spaces can relax the mind, thus reducing the cost levied on heart diseases and ailments related to stress.

H ow much green space do we need? It is important to note that cities need land for huge infrastructural development, with reference to houses, commercial complexes and industrial hubs. Land is also needed for transport and communication systems, which are the backbone of urban systems. Therefore, it becomes important to answer question like how much green a city should be, or how much green spaces should be left unoccupied by developmental activities. Infact, the perspective to be adopted is that green spaces should be developed as an integral part of planning. Let us analyse the standards set for green spaces in urban areas. A mount of green spaces in world cities Green spaces are required both in quantity and quality. Many scholars have analysed and suggested the area of green space needed per inhabitant in a city. A study by Sukoop et al. suggests that nearly 20 m2 per capita green space is sufficient for an urban dweller. A study conducted by countries like Germany and Japan in the 20th century suggests it to be 40 m2 per of high quality green space per inhabitant or 140 m2 suburb of area per capita. Recently, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) suggested a standard of 9 m2 of green space per city dweller. The project ‘English Nature’ by the Centre of Urban and Regional Ecology, Manchester, recommends at least 2 ha of accessible natural green space per thousand population should be provided to urban dwellers. Planners and policymakers should consider the accessibility provision

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as a part of balanced policy. English Nature suggests the guidelines according to a system of tiers into which sites of different sizes fit: 1. No person should live more than 300 m from the nearest area of natural green space. 2. There should be at least one accessible 20 ha site within 2 km from home. 3. There should be one accessible 100 ha site within 5 km. 4. There should be one accessible 500 ha site within 10 km.

Sq m/ person

Natural green spaces in an open space should primarily include parks, gardens, country parks, green corridors, outdoor sports facilities, community gardens, urban farms, cemeteries and churchyards. Various studies have been conducted by different scholars to analyse the green space availability in cities, with reference to the WHO standard of 9 m2 per urban dweller (Figure 1.1) As calculated by Konijnendijk in 2003, Greater Paris has an estimated 80 m2 of green space per resident. A similar study by Brack in 2002 arrived at a figure of 80 m2 of green space per person in Canberra. Jim and Wendy did their analysis in Nanjing and Wuhan cities of China and found the estimated value to be 44.3 and 10.3 m2 per person, respectively. The data in the figures have been gathered from different studies undertaken by different scholars. Several studies consider Vienna as the most liveable green city in the world. A study by Wien International found that nearly 51 per cent of Vienna is considered to be green, with 120 m2 of green area available per person. The geographical location of these cities should be kept in mind while analysing the facts, as it is very difficult to compare the cities on one platform. Cities of developing countries like India with most conducive physiographic background and low cost of living are bound to attract more people than cities in developed countries, where cost of living is very high,

80 70 60 50 40 30 20 10 0

Cies Figure 1.1  Green spaces in world cities. Source: Compiled by authors from various online sources

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like Amsterdam in the Netherlands. Therefore, in cities like Delhi, the population is very high as there is immense pressure on natural as well as manmade resources. The pressure on land leads to shrinkage of green areas. As pointed out earlier, it is not only the availability of green spaces but also accessibility of such places which makes them more beneficial. Green spaces should be in the vicinity or neighbourhood, and should have accessibility in the true sense, that is, people should have easy access to walking tracks, fresh air and sufficient number of trees and other vegetation. An open barren land should be vegetated and well maintained to be worthy. Therefore, it is difficult to assess the real availability at times. One of the ways can be per head availability of land that can always be measured by dividing the total green land by the total number of residents. The spatiality with respect to the distribution and degree of concentration is difficult to assess. This means in a city there can be certain areas which are rich in green cover and there can be certain areas that are deprived of it. The concentrated pocketed availability of green spaces can have its contextual health issues. To address this issue of disparity and uneven distribution, the modern technology of remote sensing and geographical information system (GIS) is of a great help. The technology of remote sensing acquires the information of any phenomenon or thing without making physical contact with it. It generates information through sensors and cameras fitted on various platforms like aeroplanes and satellites. The generated satellite imageries and aerial photographs are then processed with the help of GIS, a software-based system designed to capture, store, analyse, retrieve and manage the raw geographic data into vector or workable form through which various analysis can be performed. This kind of data is purely spatial data and can help in topological, hydrological and cartographic modelling. It is very difficult to estimate how much green is enough, but definitely it is never enough, as its benefits are enormous. Healthy cities or liveable cities are the concepts very closely linked to green cities. The more the green, the better it is. A mount of green spaces in Indian cities Indian cities have expanded significantly over the years, both in terms of number and space. Indian cities accommodate nearly 31 per cent (370 million) of the population of the entire country but occupy only 6 per cent of the total area. This shows the immense pressure on urban land and resources. The urban population in India is expected to increase to 50 per cent by 2051. The tremendous increase in population also indicates the dynamics of land use and unscientific use of resources. The change in land use is the most significant and evident dimension of urbanisation. If cities grow haphazardly and in an unplanned manner, they tend to lose their green spaces. This makes cities unhealthy and unsustainable to live.

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According to the India State of Forest Report (ISFR) 2017, the total forest and tree cover in India is 80.20 million hectares, which is 24.39 per cent of the total geographical area. The total carbon stock in the country’s forest is estimated to be 7,044 million tonnes. In a report in Lifestyle magazine, Nijhawan mentions that Chandigarh is the greenest city of India, followed by Nagpur, Gandhinagar, Guwahati, Mysore, Dehradun, Jamshedpur, Shimla, Bhopal, Bhubaneshwar and Delhi, respectively. Chandigarh is a well-planned city with more than 15 famous parks, such as Rose Garden, Rajendra Park, Lake of Sector 42, Pinjore Garden and Rock Garden. The city is beautifully landscaped by hierarchical plantations along roundabouts, chowks, avenues and roads. According to the ISFR 2013, nearly 8.51 per cent of the city’s total area is under tree cover. In 2006, forest department of India declared it as one of the greenest city of India as it reported to have 35.5 per cent of tree cover. Presently, the city has nearly 2 lakh trees of 87 varied species, which makes it a botanically rich area. Gandhinagar is popularly known as ‘Green City Gandhinagar’. Trivandrum, the capital city of Kerala, is known as the ‘Evergreen City of India’. A study by Sinha, ‘Urban Forestry: Urbanization and Greening of Indian Cities’, highlights the forest area in cities based on the percentage of forest area to geographical area. It found that New Delhi has the highest forest area, that is, 46.60 per cent, followed by South Delhi (31.33%), Vishakapatnam (30.81%), Central Delhi (20.20%) and Chandigarh (14.72%), respectively. The study also analyses the forest area available per city dweller. It found that Vishakapatnam and New Delhi have the maximum of 801.98 sq. m and 121.96 sq. m of forest area per city dweller. They are followed by Hyderabad and Jaipur, with nearly 90 sq. m per city dweller. A very low forest area of 1 sq. m per head is found in Ahmedabad, Mumbai City, and Chennai. A study by Roy reflects Gandhinagar with a forest tree cover of 32.56 sq. km and 162.80 sq. m of per capita green space. The data places it to be in a better position than Chandigarh, whose tree cover is around 49 sq. km but per capita green space of only 54.45 sq. m. The study shows that Delhi has 297 sq. km of green space but only 21 sq. m of green space available per head because of high population. The ISFR (2017) shows that Delhi’s forest cover has grown by 0.25 per cent but the city has lost thick dense forest since 2015.

W here should green spaces be located? Another very important question to be answered, especially in context of cities, is the location of green spaces. Cities are home to millions with a trillion needs. The competing land uses are deemed far more important than green spaces. In addition, green spaces lose their importance and existence over a period of time. The relevance and significance of green spaces makes it essential for urban planners to include them in the master plans. Green spaces have more relevance when located in the nearest neighbourhood.

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These spaces whether parks, gardens or tree plantations have to be juxtaposed with other land uses of the city. Gardens and parks are the most acceptable landscapes in residential areas. Parks and gardens make a place look aesthetically beautiful. They are pleasing to our eyes. Many cities in Spain, Australia, United Kingdom, United States, etc., encourage the concept of community gardens, wherein one single piece of land is maintained and gardened by community people. Urban farms have lost their importance in the contemporary world. They have been pushed to fringe areas by more lucrative and productive (in terms of profitability) land uses. Urban farmers sell their fertile land to profit-generating economic activities, like for recreational purposes or commercial or industrial areas. However, urban farms should be an integral part of the urban economy. These can generate employment and give opportunities for research and development in the field of agriculture. Urban farms can also be a source of food, especially at the time of calamities or some civil or political emergencies. Trees outside forests (TOF) are very commonly grown along the streets, roads and rivers. These trees help to maintain the micro-level climate and soil fertility of the cities. They also help to absorb the extra runoff during heavy rainy days. Tree plantations and gardens are also maintained in schools, offices, hospitals and other public buildings. They give fresh air and a place to walk. These trees are maintained by the concerned government authorities. The indigenous variety, especially, fruit-bearing trees are good options to be explored. The trees also attract various birds and fauna life. For example, a rose-ringed parakeet is attracted by Azadirachta indica (neem) tree, a grey hornbill nest can be spotted on Bombax ceiba (semal, and the Asian koel and hornbill can be spotted on the banyan tree in Delhi. Community gardens provide opportunities to grow local crops, flowers, trees, herbs, etc. This helps the local people develop a sense of ecological belongingness. Ecological belonging is the feeling of being attached to the ecosystem of an area. The elderly population, children and eco-enthusiasts can be actively involved in community gardening. Gardens in open spaces meant for walks and recreational purposes, can also be maintained by local authorities. Similarly, grass lawns can be built in between the colony lanes. Metro and flyover pillars can be converted into vertical gardens. Vertical walls are often known as green walls or life walls. The concept of vertical gardens is slowly becoming popular in various cities of China, Korea, United States, Australia, etc. It has been established in Delhi too along the Metro pillars of the Blue line. Such walls can be built both in internal structures like the lobbies of schools, hotels, offices and external structures like walls of backyards and pillars. Delhi National Capital Region (NCR) is constructing vertical green pillars along metro lines (Figure 1.2). Roof gardens are also an important and contemporary form of green space. These gardens are owned and maintained by individual households.

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Figure 1.2  Vertical green pillars along metro lines.

People can install solar panels for green energy and grow herbs, vegetables and flowers in their kitchen gardens, both on the ground floor or on rooftops. These are experimental laboratories that can use organic manures and less water to grow vegetables and herbs (Figure 1.3) An ecological corridor is another popular concept that is picking up in the cities. Ecological corridors are the functional connecting corridors

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Figure 1.3  Exhibition of kitchen garden practices.

between buffer zones and the core areas. These are long uninterrupted strips of vegetation. These corridors give a scope of expansion of existing habitats, dispersion of wildlife and use of empty open spaces. Biodiversity parks are being developed in the city fringes. These parks can be biologically rich with native plants and trees. An interesting example is the Yamuna Biodiversity Park in Delhi (Figure 1.4). The wetland spreads over around 450 acres of land, and the park contains a herbal garden, a butterfly conservatory and a sacred grove. A herbal garden comprises of herbs (small nonwoody plans) that can be grown in smaller areas with less water required. The herbs can have numerous benefits, like for aromatherapy, spices or medicinal value. The term ‘butterfly corridor’ became popular when former US President Barack Obama announced to build up a 1,500 mile corridor between Mexico and Minnesota. This is an ambitious project. In cities, small butterfly conservatories can be established in parks or lawns. These include native flowers that attract butterflies and bees for nectar. The Niagara Parks butterfly conservatory has 2,000 tropical butterflies. In Delhi, besides the Yamuna Biodiversity Park, Lodi Gardens too has a butterfly conservatory spread over 3.5 acres of land. One can locate a grass jewel (smallest butterfly) along with a variety of birds in this area. Butterflies are called umbrella species; they are good for the ecosystem and susceptible to even the smallest variation in climate or habitat. The answer to where green spaces should be allocated lies not only in its existence but also in its accessibility. Green spaces should be accessible within approximately 100–200 metres of a neighbourhood. Small parks and green belts should be easily accessible to the residents, while big parks should be accessible within the vicinity of 1–2 kms. Areas with a high

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Figure 1.4  Migratory birds in Yamuna Bio-diversity Park in Delhi.

Figure 1.5  Green cities and their remarkable features, as per the Economist Intelligence Unit. Source: Compiled by the authors

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density of population should be prioritised. Moreover, an assessment should be done by creating buffer zones around each park or green space, according to its size and greenness. It should also be assessed as per the population density and pollution level. Very densely populated areas or areas with high air pollution levels should have more parks and green belts.

G reen city: examining the concept A city that is green in its ambience, structure and system can be called as green city. It shall promote energy efficiency and renewable energy in all its functioning. It should be planned and developed on the principles of green growth and equity. Stockholm in the European Union has been considered for the first European Green Capital award. New York is considered to be the greenest large city in the United Sates with lowest greenhouse gas emission. Singapore is considered to be Asia’s greenest city. Keeping all these cities in mind, can we call Delhi a green city? It is very difficult to measure the greenness of a city, because a city is a complex setup with various intermixed economic and social variables. The Green City Index prepared by the Economist Intelligence Unit (EIU), Siemens (Europe), is based on 30 indicators under nine main categories, namely carbon-dioxide emissions, energy, buildings, land use, transport, water and sanitation, waste management, air quality and environmental governance. The data for the same have been collected from various international and national organisations such as Cambridge University, Ford Foundation, African Development Bank, and Organization of Economic Cooperation and Development. The data have been compiled and made comparable to an extent. Based on this index, various cities were found to be involved in different ‘best practices’. The data rank Copenhagen at the top, followed by Stockholm, Oslo, Vienna and Amsterdam, respectively. Amsterdam is a city that consumes the least water and use bicycles and trams for commuting. In Asia, Singapore is the greenest as it includes water recycling plants, waste-to-energy plants and a wonderful transport network. Singapore is followed by Hong Kong, Osaka, Seoul, Taipei, Tokyo, Yokohama, Bangkok, Beijing and Delhi, respectively.

I s Delhi a green city? According to the Forest Survey of India (FSI) in 2016, 87 per cent of Delhi’s total vegetation is non-forest or TOF, 8.41 per cent is open forest and only 0.47 per cent is very dense forest. Plantations or TOF account for 118.95 sq. km, and the ravine thorn forest spreading across 57.67 sq. km occupies a major portion of the city. New Delhi and South Delhi have 49.29 and 32.86 per cent, respectively, of their total area under vegetation. Central Delhi has nearly 20 per cent and South West Delhi has 11 per cent of its

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area under vegetation. The remaining districts have less than 10 per cent of their total area under vegetation. Is the city sufficiently green? Delhi has 40 city forests, 5 ridge areas, 2 biodiversity parks (Yamuna and Aravalli biodiversity parks) and a wildlife sanctuary (Asola). It is home to more than 450 different varieties of birds. As mentioned earlier, according to the WHO standards, a green area of 9 sq. m per urban dweller must be available in a city. According to the FSI, Delhi has 0.002 ha, that is, 20 sq. m of forest land per urban dweller, which is significantly higher than the WHO standard. This makes Delhi sufficiently green, considering the fact that it is a megacity which has numerous ongoing and planned developmental projects related to the housing, commercial, industrial and transportation sectors. Does Delhi use green energy sources? Delhi has a huge energy demand. Delhi uses multiple energy products and a variety of fuel types. According to the Delhi Statistical Handbook 2016, the city uses petrol, diesel, compressed natural gas (CNG), piped natural gas (PNG), etc., to meet its energy requirement. During the past 4 years, CNG consumption in Delhi has increased from 700,000 metric tonnes to 800,000 metric tonnes, petrol consumption is almost stagnant but diesel consumption has fallen rapidly since 2015. The credit goes to government policies that have been encouraging the use of CNG. PNG connections in Delhi have increased from 393,476 in 2013 to 522,747 in 2016. Electricity in Delhi is generated and supplied by the power stations of Delhi, mainly based upon fossil fuel, that is, coal. With regard to vehicles, the Supreme Court decided in 1995 that all cars should run on unleaded petrol. It was by 1998 that this ruling became absolutely successful and functional. All cars now run on unleaded fuel. Although Delhi has not completely utilised the non-renewable sources of energy, yet it plans to move ahead with a very ambitious task of utilising solar energy. According to a report published in the Hindustan Times on 28 August 2017, after the Delhi Solar Policy was notified in 2016, the city government had set a target of generating 84 MW of solar power only through rooftops in residences by March 2018. Till now, households are contributing only around 15 MW in Delhi’s total solar power production of 56 MW. There is a target of generating a total of 186 MW (84 MW from residential and private buildings and 102 MW from government buildings) of solar power by March 2018. The same has to be increased to 1,000 MW by 2020 and 2,000 MW by 2025. Let us examine other world cities. About 95 per cent of Singapore’s electricity requirement is met through natural gas. It is supposed to be the cleanest form of energy. Singapore is also exploring the huge potential of solar energy, which is available in abundance. In Sweden, nearly 80 per cent of electricity production is contributed by nuclear and hydroelectric power; therefore, emissions are very low. In New York, most of the electricity requirement is met by natural gas, nuclear, hydro power and solar power.

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Dependency on fossil fuel is quite low. In Beijing, fuel consumption was primarily coal-dependent till 2014. Now, the focus has shifted to solar and hydro power. The city has shut down some 55,000 coal-fired industrial boilers and shifted to clean energy, thereby reducing emissions to a great extent. Various green initiatives have been taken by the Delhi government during the past two decades. The Forest Department coordinates the entire plantation and other greening activities in the city. Many agencies/organisations and bodies work under its supervision, like the DDA, the MCD, the NDMC, the Central Public Works Department (CPWD), the Public Works Department (PWD), the Delhi Park and Garden Society, the Flood Control Department, the Education Department and the Delhi Metro Rail Corporation. All these are given duties and targets to meet. Under the Delhi Tree Preservation Act 1994, strict rules have been laid down for cutting trees. The act also stresses adoption of trees, a tree census and preservation of trees by the owner of the land. Since 1997, the Forest Department prepares an Annual Greening Action Plan. Under this plan, some 1.8 million trees have been planted every year since 2006. Since 1999, the Greening Delhi Campaign is launched every year, in which government bodies/NGOs/schools/residential welfare associations (RWAs) form a ‘task force’ to plant trees in various parts of the city. A very ambitious project to restore the Bhatti mines as a sanctuary was undertaken during 2000–2001. The 132 Infantry Battalion and Eco Task Force were deployed to carry forward the work. Till now, nearly 4,000 acres of land has been restored into a beautiful wildlife area. Government efforts also include the initiatives such as Tree Ambulance and Green Leap Delhi. Tree Ambulance is a humane gesture by the NDMC to send an ambulance to take care of all those trees that are hurt, uprooted or unwell. In 2011, many trees were planted by school students and teachers around Raj Ghat. Government distributed some one million free saplings. Various rules have been formed to curb air pollution in the city. The Central Pollution Control monitors and displays the ambient air quality at its recording stations. The National Green Tribunal (NGT) has issued stringent actions on burning waste and emissions related to construction activities. All taxis lying in Delhi have been ordered to be converted into CNG. In order to restrict the number of commercial vehicles entering the city, a huge green cess has been imposed on them. Delhi Government’s recent odd/even rule has been well-appreciated to lower the levels of pollution during the peak months. According to this rule, the cars with odd-numbered registration plates will ply on odd dates and those with even-numbered plates will ply on even dates. Time and again, the government has taken short-term or emergency actions to fight the impact of pollution. In 2017, the Delhi government watered all the tree canopies as an emergent measure to reduce the impact of pollution in the city. Recently, solid waste management by-laws have been implemented under Section 5 of the Environment Protection Act. Delhi generates nearly 14,000

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tonnes of waste per day. Even though the MCD provides a door-to-door collection service, the problem lies in the fact that people are not aware or bothered to segregate the biodegradable and non-biodegradable waste. Even the medical waste, e-waste and industrial waste are all dumped at the landfill sites located in the fringe of the city. These wastes release harmful gases and obnoxious smells all over. A lot of effort is required to consider the scientific and eco-friendly way of waste disposal and its management. Every sector in Delhi is contributing to its rising pollution levels. The question that comes to our mind is, if Delhi is sufficiently green, why the air is not sufficiently clean? Massive gas emissions from industries, vehicles, the domestic sector, construction activities and open waste disposal landfills are continuously adding to the greenhouse effect. According to various estimates and studies done in several cities, Sydney has a carbon dioxide emission rate of 20.3 tonnes per capita per annum, Beijing has 10.8 tonnes, Bangkok has 10.7 tonnes, London has 9.6 tonnes and New York has 7.9 tonnes of carbon emissions per capita per annum. In India, Delhi compares with 2.40 tonnes per capita per annum, Chennai with 4.79, Kolkata with 3.29 and Greater Mumbai with 1.88 tonnes. These figures prove that developed countries have much higher carbon emissions than Indian cities. Meanwhile, Delhi has lower carbon emissions than Chennai and Kolkata. Looking at the various parameters, both at national and international levels, it is difficult to determine whether Delhi is a green city or not. The ultimate target of a city is to become resilient and liveable for a long time. Although it is tough to call Delhi a sustainable green city, yet it has several green spaces in and around it. The existence of green areas is an important indicator of a healthy city and their existence can be more meaningful if city has sustainable waste management and energy solutions. Delhi cannot become a green city until it switches mainly to renewable energy sources like solar, nuclear and wind power to generate electricity. Waste management is also a major challenge for Delhi. From the stage of generation to collection, disposal and processing, Delhi needs to work on a proper waste management plan. Delhi is lagging behind on several parameters to be a green city, despite being one of the greenest capitals of the world. Succeeding chapters would highlight the existing green spaces of Delhi and air pollution level, its causes and impacts.

References Biello, D. 2012, Gigalopolises: Urban Land Area May Triple by 2030, in Sustainability, Scientific American Magazine, New York: Institutional Digital Access to Scientific American. https://www.scientificamerican.com/article/citiesmay-triple-in-size-by-2030/?redirect=1. Budruk, Megha, Thomas, Heidi, & Tyrrell, Tim, 2009. Urban Green Spaces: A Study of Place Attachment and Environmental Attitudes in India. Society & Natural Resources, 22. 824–839. doi:10.1080/08941920802628515.

Urban green spaces  33 Burgess, J., Harrison C. M. and Limb, M. 1988 People, Parks and the Urban Green: A Study of Popular Meanings and Values for Open Spaces in the City. Urban Studies, 25(6) (December 1988), pp. 455–473,Sage Publications, https://www. jstor.org/stable/43192315 Butler, L., & Moronek, D.M., (eds.) May 2002 Urban and Agriculture Communities: Opportunities for Common Ground. Ames, Iowa: Council for Agricultural Science and Technology. Retrieved April 1 2013. Carlos, S., Erjavec, I., & Mathey, J., 2008, Green spaces – a key resource for urban sustainability. The GreenKeys approach for developing green spaces. Urbani Izziv, 19. doi:10.5379/urbani-izziv-en-2008-19-02-012. Carlos, S. et al., 2008, Green spaces – a key resources for urban sustainability. The Green Keys approach for developing green spaces. Urbani Izziv, 19. doi:10.5379/ urbani-izziv-en-2008-19-02-012. Chaudhary, P., et al., 2011, Urban greenery status of some Indian Cities: A short communication. International Journal of Environment Science and Development, 2(2). http://www.ijesd.org/ Costello, L.R., 1993, Urban forestry: A new perspective. Arborist News, pp. 33–36. Davern, M. et al., 2017, Quality Green Space Supporting Health, Wellbeing and Biodiversity: A Literature Review, The National Heart Foundation of Australia. Dunnett, N. et al., 2002, Improving Urban Parks, Play Areas and Green Spaces, London: Department of Landscape, University of Sheffield, Department for Transport, Local Government and the Regions. FAO, 1996, The State of Food and Agriculture, Food and Agricultural Series, 29, 0081-4539 Rome. Goldsmith, E. 1996. Global Trade and the Environment. In: J. Mander and E. Goldsmith (Eds.), The Case Against the Global Economy and for a Turn Toward the Local. San Francisco: Sierra Club. GREENKEYS @ your city – A guide for urban green quality, 2008, ISBN 978-3933053-32-9, GreenKeys Team. Grimm, N.B. et al. 2008. Global change and the ecology of cities. Science 319: 756–760. http://dda.org.in/home, web site of the DDA. Harrison, C., & Davies, G., 2002. Conserving biodiversity that matters:practitioners’ perspectives on brownfield development and urban nature conservation in London. Journal of Environmental Management 65:95–108 Konijnendijk, C. et al., 2013, Benefits of Urban Parks: A systematic review, A Report for IFPRA, Copenhagen and Alnarp. Konijnendijk, C.C., Annerstedt, M., & Nielsen, A.B., January 2013. Benefits of Urban Parks: A Systematic Review, Sreetheran Maruthaveeran Copenhagen & Alnarp pub. Madureira, 2018, Preferences for urban green space characteristics: A comparative study in three Portuguese cities. Environments, 5, 23. doi:10.3390/environments5020023. www.mdpi.com/journal/environmnets. Miller, R.W. 1997, Urban Forestry: Planning and Managing Urban Green Spaces. Second ed. New Jersey: Prentice Hall. Rogers, R., et al., 1999, Towards an Urban Renaissance: Final Report of the Urban Task Force. Department of the Environment, Transport and the Regions, London. Russo, A., Escobedo, F.J., Cirella, G.T., & Zerbe, S. 2017, Edible green infrastructure: An approach and review of provisioning ecosystem services and disservices in Urban Environments. Agriculture, Ecosystems & Environment 242, 53–66.

34  Urban green spaces Shakarian, K., 2014, For Richer & For Poorer: Tying the Park Equity Knot, Gotham Gazette. http://www.gothamgazette.com/index.php/government5052richerpoore rparkequity­new­york­city. Sinha, R.S., 2013, Urban Forestry: Urbanisation and Greening of Indian CitiesEfforts for Green Delhi, Department of AYUSH, Ministry of Health and Family Welfare, Government of India Assignment: MCT Phase IV. Thompson, C.W., 2002, Urban open spaces in the 21st century in Landscape and Urban Planning, 60(2), 59–72. URGE Team, 2004, Making Greener Cities – A practical guide, UFZ-Bericht, 8(37), Stadtökologische Forschungen Nr. WHO, 2016, Urban green spaces and health, Copenhagen: WHO Regional Office for Europe. Wolcha, J., et al., 2014, Urban green space, public health, and environmental justice: The challenge of making cities ‘just green enough’. Landscape and Urban Planning, 125, 234–244 www.elsevier.com/locate/landurbplan Woolley, H., 2003. Urban Open Spaces, London: Spon Press. http://www.walkthroughindia.com/lifestyle/ten-cleanest-and-greenest-cities-in-india/

Chapter 2

Green spaces of Delhi A journey from past to present

Introduction Delhi, a union territory and the capital of India, has been the capital of numerous rulers over centuries. Every northern kingdom chose Delhi as its capital city. From Indraprastha and Hastinapur during the Mahabharat to Qila Rai Pithora, Tughlakabad, Feroz Shah Kotla, Shahjahanabad – all were magnificent cities from which the rulers administered their kingdom. Shahjahanabad was possibly the foremost perfect city, as assumed in the phraseology of contemporary city planning. To some extent, Lutyens’ New Delhi made a continuity with Shahjahanabad. Delhi has a geo-strategic location on the map of India. The landlocked city is bordered by Haryana on three sides and Uttar Pradesh on its east. It has close proximity to the Himalayas in the north and the Thar desert in the west. It has rich soil along the Yamuna flood plains. The Delhi Ridge is an extension of the Aravalli Range, that extends in the west, northwest and northeast parts of the city. Delhi is characterised by a humid sub-tropical climate and hot semi-arid climate. The extreme temperatures vary between 45°C in summers to as low as 2°C in winters. Delhi receives heavy monsoon rainfall during July– August as the Arabian Sea and Bay of Bengal branches of moisture-laden winds collide and meet above the Northern plains.

The early period The Purana Qila, one of the oldest forts in the city, is generally assumed to be the place of the prehistoric city of Indraprastha as mentioned in the Mahabharata. It is mentioned that before the construction of Indraprastha city, the land was covered with dense vegetation and known as the forest of Khandwaprastha. Lord Indra asked the consecrated planner Vishwakarma to construct a city after cutting the forest. Although the new city is referred to as a shining example of magnificence, it also destroyed the beautiful life of Khandwaprastha. The city has since then added many pages on destroying and planting of green spaces. Indraprastha was also recognised as Indapatta, Indarattha, etc., and is cited as a town in the Jatakas (stories

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about the early life of Gautama Buddha, according to Buddhist literature). Some stories in the Jataka mention royal gardens in the city. Indraprastha continued as a district (pratigana) in an inscription dated AD 1328, and as a village, Indarpat, which existed inside the Purana Qila until recently.

Mughal green spaces The history of Delhi has many chapters on planned development of green spaces too. The city experiences a hot-and-humid climate for a large part of the year. The Muslim invaders, who came from either cold mountainous regions or hot-and-dry deserts, found Delhi’s climate rather unfavourable as they settled down. This significantly influenced the construction of buildings that they built in the country. When Babar arrived in India, he was unhappy to see that there were no gardens. The square of Madrese Mader-e Shah at Isfahan is full of gardens and springs. The Mughal aristocracy felt the absence of a rejuvenating environment in a culturally different country; therefore, they contributed significantly to the history of green spaces of North India. The history of Mughal green spaces of Delhi begins with the construction of Shahjahanabad (now known as Old Delhi) by Emperor Shah Jahan. He shifted his capital from Agra to Delhi in a period of 10 years, from 1638 to 1648. According to Dutt (1983), the main structure of the Shahjahanabad City consisted of four parts: (i) The Red Fort complex was used for the habitation of the king, his wives and mistress. It was also used as his court. The complex included widespread lawns and inland waterways with fountains. River Yamuna was flowing at the eastern side of the fort. The river and the widespread barren area between the city and the river gave this complex a natural protection against an attack by outsiders. The Mughal city Shahjahanabad was constructed between 1639 and 1648. The main palace of the city was perceived as a garden. The scheme of the fortress palace, now known as the Red Fort, is based on the great Muthammanbaghdadi. It has a rectangle shape with chamfered corners. The porches and halls for the king and zanana position on a balcony (kursi) strung through a canal, which flowed along the riverbank. In the anterior of every Iram-like porch (nashiman) was a garden of seamless freshness and pleasantness, and in this way, the whole ground from one end to another looked like a paradise. In the planning of each specific complex, the principle of a waterfront garden was applied. This scheme was used for the whole riverfront. The main canal of the palace of Shahjahanabad, the Nahr-iBihisht, flowed as the water of life through the band formed by the riverfront terraces and connected to all riverfront buildings. Its outlets provided

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water to the individual gardens. At the same time, the riverfront terrace provided the terrace component (kursi) for each garden unit (baghcha). The historians of Shah Jahan named the four riverfront gardens. The Bagh-i Hayat Bakhsh was the northern-most. In the centre was the Imtiyaz or Rang Mahal, the main zanana building with its small garden described as baghcha-i-dawatkhana. Then came the pavilion of Jahanara (Nashiman-iBegam Sahib) with its baghcha, which had an octagonal hawi in its centre. At the southern end of the riverfront ‘was the baghcha between the Nashiman-iBegam Sahib and the southern tower (burj)’. There is ‘another garden (bagh) full of fruit trees’ immediately to the west of the Hayat Bakhsh (later called Mahtabi Garden). It had a building of red stone called Lal Mahal in the centre, which shows that the centrally planned garden continued to be used in the interior of the palace. There was a small garden to its north and another garden (bustan) called Bagh-I- Angur (Grape Garden), covering the area to the north of this garden group. Thus, the gardens considered worth mentioning in the official description of the palace covered a great part of its area. According to the earliest preserved maps dating the 18th and 19th centuries, there were several more gardens, particularly in the zanana quarters, which Shah Jahan’s historians do not mention. The largest and most outstanding of the palace gardens was the Bagh-i Hayat Bakhsh, which occupied the northeast corner of the palace complex. It was of gigantic size for a Mughal palace garden and represented a great innovation, not in its form but in how its formal aspects were used to express the symbolic position of the garden in the palace. The garden was not fully preserved. Today, only the two eastern garden quadrants survive. Originally, there were three buildings on the terrace, a larger structure in the middle flanked by pavilions with bangla roofs. This implies that the garden was modelled on the zanana gardens of Agra and Lahore. Only one structure remains today of the characteristic tripartite riverfront group, namely the northern bangla built adjoining the Shah Burj. The structure and its lost companion piece are not readily recognisable as the characteristic bangla component of the group, because they were planned on a larger scale and arranged differently than their forerunners in Agra and Lahore, with their longer sides towards the central pavilion and their shorter sides towards the river. The surviving northern bangla was also brought so close to the Shah Burj that it was no longer a free-standing pavilion but actually becoming a vestibule for the tower. In its new context, the bangla pavilion retained the characteristic configuration of an open hall with a curved roof, flanked by two hujras (small closed rooms), to which was added a portico with large baluster columns and another bangla vault inside (represented on the facade by a curved-up cornice). Therefore, the pavilion had two parallel bangla vaults inside. The roof group on the outside preserved the main elements of the original bangla

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pavilion, that is, the single upturned oblong roof, flanked by two pyramidal roofs with curved profiles. In this case, these roof elements were more loosely grouped (Ebba Koch Muqarnas, 1997: 143–165). (ii) Opposite to the Red Fort was the Jama Masjid, built by using pink sandstone and marbles, for the Friday prayers of the aristocracies and common citizens. A large green area separated it from the Fort. (iii) A huge boundary wall, built of granite and other stones, had within it a military base for the defence of the city. It was cut at various locations by gates, ways from which led to the various portions of the city. The city was surrounded by extensive greens on all sides, which had a beneficial effect on its environment and also provided spaces for cultural and recreational activities of the citizens. (iv) Chandni Chowk, the main street, is a broad lane which goes west to east for about one mile. It was planned to be used not only for normal movement of the inhabitants but also for demonstrations and marches. It also had an artificially built canal with fountains, which was not much deep. Shoppers and other pedestrians never faced the problem of heat and cold because of the covered shopping colonnades on both sides of the street (Nath, 1993). Historical accounts indicate that Delhi had a dense green cover during that time. The opulent green was visible in gardens for which the city was famous. These included Roshanara Garden (situated near the fringes of Shahjahanabad), the Tal Katora gardens adjacent to the village Rakabganj and near the Southern Ridge. These were planned and planted between 1650 and 1710. These large gardens also included an Alshikarghar (hunting lodge) for Nasir-ud-Din Muhammad Shah (r.1719–1748). Most of these green spaces developed a semi-circle, starting from the Yamuna in the north of Shahjahanabad to the southwest on the Southern Ridge

British green spaces Nath describes this period of Delhi on the basis of Sealey’s 1988 description. New Delhi, which was the British capital, was constructed to the west and southwest of Shahjahanabad. Both cities were separated by a wide green area known as the Ramleela Ground. At that time, Delhi was spread over 1,300 ha and provided habitation for 65,000 people. In 1912, a Royal Darbar was organised by King George V in Delhi and it was declared that the capital will be shifted from Calcutta to Delhi. Thereafter, Delhi was systematically developed as the regal capital from 1915 to 1930. For a short period, however, the anterior British Cantonment and the Civil Lines, which were situated in the northwest of Shahjahanabad, were used as provisional places for the capital. The new city was systematically built under the supervision of two eminent and well-recognised architects of that time, Edwin Lutyens and Herbert Baker. Along with a team of other architects, Lutyens

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and Baker built a well-planned capital city with the provision of substantial green spaces in between the buildings. An Imperial compound of a multifarious building was constructed in the centre of the city; this included the Viceroy’s Lodge, the Imperial Secretariat, and the Central Legislative Assembly building. The Viceroy Lodge, which was then the abode of the Viceroy of India, is now the house of president of India and known as the Rashtrapati Bhawan. Located at the southern end of the compound, a beautiful garden was built behind the Viceroy Lodge, known as the Mughal Garden. Widespread forests were also planted beyond it to the south, southwest and northwest. The Viceroy Lodge and the two buildings of the Secretariat – North Block and South Block – were constructed on a low-rise ground along with a big square and a central landscape beyond it. The central landscape was around 3 km long. Its borders were decorated by lawns and artificial canals, reminding of the beauty of Shahjahanabad. The second type of buildings constructed in the new city were residential buildings for officers, clerks and peons. Their rank was the criteria to decide the location, size, design and attached lawns of the houses. The third types of buildings were churches, schools and hospitals. They all had patches of green spaces. The Connaught Circus complex was the main shopping square of the city. Wide streets with lined trees, transverse paths and green roundabouts where the streets and paths met, were other interesting features added in New Delhi. Until the Second World War started, it was a green and uncongested city. The development of green spaces in between the buildings not only reduced the severity of Delhi’s hot summers and cold winters but also kept the city free of pollution (Nath, 1993). New Delhi is considered one of the best green city projects of the 20th century. Initially, the task of protecting and planning new green spaces was assigned to A. E. P. Griessen (1875–1935), as he was the Officer-in-Charge of the Horticultural Department, Delhi. He started his work with setting a nursery. Since the whole city was under construction, he tried to save many old trees by coordinating with Sir Lutyen’s team. Griessen did a good job, but in 1919 it was realised that he was on the verge of retirement. Therefore, the gardener, William Robert Mustoe was promoted. He took charge as the Superintendent of Horticultural Operations, New Delhi. He started his work with great zeal. He felt that the small nursery which Griessen had setup was not sufficient to meet the demands of the new city, so with Sir Lutyens’s help he converted an old, almost-decayed Mughal Garden, known as Talkatora Bagh, into a big nursery. It was full of debris and stones but Mastoe cleared it and planted many old and new species to fulfil the requirement of the new city. He consulted Sir Lutyens for selecting the species, and in the absence of Sir Lutyens, he involved his assistant George (1881–1962), who also liked gardening and contributed significantly towards greening the city. Sir Lutyen’s scheme for the city included a chain of broad avenues passing through traffic rings and at the end, meeting at the Viceroy’s house. In 1928, many

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species of trees were planted in the central landscape along the Rajpath. This planting was done according to Sir Lutyens’ selection and instructions. The reaming roads of the city were planted by Mustoe and his team. Variability was the main criteria in the selection of trees. Some were successfully planted, while others failed to grow. Successfully planted trees were the South African sausage tree, Kigelia pinnata; the tamarind, Tamarindus indica; the fig, Ficus infectoria; and the neem tree, Azadirachta indica. On the other hand, trees such as the Maulsri, Mimusops elengii, did not grow because of the ‘loo’, a hot dry wind which blows from Rajasthan. The same wind affected the vertical growth of the eucalyptus also, and the growth of the Mango trees was also affected by the wreckage at the time of its fruiting. Mustoe, in his scheme of greening the city, planted fast-growing trees in between the lanes of the slow-growing trees, so that the greening of the city would be immediately visible. Mustoe during his term remained anxious if his successor would remove the temporary plantation or not. Therefore, before leaving New Delhi, he managed to take out the temporary plantation. Planting in this new city was not easy, as the architects and engineers were not clear about the placement of public lights and entrance of buildings. Many roads were constructed with soil fill, which needed to be settled down. The builders closed 180 wells during the construction of new buildings, which created scarcity of water and hampered the growth of many species. Later, Mustoe managed to reopen some of the wells for watering the newly planted trees. Despite these problems, Mustoe managed to complete the main plantation work, and the new city got enough green space between 1919 and 1925. Another most remarkable contribution of Mustoe, at the request of Sir Lutyens, was greening the stony and bared hills known as the Ridge, which made the backdrop of the city. A boundary was prepared for this area and Mustoe was appointed as forest officer for the Ridge and the nearby area, so that anybody who wanted to remove trees from this area would require Mustoe’s written permission. Mustoe started searching for the best droughtresistant species to green this area. After a long search, he discovered that the Prosopis juliflora could be seeded in that rocky Ridge area. Mustoe and his team put years of hard work to plant the forest in the Ridge. Mustoe is also known for planting the gardens surrounding several historical buildings such as the Qutub Minar tower, the Safdar Jang tomb and the fortresses of Feroz Shah and Purana Qila. His most remarkable work was the Mughal Garden, grown behind the Viceroy’s House. It is still known as one of the best gardens in the world (Bowe, 2009). Judith Roberts in her article ‘English Gardens in India’ published in Garden History, 1998, looks at the development of the English garden design, and the role it played in sustaining the English community. In this article, she talks about the period from 1750 to 1850.

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In her paper about the gardens of Delhi, Roberts explains that in Delhi before the 1857 Mutiny, there was a time of a few years when Mughal architecture and English landscaping were visible together. British officials and the population built their own houses around the city using the traditional Mughal designs. They integrated structures like the taikhana or basement to build a cool place during the summer. Sir David Ochterlony and Charles Metcalfe used the Shalimar Garden for recreational activities at the time when they were posted as officers in Delhi. Shalimar was an encircled royal garden, and Shish Mahal was a palace built by Mughal emperor Shah Jahan at the centre of the garden. The garden also included lotus ponds, mango groves and water channels. The garden and Shish Mahal were renovated by Charles Metcalfe, but he made very little changes in the setting of the garden. It was Charles’ brother Thomas who developed many gardens near Mehrauli, in the south of Delhi. Thomas came to Delhi in 1813 and stayed for about 40 years. He constructed many buildings for which he is well known. It North Delhi, he built the Metcalf House, and in 1844, he built Dilkusha or Delight of the Heart near the Qutub Minar. It was a personal building but known for including the traditional Mughal designs. Dilkusha is known for its well-planned gardens which were based on the design of the Char Bagh. The use of Shalimar Garden by British officials and construction of Dilkusha were symbols of respecting other cultures. The lifestyle of the Europeans and Indians remained mixed until the middle of the 19th century. This changed significantly after the Revolt of 1857. A third of the city was demolished and then reconstructed. In 1863, a municipal committee was set up to provide the facilities and maintain the city. However, it remained unsuccessful in bringing about a significant change in the lives of the people because it lacked the necessary financial resources and power to act effectively. The development of infrastructure showed limited progress. Piped water supply began in the 1890s, and regular electricity supply was started in 1902. The spread of disease led to widening of the road that separated the European residents from the local people’s houses. The differences were also clearly visible in the development of green spaces. Lawns and parks were developed in between the European settlements. In 1894, Jyoti Hosagrahar noticed that only 146 houses in Delhi had piped water supply, and they were mostly Europeans. Only a few streets were maintained, and by 1912, the municipality had constructed only 25 public latrines for a population of 500,000. The government of India’s plan to develop a waterborne sanitation system for the city remained on paper. In this way, the development of infrastructure and green spaces in the colonial city of Delhi differed for the natives and the Europeans. In the beginning, colonial officers started planting ornamental gardens, nurseries, parks, lawns and trees along the paths. In 1911 and 1912, green spaces were considered an important area of urban planning, and the

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colonial administration took it seriously. During the development of the new capital, the administration ensured that enough land was provided to develop the green spaces in the city. In 1911, besides these green patches, a large green cover was spread, from the west of the Sabzimandi and Kishenganj northwards near to the Wazirpur and Azadpur villages. At that time, the green cover was double the size of the enclosed city. Deforestation of the ridge Throughout Delhi’s history, green spaces of the city have faced the challenge of ever-increasing population, and this large green cover of the Ridge was not an exception. Population data indicate that during the period from1650 to 1739, around 400,000 people were staying in the main and nearby suburban areas. Most of the population were engaged in cultivation. In the second half of the 18th century, when the Mughal empire started losing its glory, the 8–12 km of the surrounding area of the city was engaged in intensive agricultural activity. The trend continued in the 19th century as the population increased from 120,000 in 1833 to nearly 200,000 in 1901. To fulfil the demands of the increasing urban population, a large forest area was cut and utilised for agriculture. Probably in this way, the deforestation started during the Mughal era and continued in later half of the 19th century. According to a British officer, the forest of Delhi was cut extensively by the authorities in 1800 for a nominal payment without considering the long-term consequences. In the 1820s, when the British Cantonment moved adjacent to the Northern Ridge, the forest was cut again. During the 1857 Revolt, Delhi was surrounded with British soldiers who were trying to take control of the city, and in the process, they destroyed the forest of Kudsia Bagh. After the revolt, a large green cover of Tis Hazari Bagh of around 3,000 trees was cut down to construct a shooting range. In the second half of the 19th century, Delhi lost a large extent of its green cover. Even the Ridge became almost bare. In the name of vegetation, some undersised ‘kikar’ or ‘karil’, or the small bush of the ‘beri’ and moderate pastures were visible, where flocks of sheep and goats were herded by the Gujar community. Efforts to re-greening the ridge, 1883–1909 Initial efforts were made to grow some vegetation on an almost-bare Ridge were focussed on its northern excrescence because it was close to the European inhabitation in the Civil Lines. Efforts to restore the green cover were determined more by the interest of individual administrative officers than by a clear and targeted plan for afforestation. The first documented initiative to restore the green cover of the Northern Ridge was led by J. R. Maconachie and Dr. Ross. They developed a plan for

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a period of 4–5 years. There is not much information available about Dr. Ross, but Maconachie was a passionate district officer and compiled a book ‘Selected Agricultural Proverbs of the Punjab’ (1870). He had already coauthored a revenue settlement report for Delhi (completed in 1882). Maconachie (in 1880) had worked on the resumption of local band irrigation structures in hilly areas of rural Delhi while controlling soil erosion and desertification in the agriculture areas of the city. He not only tried to restore the green cover of the Ridge but also made an attempt to afforest the hilly protuberances of the Aravalli Range in Gurgaon, as the deputy commissioner of Gurgaon. He promoted the participation of the rural people in all these endeavours. During his tenure as a district judge in Delhi, Maconachie worked in close cooperation with rural communities to restore the green cover of the Northern Ridge. He also constructed earthen bands to dam the water. The plan of greening the Ridge was weak one until 1887, when a second attempt to restore the green cover on the Northern Ridge was started by Revd. G. A. Lefroy of the Cambridge Mission. He was also the Civil Station member of the Delhi Municipal Committee. After the 4 years of his first attempt to make the Ridge green, Lefroy criticised the effort and declared it a failure because it was not consistently pursued and it did not serve the part of the city inhabited by Europeans and colonial officials – the Civil Station. He felt that Maconachie’s efforts were focussed around Chandrawal village, which was located very far from the European Civil stations. As a result, the Europeans were not able to get the benefits of the afforested Ridge, including absorbing the summer heat. The climate and forestry experts understood that planting a large number of trees will provide a freshening effect to the region. Therefore, the second attempt of greening the Ridge was aimed to make the climate of the region more soothing and also increase the beauty of the area. Lefroy’s approach towards the local villagers was very different from Maconachie’s. Lefroy believed the local people were a hurdle because their cattle-grazing activity harmed the new plantation. Therefore, he totally excluded them from the reforestation efforts of the Ridge. They were forbidden to graze and enter in the Ridge. The area was declared a restricted area and regular patrolling was started in the absence of a fence. After Lefroy’s persistent efforts, the greening of the Ridge once again became a victim of administrative apathy. In 1909, Deputy Commissioner C. A. Barron once again started the effort for greening the Delhi Ridge. He conducted a survey and found that the green cover of the Ridge had increased because of Lefroy’s hard work. His survey found grown-up neem trees with a cactus boundary around them, which was probably seeded by Lefroy in the hot summer of 1887 or 1889. Barron showed keen interest in the revival of the green cover on the Ridge; therefore, he asked the superintendent of gardens to share views about the trees to be planted and the comparative benefits of the various

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methods of planting. The earlier methods of afforestation used by Maconachie were replaced by more capital-intensive methods, which included the appointment of superintendent of gardens planting tree saplings and seeds in hedged enclosures with several chowkidars to guard these. Elaborate notices of communication were prepared to prohibit the nearby rural population from entering and grazing in the reserved area. The capital-intensive methods were intensified when the New Delhi Ridge was afforested after the declaration of the shifting of the capital to Delhi.

Post-independence development of green spaces India won its independence in 1947 but also saw a partition. Delhi saw an influx of refugee population that migrated from the newly built nation of Pakistan. The migration continued for a few years, and the population of the city increased from 400,000 persons in 1990 to over 1,700,000 by 1951. The increased population put tremendous pressure on the city’s infrastructural facilities and civic amenities. This was a matter of grave concern to the administration of the newly independent country. G. D. Birla in his report on the Delhi Improvement Trust mentioned that a ‘Bad environment affects us all in a similar way; it will not leave anybody, neither us who are fortunate to get required facilities, nor those who are less fortunate in getting these’. In 1956, the minister for health and local self-government, Rajkumari Amrit Kaur, called the Ford Foundation to help in the planning of the city. A consultation team was appointed under the headship of Albert Mayer, a U.S.-based planner who had experience in planning the cities of Bombay and Chandigarh. He was also the architect of a rural community development project in Etawah. The consultation team included a physical planner, a government specialist, an industrial planner, a transportation specialist, an economist and an urban sociologist. No gardener or environmentalist was a part of this team. The planners observed that the Delhi was working as the core for functional regions. Its economy was dependent on peripheral resources, and in exchange, the city supplied goods and services to them. Above all, Delhi was the centre of attraction for both migrants and refugees. Its administration required the skill to systematically chart and command these flows so that the best-possible balance could be achieved without halting the growth of the city. The solution lay in preparing an inclusive regional plan. Since the 1920s, two approaches of regional planning were developed in the United States. One was the metropolitan regional development plan, and the other was inspired by Patrick Geddes and the Garden City movement, which recommended a low density of urban development with enough green space. In the context of Delhi, metropolitan regional development planning was found more suitable as the city was considered a functional region. Within the metropolitan regional development approach,

Green spaces of Delhi  45

two broad environmental concerns were marked: one was slums and another was industrial locations. Nobody even mentioned the requirement of green spaces in the capital of the newly independent country. The years from 1947 to 1970 in the history of Delhi are known as a period of frenetic construction. During this period, different types of houses were constructed to fulfil the demands of refugees, migrants and central government employees. Most of the construction happened in the south and southwest of New Delhi. The Delhi Development Authority (DDA) was set up in 1955, and it contributed significantly in the construction of houses for low- and middle-income group. The DDA was established under the provisions of the Delhi Development Act, to promote and secure the development of Delhi. The DDA is the first urban development authority in India which has played a significant role in the overall development and management of its green spaces. The first master plan, 1961 The first master plan of Delhi was promulgated on September 1, 1962.The responsibility of modification and implementation was handed over to the DDA. The plan was made for 20 years, considering the projection of growth of population and economic activities. The plan not only included the main city but also the areas covered by 300 nearby villages. The plan had three main objectives: 1) Shift the hazardous and polluting industries, which were initially setup inside the city, to outside the city. 2) Ensure segregated land use in town. 3) Stop encroachment in the areas designated in the plan as green belts around the city. After 20 years of the promulgation of the plan, it was seen that the plan almost failed to achieve its targeted goals. The second master plan, 1981–2001 The second master plan was prepared by the DDA but was not approved. The important reason for not approving the plan probably was that the Central Government believed that the plan should have been revised within the framework of the Regional Plan 2001 of the National Capital Region (NCR). The NCR plan was aimed at decentralisation of growth and consequently shifting the population pressure in the nearby areas of the city. Besides the Union Territory of Delhi, large areas of adjoining states of Uttar Pradesh, Haryana and Rajasthan were included in the NCR. The Regional Plan 2001 of the NCR was approved in 1988 but did not become functional. There were two important reasons for this. The Delhi administration did not intend to lose the benefit arising from commercial and industrial activities; therefore, it did not support much of the decentralisation activities. Second, the neighbouring states, which were the part of NCR, were not willing to contribute financially as they realised that

46  Green spaces of Delhi

Delhi would gain the maximum from the NCR planning. The absence of a metropolitan plan for Delhi was the most important weakness of this plan, resulting in the problem of unplanned growth. This unplanned expansion put pressure on the social and physical infrastructure of the city, which not only created the problem of social security but also affected the quantity and quality of essential requirements like water and air. This phase is also important with respect to the green spaces because during this time the government initiated the project of redevelopment of Shahjahanabad and New Delhi. As a result, the areas of Shahjahanabad or Old Delhi got some relief from congestion, overcrowding and insanitary conditions, while New Delhi became a green oasis within rapidly growing and increasingly congested city because of low density settlements and extensive green spaces. Master Plan Delhi 2001 The plan for development of Delhi provided in the Master Plan Delhi (MPD) 2001 had provision for extensive open spaces in the form of various greens as lung spaces. In this context, the DDA played a very important role by retaining the natural features such as the Ridge and green belts and developed open spaces so as to contain the growing population of this metropolitan city. As per the MPD 2001, 8422 ha of land was reserved for the greens. Although the green area in Delhi was managed by different agencies, the DDA had the largest role to play with over 5050.97 ha of land under its jurisdiction. Some important projects designed and implemented by the DDA during this phase were: ▪ ▪ ▪

Swaranjayanti Park at Rohini (100 ha) Millennium Park, Ring Road, Sarai Kale Khan (83 ha) Upgradation and ecological development of the Hauz Khas Deer Park Recreational Complex ▪ Heritage projects like QilaRaiPithora, Mehrauli Complex, Ashoka Edict and Purana Qila ▪ Landscape development of the area around Tughlaqabad ▪ Planning and designing of major greens in Dwarka, Rohini and Narela ▪ Designing of sports complexes in various part of the city; 13 are operational and one is under development ▪ Golf course development at Lado Sarai ▪ Organising garden festivals, exhibition and seminars/workshops on landscape and the environment ▪ Biodiversity park at Wazirabad, which is under development ▪ Planning of Aastha Kunj ▪ Proposed Aravalli biodiversity park at VasantVihar (DDA and Master Plan 2001, 1999)

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The DDA spends about Rs. 4,000 million for developing and maintaining the green spaces. It does not receive any financial support for this. The authority does not impose any tax on the public for this important work. For keeping the city healthy, the DDA has shifted the wholesale fruit market from the residential area, introduced a medium-capacity transport system to reduce traffic congestion, protected and developed the green cover of the Ridge, decongested Old Delhi and converted the Yamuna River Front into a green area. Master Plan Delhi 2021 The MPD 2021 was published in 2007 and reprinted in 2010, and duly approved by Ministry of Urban Development, Government of India on September 6, 2013, with the vision for 2021 to make Delhi a global metropolis and a world class city, where all the people are engaged in productive work with a decent standard of living and quality of life in a sustainable environment. In the context of environment, Delhi adopted a three-fold approach of management of natural resources; conservation and development of natural features; and development and preservation of open spaces, green covers and recreational areas (Master Plan Delhi, 2021). To enhance the green cover of the city, 18 greening agencies have been recognised. These are mainly government agencies and municipal bodies. Some of these greening agencies are the Municipal Corporation of Delhi, Delhi Development Department, Public Works Department, Central Public Works Department, Delhi Parks & Garden Society, NDMC, Education Department, Transport Department, Flood Control Department, Development Department, Delhi Metro Rail Corporation (DMRC), etc. The government assigns work on an annual basis, which the agencies do by generating their own resources. Delhi’s Forest Department coordinates the greening activities of these agencies. Policies and laws To legally control and maintain its green cover, Delhi implemented a special act known as the Delhi Preservation of Tree Act (DPTA) 1994. The act is applicable on all types of trees, regardless of their proprietorship and ownership of land on which it was grown. Section (i) of the act defines a tree, Section 2(j) is about the designation of the tree officer, Section 2(h) is about cutting, uprooting, bulldozing and harming the tree in any manner. Chapter 2 of the act is about the constitution of the tree authority, Chapter 5 is about the duty of conservation and protection of trees. Section 8 of the act is about the dangers posed by trees. It mentions that if a damaged tree is not straightway felled and there could be danger to life or property or traffic, the owner of the land may take immediate action to remove such a tree and report the fact to the tree officer within 24 hours of such a removal.

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Section 9 of the act lays down the procedure for obtaining permission to cut, remove or dispose of a tree. Section 10 of the act deals with the compulsion to plant trees by every person who is granted permission under this act to cut or dispose of any tree. In this context currently, in lieu of the permission to remove a tree, compensatory plantation of 10 plants of a tree species is to be done and maintained for 5 years. To ensure this, applicants are required to deposit an amount of Rs. 28,000 per tree permitted by the tree officer for removal. Out of the Rs. 28,000, 50 per cent (Rs. 14,000) is refundable to the applicant after 5 years, after the plantation of the five saplings of tree species and their maintenance is confirmed. If this condition is not met, the Forest Department of the Government of the NCT of Delhi is required to plant saplings and maintain them by using the refundable sum of Rs. 14,000. Balance plantation of five saplings and its maintenance is compulsorily done by the Forest Department on the identified land using the balance 50 per cent deposited amount by applicant. To stop the illegal cutting of trees, the Delhi Forest Department also started a tree helpline, which is effectively working (Sinha, 2013). Since forestry was shifted from the state list to the concurrent list in the year 1977, the central government plays an important role, particularly at the policy level in the management of state forests. Therefore, besides the DPTA, 1994, the city also adheres to the 1988 Indian Forest Policy, Indian Forest Act 1927 (Amended), Forest (Conservation) Act 1980 and The Schedule Tribes and Traditional Forest Dwellers (Recognition of Forest Right) Act 2006.

Identifying present green spaces To identify the green spaces of Delhi, mapping was done using Landsat images and ARC GIS software. The Land Use Land Cover (LULC) mapping was conventionally done through compilation of land records and revenue records of the Directorate of Economics and Statistics. This method does not reflect changes and is prone to sudden changes in definitions and administrative boundaries. The present study is based upon satellite data because it provides benefit of wide area coverage, multispectral data and compatibility with GIS. Such data are more precise and accurate. Monitoring urban land-cover dynamics with 30 m resolution is possible by using Landsat TM/ETM+ satellite data that have been freely available from 1982. Landsat satellite images are ideal for identifying and characterising both natural and anthropogenic changes over large areas of land because of the system’s acquisition, processing and distribution strategies (Hansen and Loveland 2012). In this study too, for identifying the green spaces of the capital city, Landsat images (Landsat 7 for October 2002 and Landsat 8 for April 2016) have been used for the study. Landsat 7 (2002) and Landsat 8 data (2016) with 30 metres of spatial resolution were taken into consideration. Landsat 7 bands: Band 1 (Blue), Band 2 (Green), Band 3 (Red) and Band 4 (NIR). Landsat 8 bands: Band 2 (Blue), Band 3 (Green), Band 4

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(Red), Band 5 (NIR), Band 6 and Band 7 were selected to make the bands composite. After getting the images geo-registered, a supervised classification technique was performed. After the LULC map preparation, the Normalized Difference Vegetation Index (NDVI) was also calculated to understand the density of greenness. From the LULC map, the vegetation class was derived, coupled with the agricultural and park classes. For validating the vegetation class, NDVI calculation was conducted, because NDVI is the most generalised index of plant ‘greenness’. Hence, the output maps show the classes of vegetation, agriculture and park classes for the years 2002 and 2015. It is evident from Figures 2.1 and 2.2 that, in the year 2002, the agricultural land and vegetation were mixed and dominant in the north, northwest and southwestern districts of the city, and few parks were seen in the northeast, central, southeast and south districts. On the other hand, in the year 2015, agricultural land is dominant in the northwest, north and southwest districts, and vegetation and parks are in the central and New Delhi districts of the capital city. From the study undertaken, it can be inferred that agricultural land has decreased by about 36.1 sq. km from 2002 to 2015. The total areas allotted to parks are almost the same, that is, it was 94.6 sq. km in 2002 and 93.04 sq. km in 2015. The area of vegetation, on the other hand, has increased by about 87 sq. km, from 145.5 sq. km in 2002 to 232.9 sq. km in 2015 (Figure 2.3). It can be seen that the vegetated area has increased under the

Figure 2.1  Green spaces in Delhi, 2002. Source: Authors

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Figure 2.2  Green spaces in Delhi, 2015. Source: Rajput, S., and Arora, K. (2017)

Figure 2.3  Green spaces in Delhi, 2018. Source: Authors

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TOF areas. These trees are grown mainly along the roads and the under bridges. Around the year 2010, extensive plantation drives were conducted around water and sewage treatment plants, residential areas, etc. A major shift of vegetation can be seen from the east to the south. The other probable reason is the restrictions imposed on mining in the Southern Ridge and the plantation drive by the Eco Task Force. Another important lung in this area is the Asola Bhatti Wildlife Sanctuary, which has an area of 20 sq. km. All these initiatives have led to an increase in the green cover in the south and southwest districts. There has been an upsurge in green belts and parks in the various sectors of Rohini and Dwarka, the relatively new residential hubs. Projects like the Swaranjayanti Park cover 100 hectares of land and the Millennium Park alongside the Ring Road in Sarai Kale Khan occupies 83 hectares of land. Many such projects have been carried out in the past decade, resulting in increased urban green spaces in the north and southwest districts of Delhi too. Delhi’s green spaces comprise of patchy parks and mostly open forests. According to a report in The Times of India on February 3, 2018, Delhi’s forest cover has grown 0.3 per cent since 2015. This can be credited to the recent plantation activities done by the Delhi Government along roads, metro lines, drains, etc. However, these are mainly open forests or scrubs. Dense vegetation can only be observed in the Ridge area or the biodiversity parks of Delhi (Figure 2.4). According to the Delhi Government’s Forest Department website, the total recorded forest area in Delhi is 85 sq. km, that is, 5.73 per cent of the geographic area, of which the Reserved and Protected Forests constitute 91.76 per cent and 8.24 per cent of the total forest area, respectively. According to Section 4 of the Indian Forest Act, the Ridge area of Delhi is notified as a Reserved Forest. It covers around 7,777 hectares of land. Out of this, the Southern Ridge forest is around 80 per cent of the total Ridge area. Delhi is known for its parks and well-maintained gardens. These parks offer good recreational facilities to public. The parks of Delhi are as unique as the history of this beautiful green city. Today, Delhi has nearly 20,000 small/medium/big recreation parks and gardens, 42 city forests, 4 ridge areas, 6 biodiversity parks and other green belts (delhi.gove.in). Figure 2.5 shows location of some well-known parks in Delhi and their area. It can be well observed that huge areas of parks are located in east or south part of Delhi while northwest and southwest have comparatively smaller parks. In July 2018, Delhi government decided that it would double the financial assistance provided to the Resident Welfare Associations and NGOs registered with the Delhi Parks and Gardens Society for maintenance of parks and gardens across the city (India Today, July 22, 2018). Delhi Parks and Garden Society (DPGS), an autonomous body under Department of Environment, provides financial assistance to RWA/NGOs for maintenance of parks/gardens and setting up of decentralised STP’s on the basis of no objection certificate from area MLA and concerned land owning agency.

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Figure 2.4   S patiotemporal change in agricultural land, parks and vegetation (including TOF) in 2002 and 2015. Source: Authors

How green is the green space in Delhi?

Box 2.1 NDVI Calculation for Landsat 8: (Band 5 − Band 4)/ (Band 5 + Band 4) NDVI Calculation for Landsat 7: (Band 4 − Band 3)/ (Band 4+Band 3)

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Figure 2.5  Location of selected parks in Delhi. Source: Authors

NDVI is the most widely used vegetation index. It indicates the quality of vegetation and extent of green cover in an area. It highlights the difference between vegetated and non-vegetated areas. This difference is recognised as vegetation displays high reflectance in the infrared band but has low reflectance and high absorption in the red band. It is based on the fact that the denser the vegetation, higher the NDVI. The green index percentage of the green area in each index is based on binary classification (green and non-green classes) of the NDVI measurements. The density of green spaces in the NDVI ranges between −1 to +1. The very low values of NDVI measurement are classified as built-up areas, and positive values as green classes. The NDVI may be the most relevant to considering the green space and health pathways that are related to psychological processes (such as stress reduction and attention restoration), and wider ecosystem services such as urban heat island mitigation (Bowler et al., 2010). The NDVI for Delhi shows small dense green spaces in very small pockets near the Ridge area and central New Delhi (Figure 2.6). The value of vegetation in Delhi varies between 0.04 and 0.3. This is because Delhi lies in the semi-arid region and it reflects typical features of a megacity dominated by concrete. The NDVI values are not negative. Because Landsat 8 images have a resolution of 30 m, small patches of green can be found in each pixel. In a study conducted in 2012, the NDVI value for Delhi was 0.1721 (Malik et al., 2017).

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Figure 2.6  NDVI for Delhi, 2016. Source: Authors

When you have negative values, it is highly likely that it is water. On the other hand, if you have an NDVI value of close to +1, there is a high possibility that the area has dense green leaves. When the NDVI is close to zero, there are no green leaves and the area could be urbanised. The result of this formula generates a value between −1 and +1. If you have low reflectance (or low values) in the red channel and high reflectance in the NIR channel, this will yield a high NDVI value, and vice versa. Overall, the NDVI is a standardised way to measure healthy vegetation. High NDVI values indicate healthier vegetation, while low NDVI value simply scarce or no vegetation. Almost similar readings could be observed from the images capture in 2018 (Figure 2.7). The NDVI is around 0.3 along the eastern bank of the Yamuna, Central Delhi and New Delhi. The NDVI is below 0.1 in almost all parts of Delhi, especially in the north and northwest of Delhi, because of high concretisation in these areas. In the south and southwest, few patches have comparatively higher NDVI values, especially along the roads and drains. Figure 2.8 shows the potential areas for forestry and plantation. The map has been created in consultation with the authorities. In fact, many of these have been identified and are under different phases of development. In order to develop these nature reserves, and retain the ecological, aesthetical and

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Figure 2.7  NDVI for Delhi, 2018. Source: Authors

cultural quality of Biodiversity sites in the National Capital Territory of Delhi, the DDA has set up the Delhi Biodiversity Foundation. The foundation, in turn, is setting up biodiversity parks, which are being developed by DDA technical inputs by team of scientists who have specialised in the areas of field biology, ecology, wildlife, taxonomy, conservation, habitat restoration, natural resource management and nature education. Foundation is planning to develop four biodiversity parks in addition to the Yamuna and Aravalli biodiversity parks. Of these, the Tilpat Valley, which is contiguous to the Asola and Bhatti sanctuaries, will be used for compensatory plantation to be carried out by the DMRC. ‘The land is on the Haryana border and will provide a direct corridor for the wildlife of both states’. According to Prof. C. R. Babu, plantation by the DMRC will not be in the usual order of 10 trees to one, but will be in keeping with the local biodiversity. Phase Two of the Yamuna Biodiversity Park has commenced, while work is ongoing to develop the Aravalli Biodiversity Park as a nature reserve. In a few years, the Aravalli Biodiversity Park will welcome visitors to a specially designated zone, which will function as a park within the park. This will be built in 70 acres of total area and will feature more than 200 species of threatened plants and trees native to the Aravalli areas of Delhi, Haryana and Rajasthan. The remaining area will be designated as a nature reserve. In recent development in 2018, a project of the National Highway Authority of India proposed to build a road through a green stretch of the

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Figure 2.8  Potential green spaces in Delhi, as proposed by several authorities. Source: Authors

Aravalli Biodiversity Park. This led to a huge protest among the residents of Gurugram, as it threatened to harm the lungs of the city. Throughout the history of Delhi, green areas have traditionally shown a swinging trajectory of growth. The Mughal as well as the British periods in the history of green spaces are known for elite greening. Public green spaces

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have been properly developed only in the post-independence period, although New Delhi still shows skewed development of green spaces. The partition period showed massive migration of people into Delhi. At present, migrants comprise nearly 40 per cent of Delhi’s population. Although the growth rate of Delhi has declined from 5.08 per cent in 1960 to 2.81 per cent in 2018, most of it is attributed to migration. In the process of development and conversion of a city into a megacity, Delhi has scarified its green spaces to accommodate its rising population. The shrinking green spaces, rising population and faulty growth model has led to several environmental issues in Delhi, among which air pollution has become a demon. The environmental challenges have resulted into numerous health issues. The present health status of the city provides a compelling case for provision of more green areas for the common public. Public green areas can only be developed and maintained if supported by the government, policymakers and the public.

References Bowe, P., 2009, The genius of an artist: William R Mustoe and the planting of the city of New Delhi and its gardens. The Garden History Society publications, 1 (37), 68–79. Bowe, P., 2012, Lal Bagh—The botanical garden of Bangalore and Its Kew-trained gardeners. Garden History Society Publication, 40: 228–238. Bowler, D.E., Buyung‐Ali, L., Knight, T.M., & Pullin, A.S., 2010, Urban greening to cool towns and cities: A systematic review of the empirical evidence. Landscape and Urban Planning, 97: 147–155. doi:10.1016/j.landurbplan.2010.05.006 Delhi Development Authority, 1990, Master plan for Delhi, August 1999: http://14.139.60.153/bitstream/123456789/4074/1/Master%20Plan%20 for%20Delhi%2C%20August%201990.pdf Delhi Development Authority, 2010, Master Plan for Delhi, 2021, https://assetyogi. com/wp-content/uploads/2014/09/Delhi-Master-Plan-2021-Report.pdf Delhi government to double financial assistance for maintenance of parks, 2018, July 22.IndiaToday.https://www.indiatoday.in/pti-feed/story/delhi-govt-to-doublefinancial-assistance-for-maintenance-of-parks-1292884-2018-07-22 Dutt, Ashok K., 1983, Cities of South Asia, in Brunn, S., & Williams, J. (Eds.), Cities of the World. New York: Harper and Row Publishers. Ebba, K., 1997, Mughal Palace Gardens from Babur to Shah Jahan, 1526-1648. In Necipoglu, G. (Ed.) Muqarnas XIV: An Annual on the Visual Culture of the Islamic World, Leiden: E.J. Brill, 143–165. Ewing, J.R., 1969, Town planning in Delhi: A critique. Economic and Political Weekly, 40(4), 1591–1600. https://www.jstor.org/stable/i40033497 Hansen, M.C., & Loveland, T.R., 2012, A Review of Large Area Monitoring of Land Cover Change Using Landsat Data, Remote Sensing of Environment. Elsevier, 122, 66–74. doi:10.1016/j.rse.2011.08.024 Judith, R., 1998, English gardens in India, garden history. The Garden History Society Publication, 26(2), 115–135. Malik, M., Siwach P., & Prakash, P., 2017, Urban green spaces: A comparison of the Delhi NCR region and Kolkata municipal region. International Journal of Research in Humanities & Social Sciences, 1(5), 20–26.

58  Green spaces of Delhi Mann, M., & Sehrawat, S., 2009, A city with a view: The afforestation of the Delhi Ridge, 1883-1913. Modern Asian Studies, Cambridge University Press pub. 2(43), 543–570. Nath, V., 1993, Urban Issues and Urbanization Characteristics of Asia in Planning for Delhi. Geo Journal Springer, 2(29), 171–180. Plantation, Department of Environment, Government of NCT of Delhi Delhi.Gov. in. http://web.delhi.gov.in/wps/wcm/connect/environment/Environment/Home/ Environmental+Issues/ Rajput, S., & Arora, K., 2017, Analytical Study of Green Spaces and Carbon footprints, in Sharma, P., and Rajput, S. (Eds.) Sustainable Smart Cities in India, Switzerland: Springer publications. Sinha, R.S., 2013, Urban Forestry: Urbanisation and Greening of Indian CitiesEfforts for Green Delhi. Assignment: MCT Phase IV: Department of AYUSH, Ministry of Health and Family Welfare, Government of India, TERI University New Delhi. Shafi, S.S., 2002, Many Windows in Time and Space. India International Centre Quarterly, Delhi: India International Centre, 1(29), 127–135. Sharma, J.P., 2002, A Cross-cultural Dialogue: A Case Study of Pre-Mughal Mosques in Delhi in Built Environment (1978-), Islam and Built Form: Studies in Regional Diversity, Alexandrine Press, (28)3, 249–262.

Chapter 3

Level and extent of air pollution in Delhi

Introduction The human respiratory system is naturally made to inhale oxygen and exhale carbon dioxide. Plants and trees, on the other hand, breathe in carbon dioxide and exhale oxygen. This is a natural symbiosis created in the Earth’s biosphere. Photosynthesis is considered to be the most important driving factor of the oxygen cycle. Green plants make their food and exhale oxygen. In fact, photosynthesis and respiration are considered to be complimentary to each other in the living world. These two processes mainly maintain the balance of the oxygen in the biospheres. Any imbalance in these two equations can cause an imbalance in the natural ecosystem.

Gases in the atmosphere and their effects Air consists of several gases, water vapour, smoke, microbes, etc. Among the various gases are oxygen, carbon dioxide, ozone, sulphur, nitrogen, methane, etc. These gases have their own biochemical cycles that operate between the different realms of the Earth, namely the hydrosphere, atmosphere, lithosphere, and biosphere. These gases are essential for the survival of various life forms. Oxygen in our body oxidises our food during the process of cellular respiration. It then releases energy, which is stored in adenosine triphosphate (ATP, a molecule that supplies cells with energy) in the electron transport chain. Carbohydrates and fatty acids are also broken into simpler carbohydrates and are finally oxidised in our cells to release energy. Moreover, our body cells are 70–90 per cent water by mass. Oxygen is a part of the water molecule (H2O). Blood absorbs oxygen from the air in our lungs to fuel the cells in our body, and the brain is the most sensitive organ, vulnerable to the lack of oxygen. Therefore, sufficient oxygen is a necessary requirement of our body. Oxygen affects our health status, activity level and hydration. Oxygen deprivation due to poor air quality or pollution can have serious lifelong impact on the health of an individual.

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Now the question arises, how much oxygen is needed by a human body? The atmosphere consists of nearly 20.95 per cent of oxygen in dry air, by volume. Various studies have been conducted in this context. According to a report titled ‘Economic Valuation of Oxygen Supplying Ecosystem Service of Healthy Trees’ by an NGO Delhi Greens, an adult human breathes 11,000 litres of air per day out of which he uses 550 litres of pure oxygen. It found that trees like areeca palm, neem (Azadirachta indica), aloe vera, and tulsi (Ocimum sanctum) give more oxygen than other trees and plants. According to the Lawn Institute of Roosevelt, a turf area of 50 feet by 50 feet produces oxygen for four people in a day. Similarly, a study by Gifford points out, two big mature trees give sufficient oxygen for a family of four. According to a study by Ilana Goldowitz, a plant scientist: ‘Respiration in plants is like photosynthesis run backwards: instead of capturing energy by manufacturing sugars and releasing oxygen, cells release energy for their own use by breaking down sugars and using up oxygen’. Oxygen is an important gas that all living beings need. Now let us see what can be its effect when not sufficiently available. According to a study published by https://sciencing.com/, Malesky (2018) shows that 19.5 per cent of oxygen concentration in air has a mild effect on the human body. Lesser concentration of oxygen in air can lead to an increase in pulse rate, decreased ability to work, abnormal fatigue, etc. Less than 10 per cent of concentration of oxygen in air can cause serious impacts on the human body, like inability to move, loss of consciousness, convulsion or death. Human beings can experience the chronic impact in poorly ventilated indoor places, laboratories or areas closer to hazardous gaseous activities. It is important to maintain a significant level of oxygen in such places. Cities also behave like laboratories where developmental experiments have led to pollutants in the air. At times, it leads to congestion and suffocation. Particle pollution includes PM2.5 and PM10. The latter comprises inhalable particles with a diameter of 10 micrometres and smaller. It also consists of PM2.5, which are fine inhalable particles that have diameter equal to or less than 2.5 micrometres. PM2.5 is small and light particles in the air, mainly a mixture of solid particles and liquid droplets in the air. These are hazardous to human health and can lead to chronic diseases like asthma, heart attack, bronchitis and other respiratory problems. These particles are made up of hundreds of chemicals that are emitted from various sources. PM2.5 is a common pollutant in cities, as a number of particles are emitted from construction sites, automobiles, industries, power plants, etc. Carbon dioxide provides a congenial temperature to the Earth’s atmosphere by creating a greenhouse effect. Earth’s actual surface temperature is 14°C, which is due to the greenhouse effect caused by carbon dioxide. Without the greenhouse effect, the temperature is estimated to be around −18°C. Excess of carbon dioxide in the atmosphere can lead to a disturbance in the bio–geo chemical cycles, thus leading to several health issues in living beings. According to a study published on www.dhs.wisconsin.gov,

Level and extent  61

breathing small amounts of carbon dioxide does not lead to any evident health concerns, but inhaling more than 1,000 parts per million (ppm) of carbon dioxide can lead to issues like drowsiness, headache, lack of concentration and nausea. More than 40,000 ppm of carbon dioxide in air can cause permanent brain damage, coma, and even death. The data acquired from the NOAA website show that there was a fluctuating trend of level of carbon dioxide in air till 1950, that is, much below 300 ppm. After the industrial revolution, it rose from 300 to 390 ppm till 2018. The trend clearly shows that if immediate remedial action is not taken to curb the rising levels of carbon dioxide, it will keep increasing. This increase will not only impact human health but also the health of other organisms on Earth. Is too much of carbon dioxide good for plants? A study conducted by Randall Donohue and his team shows that between 1982 and 2020, carbon dioxide levels increase by 14 per cent, this should have considerable ‘carbon dioxide fertilisation effect’, that is, foilage worldwide should increase by 5–10 per cent. Although it is very difficult to relate the sudden increase of plant growth due to the fertilisation effect, the team considers it to be the best explanation for growth in the Tundra and Praire regions. ‘Even if nothing else in the climate changes as global carbon dioxide levels rise, we will still see significant environmental changes because of the carbon dioxide fertilisation effect’ (Donohue et al., 2013). Another prominent researcher and author, Ranga Myneni, in one of his interviews to BBC, said that the fertilisation effect would diminish over time and would not be able to compensate the impact of global warming resulting from factors such as rising sea levels and glacial melting. Similarly, Dr. Philippe Ciais pointed out in 2016 that plants acclimatise to the rising of carbon dioxide concentration, and the fertilisation effect would diminish over time, due to the lack of water and nutrients. Such studies, with contradictory results and conclusions, do not give a concrete and sure reply to the question of increase of plant growth due to the increase in carbon dioxide levels in the atmosphere. Sulphur dioxide forms sulphuric acid, sulphur trioxide, and sulphates when it reacts with air. These acids are highly harmful for human health. About 0.3 μg per cubic metre of sulphur dioxide in air implies a potential risk for human health, but for trees, 0.2 μg is extremely dangerous. The US EPA has set an air quality standard of 0.03 ppm for long-term, 1-year average concentrations of sulphur dioxide. Short-term, 24-hour air concentrations should not exceed 0.14 ppm more than once a year (www.atsdr.cdc. gov/toxfaqs/tf.asp). Several harmful effects of human exposure to high levels of sulphur dioxide are corneal haze, breathing difficulty, airways inflammation, eye irritation, psychic alterations, heart failure, circulatory collapse, etc. Higher and prolonged exposure to sulphur dioxide can lead to asthma, chronic bronchitis, morbidity and mortality increase in infants and elderly persons.

62  Level and extent

High levels of sulphur dioxide in the air can cause damage and destruction of vegetation, soil, construction material and watercourses. Carbon monoxide in combination with oxygen forms carbon dioxide. Carbon monoxide has a tendency of replacing oxygen and leads to the formation of ground ozone. Exposure of more than 350 ppm of carbon dioxide can lead to several health issues, but a more-than-800 ppm exposure of carbon monoxide can lead to death in 2–3 hours. Carbon monoxide exposure of more than 12,800 ppm can lead to death in 1–3 minutes (Source: www.dhs.wisconsin.gov). Methane gas is naturally found under the sea or below the ground. Methane is a non-toxic gas and does not cause much harm to human beings. However, a high level of methane gas in the air accelerates the greenhouse effect. Studies show that methane’s global warming potential is nearly 20 per cent more than that of carbon dioxide. The main sources of methane are livestock cultivation, bio fuel, biomass burning, fossil fuel production, distribution and consumption. A lot of waste in cities is generated and disposed of in open dumping grounds, which releases excessive methane gas. Methane gas is also released through fossil fuel production undertaken by the thermal power plants.

Gases and their ill effects on flora Chemical exposure of plants leads to several problems related to their growth and development. According to a study published by Alabama and Auburn University, there are three types of injuries visible in plants: 1. Collapsing of leaf tissue with the development of necrotic patterns, 2. Yellowing or other colour changes, and 3. Alterations in growth or premature loss of foliage. Plant injury caused by air pollution is most common in large cities, near smelters, refineries, electric power plants, airports, highways, incinerators, refuse dumps, pulp and paper mills, and coal-, gas-, or petroleum-burning furnaces. Plant injury also occurs near industries that produce brick, pottery, cement, aluminium, copper, nickel, iron or steel, zinc, acids, ceramics, glass, phosphate fertilisers, paints and stains, rubbers, soaps and detergents, and other chemicals. Damage in isolated areas occurs when pollutants are spread across long distances by wind currents. Table 3.1 shows that air is necessary for plant survival. Contamination and unwanted chemical intrusion and pollutants in air can be harmful to plants and human beings. There can be both internal modifications and ailments in plants due to pollution. Possible causes in a city can be industries, construction activities, agriculture, vehicular pollution and power generation.

Level and extent  63 Table 3.1  Impact of pollutants on trees and plants Pollutant

Effect on plants

Source area/activity

Sulphur dioxide / sulphuric acid

Dry papery blotches that are usually white tan or straw coloured. Brown to red brown blotches on upper and lower blade of the leaf.

Fluorides

Yellowish mottle to a wavy, reddish brown or tan ‘scorching’ at the margin and tips of broadleaved plants or a ‘tipburn’ of grasses and conifers. A narrow, chlorotic to dark brown band often occurs between the living and dead tissue. On broad-leaved plants, necrotic, bleached, or tan to brown areas tend to be near the leaf margins, tips, and between the principal veins. Injured grass blades develop progressive streaking towards the main vein in the region between the tip and the point where the grass blade bends. The streaking usually occurs alongside the veins. Middle-aged or older leaves are often more susceptible than the young ones. Bleaching and tissue collapse can occur. Conifers may show tipburn on the current season’s needles. Variety of symptoms on broad-leaved plants: tissue collapse, interveinal necrosis, and markings on the upper surface of leaves known as stipple (pigmented yellow, light tan, red brown, dark brown, red, black or purple), flecking (silver or bleached straw white), mottling, chlorosis or bronzing, and bleaching. Ozone stunts plant growth and depresses flowering and bud formation. It also causes marginal rolling and scorching of leaves on lilac. Affected leaves of certain plants, such as citrus, grape and tobacco, commonly wither and drop early.

Electric power plants, copper and iron smelters, oil refineries, chemical factories and other industries that burn soft coal, coke or high sulphur oil as fuel. Glass, aluminium, pottery, brick, and ceramic industries and near refineries, metal ore smelters and phosphate fertiliser factories. Glassmaking factories and refineries. Also observed near swimming pools, water-purification plants and sewagedisposal facilities.

Chlorine

Ozone

Sunlight reacts with nitrogen oxides and hydrocarbons formed by refuse burning and combustion of coal or petroleum fuels, especially the exhaust gases from internal combustion engines. When oxidant levels in the air are high, more than 90 per cent is ozone.

(Continued)

64  Level and extent Table 3.1  (Continued) Pollutant

Effect on plants

Source area/activity

Ethylene

Ethylene modifies the activities of plant hormones and growth regulators, which affect developing tissues and normal organ development, without causing leaf-tissue collapse and necrosis. Injury to broad-leaved plants occurs as a downward curling of the leaves and shoots (epinasty), followed by stunted growth. Ethylene also causes dry sepal in Cattleya, Phalaenopsis, and other orchids; it also causes ‘sleepiness’ (an inward petal curling and failure of buds to open).

Ethylene is one of the many products of auto, truck, and bus exhaust. Ethylene also results from the incomplete combustion of coal, gas, and oil for heating; it is also a by-product of polyethylene manufacture.

Compiled and tabulated from http://www.aces.edu/pubs/docs/A/ANR-0913/ANR-0913.pdf

Sources of pollution in Delhi and its satellite towns As pollution does not follow administrative boundaries, Delhi’s pollution is also not limited to its administrative boundaries; rather, its cause and impact can be marked by the developmental activities happening in the Delhi National Capital Region (NCR). The multifaceted growth of the fringe areas has led to a significant increase in vehicular traffic, development of industrial units, residential complexes and commercial areas. The development of satellite towns have also led to massive construction activities in Noida, Ghaziabad, Gurugram, Faridabad and other adjoining places. Gurugram became a commercial hub after 1990, resulting from a policy of liberalisation and development of a corporate park by GE (General Electric). This led to an increase in the number of colonies, from 33 in 1990 to 66 in 1998. Gurugram’s population has increased manifold, from 135,884 in 1991 to 1,514,000 by 2011. Gurugram has semi-arid climate, and it has lost significant green area over the period of time due to massive construction. It has many small- to medium-sized parks. The city’s built-up area, which was nearly 8 per cent in 1971, has now grown to around 70 per cent, mainly by occupying agricultural land and open areas. The population of Noida city has grown from 770,367 in 1991 to 1,648,115 in 2011. Although Noida has the Okhla bird sanctuary and a botanical garden, its built-up residential area is around 47 per cent and industrial area is around 16 per cent of its total area. The newly developed areas in Noida are planned, even though most parts of the city are unplanned and have haphazardly mushroomed around the planned places. Private

Level and extent  65

builders have bought the land and a huge area is still under construction for multistorey buildings, malls and other commercial activities. Open huge dumping grounds have been developed in a planned manner by the government, just a few metres away from residential areas. On June 10, 2018, residents of Sector 123, Noida, protested against the waste-to-energy plant to be established in a densely populated area. Many times, these dumping grounds become hazardous as they emit harmful and obnoxious gases and also lead to fire hazards around the area. Faridabad is one of the most populated cities of Haryana. It is considered to be the industrial hub in Delhi NCR. It produces tractors, motorcycles, switch gears, refrigerators, shoes, tyres and garments, etc. The population of the town has risen from approximately 6 lakhs in 1991 to 14 lakhs in 2011. The concretisation of fringe areas around Delhi and development of highrise buildings have added to the extent of pollution problems in Delhi. The robust construction activities, traffic flow and evasion of green spaces around Delhi have worsened the city’s mitigation plans. The needs of population multiply year after year. Delhi’s annual exponential growth rate has risen from 1.6 in 1921 to 6.4 in 1951. After that it started falling, it came to 3.85 in 2001 and 1.94 in 2011. But the migration is still on rise, the migrated population was 37 lakh in 1991, that became 60 lakh in 2001 and in 2011 it was 76 lakhs. In one of the studies published in Times of India in March 2018, In Delhi, nearly 33 per cent of population growth is of migrants, in 2016, which is highest in last 15 years. The contribution of Delhi’s satellite towns can be seen both in cause and effect of air pollution. Business Today, December 25, 2018, reported the Central Pollution Control Board (CPCB) data, that is, in Faridabad, Ghaziabad, Noida, Greater Noida and Gurugram air quality was marked as ‘severe’ and ‘very poor’ with the AQI level falling between 444 and 464. The Supreme Court-appointed Environment Pollution Control Authority (EPCA) and shut down industries located in hotspot industrial areas of Wazirpur, Mundka, Narela, Bawana, Sahibabad and Faridabad and halted construction activities across Delhi-NCR. (https://www.businesstoday.in/current/economy-politics/pollution-indelhi-reaches-hazardous-level-in-delhi-ncr-32-areas-record-severe-air-quality/story/304020.html.) There are various sources of air pollution in Delhi. Some main ones are: Vehicular pollution According to the Statistical Handbook of Delhi, there are more than 7.3 million vehicles running on its roads. Numerous varieties of vehicles, from cars, jeeps to lorries, trucks, buses, tractors and trailers can be seen on Delhi’s roads. It also has Asia’s biggest metro train network. Besides the huge number of vehicles on the roads, the stations and stops are crowded and chaotic.

Number of registered vehicles

66  Level and extent

5000000 4000000

Buses

3000000

Trucks/lorries

2000000

Taxis

1000000

Two wheelers

0

Cars

Selected million-plus cies

Figure 3.1  Registered private vehicles in million-plus cities, 2017. Source: Authors

Figure 3.1 shows a clear picture of Delhi having a major ownership of private vehicles, especially cars and two wheelers in the country. Greater Mumbai has a population of nearly 22 million and is considered to be the fourth most populous region of the world. Delhi stands next to Mumbai with respect to population in India, but the total number of cars are nearly double than that of Mumbai. The number of two wheelers is also almost five times more in Delhi than in Mumbai. Mumbai has a good network of local trains, while Delhi boasts of an extensive metro train network. The Mumbai local suburban railway covers nearly 465 kms and carries more than 7.5 million passengers every day. It is the busiest commuter rail system in the world. In comparison, the Delhi Metro Rail covers a length of 231 kms with a daily ridership of 2.76 million. Besides cars and two wheelers, Delhi also has a good network of buses, both public and private. According to the Census data, there were nearly 21,000 buses in Delhi in 2012. Bangalore, Ahmedabad, Chennai and Hyderabad separately have a greater number of buses than Delhi. Taxis and cabs are also becoming popular day by day. Private companies have geared up the number of taxis and provide dependable smart services to the commuters. Chennai has the highest number of taxis, followed by Delhi, Greater Mumbai and Bangalore, respectively. Vehicular traffic has been increasing, especially after 1990; Delhi has seen a tremendous increase in the number of private vehicles. Analysing the vehicular traffic in the last decade, it can be observed from Figure 3.2 that there has been an increasing trend in vehicular traffic. The data show a nearly three-time increase in the number of vehicles since 2002.

number of vehicles in thousand

Level and extent  67

12000 10000 8000 6000 4000 2000 0

200220032004200520062007200820092010201120122013201420152016 Years

Figure 3.2  Registered vehicles in Delhi. Source: Compiled by author from the census abstract, Delhi 2017

The number of registered vehicles in the city was 3,699,000 in 2002 and rose to 9,704,000 by 2016. In 1996, the Centre of Science and Environment (CSE) published its report on urban air pollution. This report pinpoints the problem of vehicular pollution in India as a result of a combination of outdated engine technology, poor fuel quality, and defective transportation planning and bad maintenance of vehicles. No statistics of energy input and pollution output were available, but it was estimated that vehicles were responsible for 64 per cent of emissions (power production was responsible for 17% and local industries for 10%). The conclusion of this report, and CSE’s objectives for the future, were to press for clean fuels and a rapid introduction of EUR II standards. Figure 3.3 shows a clear increase in vehicle fuel utilisation in Delhi during 2013–2016. The most commonly used fuel is diesel, followed by petrol and compressed natural gas (CNG), respectively. The trend also shows a downfall in diesel consumption and increase in CNG consumption, which can be credited to the policies of the government. According to a study by the Union of Concerned Scientists, Our personal vehicles are a major cause of global warming. Collectively, cars and trucks account for nearly one-fifth of all US emissions, emitting around 24 pounds of carbon dioxide and other global-warming gases for every gallon of gas. About five pounds comes from the extraction, production, and delivery of the fuel, while the great bulk of heat-trapping emissions – more than 19 pounds per gallon – comes right out of a car’s tailpipe (www.ucsusa.org).

68  Level and extent

Thousand Metric tonnes

1600 1400 1200 1000 800

Petrol

600

Diesel

400

CNG

200 0

2013

2014

2015

2016 Years

Figure 3.3  Fuel utilisation in Delhi. Source: Compiled by authors from census Abstract of Delhi (2011)

Similarly, several studies worldwide, have found that nearly 51 per cent of carbon monoxide, 31 per cent of carbon dioxide and 34 per cent of nitrogen dioxide in the cities’ air is due to cars. Delhi has the highest number of cars among Indian cities, and this number is increasing day by day. As per the data of the Transport Department of the Delhi government, the total number of registered vehicles stood at 10,567,712 on May 25, 2017. Of these, there were 3,172,842 registered cars and 6,648,730 registered motorcycles and scooters, which are major air polluters due to poor emission standards. According to a study conducted by IIT Kanpur, vehicular pollution contribution to PM2.5 is nearly 20 per cent of the total PM pollution in Delhi. Vehicles also account for nearly 36 per cent of nitrogen oxide in Delhi. Therefore, there is an urgent need to check and manage the number of vehicles and their pollution level. It is therefore important to promote public transport, especially the metro rail network. Industrial pollution Delhi also faces a problem of excessive industrial pollution. According to a study by IIT Kanpur, industries contribute nearly 11 per cent of PM2.5 and 52 per cent of nitrogen oxide. Besides these gases, the industries emit high amounts of sulphur dioxide and carbon monoxide. Due to haphazard growth, unscientific use of technology and lack of regulations, Delhi’s industries add a lot of pollutants both in air and water. According to a report submitted by Delhi-based NGO Toxics Link in 2013, there are more than 100,000 industrial units operating in unauthorised,

Level and extent  69 Table 3.2  Gases emitted by different types of industries in Delhi S. No.

Type of Industry

Type of Gases Emitted

1. 2. 3. 4 5.

Textile Metal and iron and steel Rubber Leather Food processing

6. 7. 8. 9.

Fertilisers Cement dust Cement Thermal power

Smoke, organic waste Carbon monoxide, carbon dioxide and small amounts of methane and hydrogen Hydrogen sulphide, nitrogen Hydrogen sulphide, ammonium sulphide Alkalines, chromate, organic matter and particulate matter Ammonia, cyanide, oxides of nitrogen and sulphur Smoke and particulate matter Particulate matter Fly ash, sulphur dioxide

Source: Compiled by authors

non-conforming zones located in residential areas, out of a total of 130,000 industrial units in the city. This is a serious issue, affecting the health of the people. The polluting industries comprise mainly of chemical, rubber, metal, asbestos and plastic factories. Some manufacture inferior-quality products. In addition, there are small factories that produce electrical spare parts, wires, auto-spare parts and assembling of parts, seat covers, cases and boxes, plastic bags, iron smelting, textiles, etc. Only a few of these factories are registered (Table 3.2) Toxics Link identified the residential areas in Delhi that have factories in the localities, causing unacceptable environmental damage. These areas are Okhla, Patparganj, Mayapuri, Naraina, Samaypur Badli, Nazafgarh, Mandoli, Motinagar, Ghazipur, Libaspur, Anand Parbat, Wazirpur, Yamuna Vihar, Shastri Park, Mustafabad, etc. (Phukan, 2014). According to the Annual Survey of Industries, there are varied types of industries in Delhi. Around 29 per cent of the industries located in Delhi are textile industries, 27 per cent are metal, 11 per cent are paper, 10 per cent are rubber and 8 per cent are basic metal and alloy industries. The Master Plan prohibits the establishment of big and heavy industries in Delhi. The summary results reveal that during the reference period of 2011–2012, a large number of factories were engaged in the manufacturing of apparel dressing and dying of fur (11.90%); followed by electrical equipment (9.08%); fabricated metal products except machinery & equipment (8.63%); wholesale and retail trade, repair of motor vehicles and motorcycles (7.62%); publishing, printing and reproduction of recorded media (7.30%); and machinery & equipment (6.94%). These six industries have accounted 51.48 per cent of the total working factories, provided employment to 54.08 per cent of the

70  Level and extent

Wearing Apparel Publishing, prinng and other acvites Fabricated metal

12 8 8

53 5

4

4

6

Parts and accessories of motor vehicles Basic Iron and Steel Manufacturing footwear Texle others

Figure 3.4  Types of industries in Delhi. (Per cent to total) . Source: Compiled by authors from Annual Survey of Industries of Delhi 2016

total employees and utilised only 24.12 per cent of fixed capital stock. Their share in the gross value of output and net value added by manufacture were 36.81 and 30.66 per cent, respectively. Delhi is also a hub of some so-called ‘smokeless industries’, like hotels, telecommunications, media and information technology. These industries contribute to significant growth and GDP of Delhi. Although they do not have chimneys to produce pollution, lots of vehicles and people commute daily to reach their destinations, which cause pollution. The demand of resources, both in quantity and type, is so massive and varied that it leads to pressure on existing resources. Demand for electricity and water has increased exponentially as Delhi attracts millions of domestic and international tourists throughout the year. In its latest report, the Centre for Asia Pacific Aviation (CAPA) India said that IGI airport, which handled 65.7 million passengers in the 2017–2018 fiscal, is likely to cross 80 million passengers by 2019–2020 (Hindustan Times, 2018). The manufacturing sector in Delhi employs more than 1.5 million workers. These workers commute to their destinations daily. The Delhi State Industrial Development Corporation (DSIDC) has developed 944 industrial sheds at eight industrial complexes. Major industrial hubs developed by DSIDC are Okhla, Kirti Nagar, Mangol Puri and Naraina. According to the 1996 survey conducted by the Delhi Pollution Control Committee (DPCC), there are around 137,000 lakh industrial units operating in Delhi. Out of these, nearly 25,000 industrial units are located in 28 industrial areas and the remaining units are located in other areas. As mentioned earlier, these industries are among the major sources of pollution and smoke in the places they are located.

Level and extent  71

Number

1000

500

2011-12 2013-14

0

Districts

Figure 3.5  Distribution of factories.

Rupees in 00,000

Source: Compiled by Authors, Annual Survey of Industries, 2014.

60000 40000

2011-12

20000

2013-14

0

Districts

Figure 3.6  Industrial fuel consumption. Source: Authors

Most of the industries are located in the northwest, followed by south Delhi and west Delhi. These regions also show high fuel consumption. These areas have more than 600–1,000 industries of varied nature. Figure 3.5 shows that the factories are mainly located in the northwest, southwest and west Delhi. Fuel consumption is much higher in the northwest district of Delhi, as compared to other districts. In October 2017, the National Green Tribunal (NGT) directed the inspection and closure of industries causing pollution. Many of the operating units were burning carbon and plastic illegally. In the past few years, many industries have been relocated to the fringe areas of Delhi. This means simply a displacement of the source of pollution from the heart of the city to the lungs of city, as the outer fringe areas are comparatively greener than the core. Construction activities A huge quantity of particulate matter is generated by construction activities. Due to various construction activities and vehicular movement, a significant amount of dust aerosols and soot is added to the air. Construction

72  Level and extent Table 3.3  Sources of PM10 and PM2.5 PM10 PM2.5

Construction activities and vehicular movement add a lot of dust aerosols and soot to the air Emissions from diesel, petrol and natural gas combustion; most of the open waste burning pollution, biomass burning pollution, and coal combustion at boilers

Source: Compiled by authors

activities have become detrimental to the air of the Delhi NCR, as they remain everexpanding. The construction and demolition activities have increased manifold. Due to large-scale construction work of residential and non-residential complexes, the capital is often impacted by dense smog and low visibility, especially in the months of November and December. Some of the huge construction projects in Delhi include the Delhi Metro and the flyovers. The Delhi NCR also sees heavy construction of small- and largescale housing and commercial complexes. Due to paucity of appropriate data, it is difficult to estimate the contribution of construction activities to air pollution in Delhi; however, it definitely is one of the major contributors to the pollution (Table 3.3). While conducting the survey related to flyover construction and metro line construction to understand the impact of construction activities on human heath, it was found that most of the workers complained about cement and sand mix air causing breathlessness. Workers are usually involved in picking, transferring, demolition, loading and unloading the cement and sand sacks. This exposes them significantly to fine dust and smaller particulate matter. As an emergency measure, construction activities were stopped by the government at a time of high concentration of particulate matter in the NCR air during November–December 2017, during very high level of air pollution. According to the researchers from the Johns Hopkins Bloomberg School of Public Health, there is a link between higher levels of a specific kind of air pollution in major urban areas and an increase in cardiovascular-related hospitalisations, such as for heart attacks in people, of especially 65 and older age. The findings, published in the November issue of Environmental Health Perspectives, are the strongest evidence to date that coarse particulate matter – airborne pollutants that range in size from 2.5 to 10 microns in diameter and can be released into the air from farming, construction projects or even wind in the desert – impacts public health. It has long been understood that particles smaller in size, which typically come from automobile exhaust or power plants, can damage the lungs and even enter the bloodstream. This is believed to be the first study that clearly implicates larger particles, which are smaller in diameter than a human hair (www. jhsph.edu/news/news-releases/2015/researchers-find-link-between-air-pollution-and-heart-disease.html).

Level and extent  73 Table 3.4  Health impacts of construction material Material

Use

Health Impact

Lead

Paints, pipes and roofing

PVC (polyvinyl chloride)

Water and sewage pipes, door and window frames, moulding and electric cables Windows, doors, wardrobes, etc.

Blood and brain disorder, breakdown of nervous system, blindness and lung problems Thyroid, malfunctioning of pituitary and reproductive glands, cancer, asthma, etc.

Wood treatment Halogenated flames Asbestos Cadmium Volatile organic compounds Silica Fibre glass

Mixed in construction materials to slow down or stop the spread of fire or flames Pipe cover, flooring, adhesive, fire proofing, etc. Corrosion-resistant plating, stabilised plastic and coloured glass Paints, synthetic fibre, solvents, adhesives, protective coatings, etc. Found in stones, sand, concrete, tiles and bricks Thermal insulation and roofing material

Creosotes cause cancer, abdominal pain, kidney and nervous system malfunctioning Reproductive health and cancer Pulmonary disease and lung cancer Prostate, breast and lung cancer Irritation in eye and respiratory tracts; damage to kidney, liver, etc. Lung infection and lung cancer Bronchitis and asthma

Table 3.4 shows the material that has been used at various construction sites and its impact on health. According to a study conducted by the EPCA in 2014, particulate matter in Delhi increased by 75 per cent and numbers of vehicles on the roads increased 97 per cent during 2002–2012, contributing enormously to pollution and direct exposure to toxic fumes. The situation is worst in winters. In the winter of 2013–2014, Delhi’s air pollution increased to dangerous levels. PM2.5 particles were recorded at 2–3 times the national standard and reached 8–10 times those standards in high-smog episodes. According to the Transport Research Wing, Ministry of Road Transport and Highway 2013, the total surfaced road length has increased manifold since 2008. It rose from 400 to 2,405 kms in nearly 6 years. This shows the massive construction in Delhi with regard to roads. The road, metro and flyover networks crisscross Delhi and its fringe areas. The construction, extension and repair work of these networks is a continuous process.

74  Level and extent

Road Length in Kms

3000 2500 2000 1500

Naonal Highway

1000

Total Surfactd Road Length

500 0

2008

2009

2010

2011

2012

2013

Years

Figure 3.7  Road length in Delhi. Source: Compiled by Authors from the District Census Handbook, 2014

Besides roads, Delhi and its adjoining towns have seen heavy regular housing construction activities (Figure 3.7). Accommodating the huge migrant population and poor building standards make the situation worse. Private builders and real estate owners do not follow norms properly, and provide low-quality houses at high prices to generate profit. The construction industry is still labour-intensive. Due to availability of cheap labour, most of the construction activities are done by people and in open pits. This creates dust and smoke, which further worsens the health of the labour and people living in the vicinity. According to a study published by The Guardian (international edition): A study of 19 large Delhi construction sites found the air quality around all of them exceeded safe limits by at least three times, with workers on these sites, mostly daily wage labourers, bearing the brunt. Almost none wear pollution masks, while a handful tie handkerchiefs across their faces to guard against the dust (https://www.theguardian.com/cities/2017/feb/15/delhi-deadly-dust-how-construction-sites-choking-city). Power generation Delhi is a power-hungry city. Massive development in the city needs uninterrupted and large amounts of energy. Distribution of power has been privatised in Delhi with effect from July 1, 2002, and both transmission and generation have been handed over to three government-owned companies: Delhi Transco Limited, Indraprastha Power Generation Company Limited (IPGCL) and Pragati Power Corporation Limited (PPCL). The two main coal-fired power plants are located at Badarpur and Rajghat. The installed capacity of IPGCL as on July 31, 2010 is 405 MW comprising 135.00 MW from coal-based thermal and 270.0 MW from gas-based thermal power plant (http://ipgcl-ppcl.gov.in/board_ipgcl.htm).

Level and extent  75

The total installed capacity of electricity in Delhi has risen from 585 MW in 2001–2,118 MW in 2015. The per-capita consumption in Delhi is more than 1,400 units per annum, as against the national average of 355 units. Delhi, being an urban place with a high load density, has seen electricity consumption increase from 20,040.22 million units (MUs) in 2003–2004 to 23,790.99 MUs in 2009–2010 to 37,484 MUs in 2014–2015. Around 50 per cent of electricity is mainly distributed in domestic sector followed by commercial and industrial sector, respectively. The increase in electricity consumption has been 18.71 per cent for Delhi for the past 7 years. The power sector has become a serious challenge for the government, as it is the primary driver of all-round development of the territory. Coal-fired power stations are one of the major causes of pollution in the city. They are responsible for more than half of the sulphur dioxide emissions from the energy sector. Coal used in the power generation is cheap and low quality, with less of sulphur content and more of ash coal. The technology used in the plants is outdated, with low levels of dust-removal efficiency. The other major source of air pollution load in Delhi is fuel combustion by both large-scale and small-scale industries. Among the large-scale industries, thermal power plants have been the most prominent contributors to air pollution. Three coals based thermal power plants namely, Rajghat, Indraprastha and Badarpur Power Plant, which have a total generation capacity of 1,087 MW, have been responsible for as much as approximately 10 per cent of the air pollution (CPCB, 2001). By 1996, the total number of small-scale industries in Delhi grew to a record number of 126,000. Most of the growth has been witnessed in the pollution-intensive areas and sectors. In addition, significant pollution has been caused by a large number of diesel generator (DG) sets, which have been installed at various commercial and industrial establishments (CPCB, 2000) (Jain, 2008). It is high time Delhi met the rising demand of power by solar and wind power generation as these are renewable and clean forms of energy. Solid waste Greenhouse gases get accumulated in the atmosphere of cities, leading to global warming. It is important to note that improper solid waste disposal and management also causes accumulation of hazardous gases in the atmosphere. The gases released by solid waste disposal are carbon dioxide, large quantities of methane and small quantities of nitrous oxide. Cities are house to solid waste, municipal waste and industrial waste. It is again essential to note that methane plays a significant role in global warming. It is 25 times more lethal than nitrous oxide and 298 times more lethal than carbon dioxide over the long run. According to an estimate, the NCR generates some 10,000 tons of solid waste per day. As per the United Nations Framework Convention on Climate Change (UNFCCC), greenhouse gases from solid waste disposal in India increased at the rate of 3.1 per cent per annum

76  Level and extent

during 2000–2010. The major problem that has been identified by various studies is that garbage is not segregated at the time of generation and disposal. This not only poses a problem of both transportation and management. In Delhi, despite several efforts to create awareness among citizens regarding separate disposal of biodegradable and non-biodegradable waste, the majority seem to be least bothered. The unsustainable disposal of waste at open landfill sites for months leads to accumulation, forming mounds and hills of garbage in or around the city. According to the CPCB, Delhi generates around 4,000 tonnes of Municipal waste per day. This waste includes household, commercial, construction, industrial and hospital waste. The study also shows that it has nearly 32 per cent of compostable waste, 6 per cent paper, 1.5 per cent plastic and 2.5 per cent metal. Only 28 per cent of the total waste generated is treated. This is a huge problem with regard to pollution. This waste generates harmful gases, dirt, filth and an obnoxious smell. Composting of biodegradable waste can be done by collecting it separately and converting into organic fertilisers. In one of the interviews published in The Guardian, a senior environmental engineer at the DPCC said that Delhi’s current facilities allow for only about 1,000 tonnes of waste to be processed per day, but the city produces an estimated 3,600–4,000 tonnes. A study by Siddiqui and Khan (2011) indicates that the energy potential from landfill gas available at selected sites in Delhi (Balswa, Gazipur and Okhla) is 8.4 MW, Mumbai (Deonar and Gorai) 5.6 MW, Ahmedabad (Pirana) 1.3 MW and Pune (Urli) 0.7 MW annually. A Planning Commission Report (2014) indicated that 62 million tons of annual municipal solid waste (MSW) generated in the urban areas can produce 439 MW of power from combustible component and refuse-derived fuel (RDF), 72 MW of electricity from landfill gas and 5.4 million metric tons of compost for agriculture use, as methane has 298 times higher global warming potential than carbon dioxide. The utilisation of landfill gas, particularly methane for energy production, is important as it finally converts into primary constituents (i.e., carbon dioxide and water). A study conducted by the United Nations Environmental Program (UNEP) has shown that greenhouse gas emission from landfills can be significantly reduced by following environmentally sound management of hazardous and other wastes (UNEP, 2008, 2010), (Joshi and Ahmed, 2016). To understand the extent of air pollution, let us examine various reports and studies highlighted in the past few years. The Ministry of Environment and Forests, India, in 1997 published a report about the environmental situation in Delhi. Air pollution was considered to be one of the most important areas of concern. It was estimated that about 3,000 metric tons of air pollutants were emitted every day in Delhi. Major contributors to the air pollution were vehicular pollution (67%) and coal-based thermal power plants (12%). As monitored by the CPCB, there was a rising trend of pollution from 1989 to 1997.

Level and extent  77

According to a report in the Vox by Irfan on November 25, 2017, ‘breathing in the Indian capital this month is like smoking 50 cigarettes a day’. A live map generated by Berkeley Earth, an independent research consortium, shows that Delhi reached PM2.5 concentrations of more than 1,200 micrograms per cubic metres. This is much higher above the accepted limit of about 100–200 micrograms per cubic metres. It was 48 times more than the acceptable limit and guideline values of the WHO. The air quality lies in the very unhealthy to hazardous range, based on the PM2.5 concentrations in the air. A study published by IIT Kanpur in coordination with the Government of National Capital Territory (NCT) of Delhi covered six locations in Delhi during the summer and winter season. The six locations selected for recording the air pollution levels (PM10 and PM2.5) were Dwarka (residential), Rohini (residential and industrial), Okhla (industrial), Vasant Kunj (residential-cum-commercial), Dilshad Garden (industrial) and Pusa Road (residential-cum-commercial). The study concluded that the major sources of air pollution are the burning of biomass, vehicular emission, road dust, coal and fly ash, secondary particles, etc. The study shows high levels of PM2.5 and PM10 in winter, attributed mainly to biomass burning and vehicular pollution. The highest PM2.5 was recorded at Anand Vihar, Mandir Marg and Dilshad Garden. It was low in Dwarka. Nitrogen oxide concentration was high at ITO, Punjabi Bagh and Anand Vihar.

Temperature and heat stress ‘Heat stress’ refers to the adverse effect on the health of a person due to exposure to excessive heat. This term is a source of confusion, because in the scientific literature ‘heat stress’ is synonymous with ‘heat load’, which carries the connotation that adverse health effects will occur only if the heat stress exceeds the person's heat tolerance capacity (Dukes-Dobos, 1981). There are a number of other studies that define heat stress. According to the Health and Safety Executive, UK Government, heat stress occurs when the body’s means of controlling its internal temperature starts to fail. Other than air temperature, factors such as work rate, humidity and clothing worn while working may lead to heat stress. Therefore, it may not be obvious to someone passing through the workplace that there is a risk of heat stress (http://www.hse.gov.uk/temperature/heatstress/). The Iowa State University Environmental Health and Safety guidelines suggest that heat stress includes a series of conditions when the body is under stress from overheating. Heat-related illnesses include heat cramps, heat exhaustion, heat rash, or heat stroke, each with its own symptoms and treatments. Symptoms can range from profuse sweating to dizziness, cessation of sweating, and collapsing. According to the Health and Human service of the Victoria State Government, heat stress occurs when our body is unable to cool itself enough to maintain a healthy temperature. Normally,

78  Level and extent

the body cools itself by sweating, but sometimes sweating is not enough and the body temperature keeps rising (Health and Human service, 2015). In all instances, heat stress is caused by a working environment that can potentially overwhelm the body's ability to deal with heat. Heat is a natural hazard, and much is known about the effects of high temperatures on the human body. Episodes of extreme temperature can have significant impact on health and present a challenge for public health and civil protection services. Furthermore, one of the more certain impacts of future anthropogenic climate change will be an increase in heat waves in many populations, and such heat waves will be more intense. According to a study by the National Academy of Sciences, the average number of days per year with a daily heat index value of 40.6°C or more in Delhi is around 25 days. The study also highlights that Earth’s temperature would soon be +1.5°C warmer than that in 19th century due to the increasing greenhouse gases in the atmosphere (Table 3.5). It can be observed from Figure 3.8 that the Universal Thermal Climate Index (UTCI) is very high in Delhi, especially in the month of June. In May, the temperature was considerably high in the years 2012, 2004, 2003, etc. The temperature in May has always remained above 35°C, and the humidity varies between 30 and 100 per cent. In the month of June, the temperature again rises to between 35°C and 45°C. In the past one and half decade, the humidity level in June has ranged between 50 and 90 per cent. The UTCI response shows the heat stress levels are above 38°C in May every year. The UTCI even reached 63°C in 2006, followed by 60°C in the years 2009 and 2016. Since the UTCI level of Delhi is above 38°C, it can be concluded that Delhi lies in the Very Hot to Sweltering categories of thermal sensation. The situation is worst in the month of June. The UTCI touched around 80°C in the year 2006, followed by 65°C in the year 2016. It remained above 40°C in the rest of the years. This shows Very Hot and Sweltering or Extremely Sweltering conditions in Delhi prior to the monsoon month. The Wet Bulb Globe Temperature (WBGT) scores reveal that all the readings were above 30°C for the month of May. The readings were as high as 39°C in the years 2004 and 2006. This again falls in the Sweltering category of Thermal Sensations. Similarly, the WBGT figures for the month of June are high in 2006, 2009 and 2010. In all these years, the scores were close to Table 3.5  Selected heat stress indices temperature limits Thermal Sensation

Wet Bulb Globe Temperature (WBGT) (°C)

Universal Thermal Climate Index (UTCI) (°C)

Neutral Warm Hot Very hot Sweltering

30

9–26 26–32 32–38 38–46 >46

Level and extent  79

70 60

heat stress ˚C

50 40 30 20 WBGT

UTCI

10 0

20002001200220032004200520062007200820092010201120122013201420152016

Years

Figure 3.8  Delhi heat stress May 2000–2016. Source: Authors

39°C. The WBGT was also high, closer to 37°C in the years 2000, 2013 and 2016. The observations thus prove that Delhi lies in Very Hot to Sweltering thermal sensation zones (Rajput and Arora, 2017)

Spatial variation of heat stress and air pollution in Delhi The spatial analysis of temperature variation and air pollutants – mainly PM2.5, PM10 and carbon dioxide – has been done on the basis of data collected through manual air quality monitors. Data have been collected from 35 different locations of the city. The sample has been thus determined by keeping in view various sectors and green and non-green spaces of Delhi. The GPS instrument was also used at the locations in order to acquire the absolute location (cardinal points). Data were collected twice in the month of June, between 10th and 15th, 2016 (11.00 am to 3.00 pm). The data recorded at different locations were done and mapped to check the relevant role of green spaces and type of economic activities. Data related to temperature and relative humidity were also collected to calculate the heat stress, by using the heat stress calculator (WBGT and UTCI). This data were then represented on the map using geographic information system software (ARC GIS) for better understanding. The limitations of the study are that the air quality monitor was not equipped to record sulphur dioxide and nitrogen dioxide levels. Since reaching the same 35 locations twice in span of three days is a tedious job, the task was ceased for more rounds.

80  Level and extent

Heat stress The temperature of 35 locations varied between 33°C and 47°C on the same dates and nearly the same time. Within the northeast district, Shahadara recorded the maximum of 46°C. The temperature was found more than 45°C in the Patparganj Industrial Area and Anand Vihar in east Delhi. In the northwest district, Azadpur, Wazirpur Industrial Area and Rithala recorded higher than 45°C. The areas of AIIMS, Sarojini Nagar and Dhaula Kuan also recorded more than 45°C. Karol Bagh in Central Delhi also recorded more than 45°C. Punjabi Bagh and Rajouri Garden in west Delhi also recorded more than 45°C. In the west district, Mayapuri and Brar Square recorded more than 45°C. In the southwest district, Nazafgarh recorded the highest temperature in the district. During the same period, the temperature recorded was less than 40°C near Sanjay Lake, the Yamuna Bank of the east district; Connaught Place, Rashtrapati Bhavan, 7RCR and Jor Bagh in New Delhi; Darya Ganj in Central Delhi; and Jahapanah Forest and Asola Wildlife Sanctuary in the south district. Taking into account both temperature and relative humidity (considering constant air velocity), heat stress has been calculated by using the heat stress calculator for both WBGT and UTCI . Based on the WBGT, it can be observed that some of the areas lie in the range 28°C–30°C, while 99 per cent of the areas lie above 30°C. This shows that Delhi lies in Very High to

Figure 3.9  Temperature distribution in Delhi, 2016. Source: Mapped by Authors, based on primary survey

Level and extent  81 Table 3.6  Heat stress in Delhi, 2016 Heat stress categories

WBGT classes by NSA

Percentage of recorded areas of Delhi

UTCI classes by NSA

Percentage of recorded areas of Delhi

Hot Very Hot Sweltering

30

0.5 Nil 99.5

32–38 38–46 >46

22 22 56 Source: Rajput and Arora, 2017

Sweltering zones. According to the UTCI data, it can be seen the Asola Wildlife Sanctuary, Brar Square, Jor Bagh and Rithala lie in the Hot Zone (28°C–32°C). Around 55 per cent of Delhi lies in the Sweltering zone, that is, above 46°C (Table 3.6). Air pollution It can be observed from Figure 3.10 that a high concentration of PM2.5 can be seen in Chandni Chowk, Darya Ganj, Connaught Place, Jor Bagh, AIIMS and 7RCR. These areas have heavy traffic and witness a lot of medium- and large-scale construction activities. Very low concentration, that is, less than

Figure 3.10  Concentration of PM2.5 in Delhi. Source: Mapped by Authors, based on primary survey

82  Level and extent

36 micrograms per meter cube (μg/m3) of PM2.5, can be found in Asola Wildlife Sanctuary, Jahapana Forest, Pusa Hill Forest, Sanjay Lake, Yamuna Belt, Anand Vihar and Dilshad Garden. These are the green spaces of the city that are less polluted. The vegetated areas here are denser than those in the other parts of the city. The PM10 concentration level was very high, that is, in the range 287– 357 μg/m3 in Darya Ganj, Connaught Place, AIIMS, Sarojini Nagar, Jor Bagh, Chandni Chowk, Rashtrapati Bhawan, 7 RCR, AIIMS, Dhaula Kuan, Hauz Khas and Malviya Nagar. PM10 concentration was found to be below 143 μg/m3 in the Pusa Hill Forest, Shahadara, Dilshad Garden, Seelampur, Patpar Ganj Industrial Area, Sanjay Lake, Yamuna Bank, Rithala and Asola Wildlife Sanctuary. These areas have lesser vehicular traffic and are comparatively greener than other areas (Figure 3.11). Analysing the spatial variation, the carbon dioxide concentration in the air was found to be very high at 672 ppm in Azadpur, Wazirpur Industrial Area, Connaught Place, Civil Lines, Rashtrapati Bhawan, 7RCR, AIIMS, Sarojini Nagar Market, Jor Bagh, Darya Ganj, Karol Bagh, Punjabi Bagh, Rajouri Garden, Mayapuri and Malviya Nagar (Figure 3.12). The carbon dioxide levels were less than 300 ppm in Uday Vihar and Asola Wildlife Sanctuary, and in the range of 400–500 ppm in Dwarka, Jahapana Forest, Hauz Khaz, Pusa Hill Forest, Chandni Chowk, Rithala, Yamuna Bank, Sanjay Lake, Anand Vihar, Patparganj, Dilshad Garden and

Figure 3.11  Concentration of PM10 in Delhi. Source: Mapped by Authors, based on primary survey

Level and extent  83

Figure 3.12  Distribution of carbon dioxide in Delhi. Source: Authors, based on primary survey

Shahdara. It can be seen that areas that are open, planned or green have lower concentrations of carbon dioxide. Chandni Chowk has lesser four wheelers and heavy traffic inside the market. According to a report published in The Hindu in June 2017, it’s generally been agreed that for every million gas molecules in the atmosphere, anything beyond 350 carbon dioxide molecules, is considered unsafe. These concentrations are likely to trap enough heat to trigger extreme climate events the world over and it would become progressively harder, and costlier, to suck out the excessive CO2. According to Chhabra and Goel, … It is difficult to precisely attribute the causes for such higher values; however, there could be a few possible reasons like lack of a CO2 sink, point sources like forest fires or biomass burning or an urban source, and gaseous transport from neighbouring regions based on prevailing weather conditions (Koshy, 2017a) (https://www.thehindu.com/sci-tech/ energy-and-environment). Natural sequestration (long-term capture and storage of carbon dioxide to mitigate greenhouse effect) can be done by increasing green cover and wetlands in and around the city. Therefore, assessment of carbon dioxide level

84  Level and extent

is essential to measure for assessment of right green cover. Trees and dense vegetation are a sink for carbon dioxide. The hotspots can be identified by looking at temperature and pollution levels of the places. The hotspots in this study refer to areas with high temperature and high levels of air pollution. The areas with high pollution levels and high temperature are Wazirpur Industrial Area, Chandni Chowk, AIIMS, Sarojini Nagar, Dhaula Kuan, Punjabi Bagh and Rajouri Garden. The areas of Sanjay Lake and Yamuna Bank experience having low air pollution and less temperature. The combination of lowest pollution and temperature is found in the Asola Wildlife Sanctuary. This shows that green areas with water bodies have low temperature and pollution levels. Areas experiencing higher pollution levels and high temperature are mostly located in the central and western parts of the city. These areas are highly commercialised and experience heavy traffic during the entire day. Analysing the relationship between particulate matter and temperature at different locations, it can be seen that high temperature and high PM levels exist in Chandni Chowk, AIIMS and Sarojini Nagar. These areas have traffic congestion and haphazard growth. The area around AIIMS is almost concrete and commercial and has a high density of traffic. High temperatures and low PM levels can be seen in Rithala, Shahdara, Seelampur, Patpar Ganj and Anand Vihar, because these are fringe areas with some open spaces. These areas are majorly residential or industrial, so traffic flow is comparatively low. Asola Wildlife Sanctuary, Jahapanah Reserve, Sanjay Lake and the Yamuna Belt experience low temperatures and low PM levels. These areas are open with green spaces and water bodies, as well as very low density of population and least traffic influx (Table 3.7). Analysing the relationship between the carbon dioxide and temperature levels, it can be seen that high temperature and high carbon dioxide levels exist in the Azadpur Industrial Area, Wazirpur Industrial Area, AIIMS, Sarojini Nagar, Punjabi Bagh, Rajouri Garden and Mayur Vihar Industrial Area. The reason seems quite obvious – industries and traffic generate carbon dioxide. These areas are less green and mostly concrete. On the other hand, areas with low carbon dioxide and low temperature are Asola Wildlife Sanctuary, Hauz Khas, Jor Bagh, Jahapanah Forest, Sanjay Lake and the Yamuna Belt. These areas are green belts with lots of trees. Densely vegetated areas help to maintain temperature, absorb carbon dioxide and contribute to rainfall by evapotranspiration (Table 3.8). Most parts of Delhi have experienced a haphazard growth through the ages. The focus of planners has been mostly to develop it in terms of robust infrastructure, substantially ignoring the relevance of green infrastructure to the city. A huge number of people migrate to Delhi every year, looking for economic and educational opportunities. They need to be accommodated in terms of jobs, houses, medical and other basic facilities. This pushes the priority of green spaces to the last on the list. The high-rise buildings on the one hand solve the problem of accommodation but create several other

Level and extent  85 Table 3.7  Temperature and pollution (PM2.5) regions of Delhi PM2.5 in μg/m 3

Temperature in °C 33.4–36

17–36

36–38.6

Asola Jahapanah Wildlife Forest Sanctuary

36–54

54–72

72–91 >91

Hauz Khas, Malviya Nagar Jor Bagh, 7CRC

Connaught Place, Rashtrapati Bhawan, DaryaGanj

38.6–41.2 41.2–43.8 43.8–46.4 Sanjay Lake, Yamuna Bank

Dilshad Rithala, Uday Garden, Vihar, Shahdara, Pusa Najafgarh, Hill Anand Vihar, Seelampur, Patparganj Industrial Area Model Wazirpur Town, Industrial Area, Delhi Brar Square Ridge Civil Lines Azadpur, Punjabi Bagh, Rajouri Garden, Mayur Vihar, Dwarka DhaulaKuan, Karol Bagh Chandni Chowk, AIIMS, Sarojini Nagar

problems. Tree plantations done so far in the city is in the form of trees outside the forest (TOF), along the roadside and the metro lines. The plantation is not dense, and therefore not really an effective remedy. In peripheral Delhi, residential buildings have been developed on agricultural land or open areas. Most of the high-rise buildings are located in the peripheral regions of Delhi. Therefore, the pollutants from the high-rises, chimneys of industries or vehicles are not able to escape the city’s atmosphere. In comparison to the height of the high-rise buildings, the tree canopies are much lower. In summers, the dust or loo blowing from western India is hot and light. These winds spread over the city and get trapped due to high-rise buildings and flyovers. A proper vertical circulation of air does not take place due to the lack of vegetation, high-rise buildings and the already existing pollutants in the area. The dusty hot air thus gets trapped and adds to the greenhouse effect. In such a case, the only solution left with the people is to wait for rain, which acts as a scrubber. In winters, on the other hand, the air becomes dense and traps the pollutants. The biomass burning in the paddy fields of Haryana, cracker burning in the festival season, vehicular

86  Level and extent Table 3.8  Temperature and pollution (carbon dioxide) regions of Delhi CO 2 ppm

Temperature in °C 33.4–36

36–38.6

0–168

168–336 336–504

Asola Wildlife Sanctuary HauzKhas Jahapanah Forest

504–672

Jor Bagh

Connaught Place, Rashtrapati Bhawan

672–840

7CRC, Malviya Nagar

Darya Ganj

38.6–41.2 41.2–43.8 43.8–46.4 Sanjay Lake, Yamuna Bank

Dilshad Shahdara, Patpar Garden, Ganj Industrial Pusa Area, Anand Hill Vihar, Rithala, Uday Vihar, Dwarka Model Najafgarh, Town, Seelampur, Delhi Chandni Ridge Chowk, Dhaula Kuan, Karol Bagh, Brar Square Civil Azadpur, Lines Wazirpur Industrial Area, Punjabi Bagh, Rajouri Garden, Mayur Vihar, AIIMS, Sarojini Nagar

and industrial pollution, etc., all get trapped in the dense cool air, and the situation becomes even worse. PM levels are very high in the months of November and December. The intensity of air pollution has made the people of Delhi suffer from a variety of illnesses, ranging from breathlessness to lung cancer. The situation has become worse over the years. The real remedies may be detrimental to the economic growth of the city, but the time has come to take some harsh and stringent decisions. Tough governmental policies and laws on the one hand and habitual environmental practices by the citizens on other hand can save the city and make it liveable in the future. A recent incident of spread of contagious coronavirus, specifically in Delhi, has led to complete lockdowns of several places. There has been shutdown of factories, commercial areas, markets, etc. Vehicular traffic on road has become negligible and movement of people have got almost restricted, considering a drastic fall of air pollution in Delhi. The data of CPCB as

Level and extent  87

published by Times of India show PM2.5 is around 146 AQI μg/m3 and PM 10 is 147 AQI μg/m3. The level of pollution can still be considered unhealthy as it lies in the range of 100–200 AQI μg/m3. At night, the level reaches to 80 AQI, which is moderate. So even if the economic and developmental activities fall to their lowest level the air pollution in Delhi still do not fall to reach good or moderate AQI in the daytime. Delhi has to prepare a full proof plan to curb air pollution. Global climate change and air pollution emphasises the need for consistent policy change to fix air quality and fight climate change. Air pollution is a continuous and slow poisoning of the ecosystem. Therefore, it’s important to manage pollution with a long-term consistent set of rules and laws which are stringent and well monitored throughout. Good environmental practices should be learned from other cities of the world and followed as per their applicability in Indian context. Exchange of ideas and technology can prove to be very conducive for dealing with such challenges.

References Census Abstract of Delhi, 2011, Directorate of Census Operation, Ministry of Home Affairs, Delhi. http://censusindia.gov.in/2011 CPCB, 2000, Air quality status and trend in India, Parivesh Newsletter, 4(3). Central Pollution Control Board, Parivesh Bhavan, Delhi, India. CPCB, 2001, National ambient air quality statistics of India. Central Pollution Control Board, Parivesh Bhavan, Delhi, India. Dangers of Oxygen Deficient Atmosphere, http://www.airproducts.com/~/media/ Files/PDF/company/safetygram-17.pdf Department of Health and Human service Annual Report, November 2015, Victoria State Government publications. Donohue, R.J., et al., 2013, Impact of CO2 fertilization on maximum foliage cover across the globe’s warm, arid environments, Geophysical Research Letters, 40, 1–5. doi:10.1002/grl.50563 Dukes-Dobos, F.N., 1981, Hazards of heat exposure: A review, Scandinavian Journal of Work, Environment & Health publication, 7(2): 73–83. doi:10.5271/sjweh.2560. Economic Valuation of Oxygen Supplying Ecosystem Service of Healthy Trees, by an NGO Delhi Greens, Aug 20, 2013, in The Economic Times, The Times Group pub economictimes.indiatimes.com/articleshow/21927419.cms?utm_source= contentofinterest&utm_medium=text&utm_campaign=cppst Ganesh, G., et al., 2016, Air Pollution in Delhi: An Analysis, ENVIS centre CPCB, Ministry of Environment, Forest and Climate Change, Parvesh Bhawan pub. Gifford, D., 2015, Sustainability Starts at Home: How to Save Money While Saving the Planet, B00Z3Z2E8S, Dawn Gifford of Small Footprint family publications. Ilana Goldowitz Jimenez, Gardening Know How: Oxygen for Plants – Can Plants Live without Oxygen Plant Scientist & Writer pub. https://www.gardeningknowhow.com/garden-how-to/info/can-plants-live-without-oxygen.htm Jain, S., 2008, Urban air quality in mega cities: A case study of Delhi City using vulnerability Analysis, in Environmental Monitoring and Assessment doi:10.1007/ s10661-007-9681-7

88  Level and extent Johns Hopkins Bloomberg School of Public Health, 2015, Researchers Find Link Between Air Pollution and Heart Disease, Peng, R.D., et al. www.jhsph.edu/news/ news-releases/2015/researchers-find-link-between-air-pollution-and-heart-disease.html Koshy, J., June 2017a, At 399 ppm, India matches the world in atmospheric carbon dioxide levels, in The Hindu, https://www.thehindu.com/sci-tech/energy-andenvironment. Koshy, J., June 26 2017b, At 399 ppm, India matches the world in atmospheric carbon dioxide levels, https://www.thehindu.com/sci-tech/energy-and-environment; http://ipgcl-ppcl.gov.in/board_ipgcl.htm; https://timesofindia.indiatimes. com/india/pollution-news Malesky, M., 2018, Minimum Oxygen Concentration for Human Breathing in Sciencing. https://sciencing.com/ Nowak, D.J. et al., 1998, “Modeling the effects of urban vegetation on air pollution” in Gryning, S.-E. et al., (Eds.), Air pollution modeling and its application XII. New York: Plenum Press: 399–407. Phukan, S.R., 2014, Pollution in Delhi: Industrial Units Choking Residential Areas, My India pub,www.mapsofindia.com/my-india/cities/pollution-in-delhi-industrialunits-choking-residential-areas Radford, T., 2013, Study Finds Plant Growth Surges as CO2 Levels Rise, Climate News Network, Climate Central Publications, https://www.climatecentral.org/; www.dhs.wisconsin.gov/chemical/carbondioxide.htm; http://www.hse.gov.uk/ temperature/heatstress/ Rajput, S., & Arora, K., 2017, “Assessment of Heat Stress Levels of Delhi: Application of UTCI and WBGTI”, in Climate Change: Perspective and Challenges in 21st Century by Negi, V.S., Research India Press, New Delhi, ISBN: 978-935171-094-3, pp. 327–348 Rizwan, S.A. et al., 2013, Air pollution in Delhi: Its Magnitude and Effects on Health in Indian Journal Community Medicine; 38(1): 4–8. Safi, M., 2017, Delhi's deadly dust: how construction sites are choking the city in The Guardian, International edition. https://www.theguardian.com/cities/2017/ feb/15/delhi-deadly-dust-how-construction-sites-choking-city Sharma, M. (Ed.), December 25 2018, https://www.businesstoday.in/current/economy-politics/pollution-in-delhi-reaches-hazardous-level-in-delhi-ncr-32-areasrecord-severe-air-quality/story/304020.html; https://www.hindustantimes.com/ delhi-news/delhi-s-igi-airport-could-overtake-london-s-heathrow-in-traffic-volume-by-2020-report/story.SwarajyaStaff-Sep4, 2018. Sikora, E.J. and Chappelka, A.H., 2004, Air Pollution Damage to Plants, Alabama Cooperative Extension System, Agriculture and Natural Resource, ANR- 913, University of California. http://www.aces.edu/pubs/docs/A/ANR-0913/ANR0913.pdf Taylor, J., July 10, 2013, Global Warming? No, Satellites Show Carbon Dioxide Is Causing 'Global Greening' Forbes publications, https://www.forbes.com Union of Concerned Scientists, July 2014, Car Emissions and Global Warming, www.ucsusa.org/resources/car-emissions-global-warming

Chapter 4

Health challenges in Delhi

Introduction Cities are potentially unhealthy spaces. The increasing pollution in the cities leads to various health hazards, as speedy economic growth and the development process lead to unsustainable models of development. Health is a broad concept that deals with both physical and mental fitness. Health indicates the quality of life. According to World Health Organisation (WHO), health is defined as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. Economic growth is essential for cities, but the focus should also be on the availability of a hygienic and healthy environment. Cities are considered to be the engines of economic growth and enormous job opportunities. Economic growth of the country is indicated by an increase in the Gross Domestic Product (GDP) of the country. The GDP is the total monetary value of the goods and services produced by the country over a specific period of time, which will increase capital spending, productivity, wage and real income of the people, and thereby improve the standard of living of the people. It helps to lift people out of extreme poverty and improve development outcomes. The quality of life of any nation or place is measured by using the Human Development Index (HDI). The HDI is a composite index of life expectancy, education and per capita income of a country. Life expectancy is believed to be the key indicator of human health. As an economy grows, there are many problems which come parallel with the growth process. Some of the major problems in the growth process are pollution, degradation of environment and overexploitation of natural resources, which hamper the growth process in one way or the other in the long run. Economic growth of a nation can lead to several different types of pollution. This in turn leads to a negative externality, such as pollution and the unsustainable extraction of natural resources, which are limited. A negative externality is a cost that is suffered by a third party as a result of an economic transaction. In a transaction, the producer and consumer are the first and second parties. Third parties include any individual, organisation,

90  Health challenges

property owner or resource that is indirectly affected. Externalities are also referred to as spillover effects. A negative externality is also referred to as an external cost. Growth can create negative externalities, increased consumption of de-merit goods, and a huge increase in household and industrial waste. These externalities can lead to market failure, environmental damage, reduce social welfare and lower the sustainable rate of growth. Thus, as an economy grows, so does the level pollution, affecting the environment, health and well-being. Long-term exposure to pollution can result in significant health problems like respiratory diseases, flu, pneumonia, cancer, heart diseases, hypertension, eyes infection, viral fever, chikungunya, and even lead to premature death in adults and infants. India is among the bottom-five countries on the Environmental Performance Index (EPI), 2018. It ranks 177 out of 180, falling 36 points from 141 in 2016. India is at the bottom of the list in the environmental health category; it ranks 178 out of 180 as far as air quality is concerned. Delhi, the national capital of the country, is tagged as the most heavily polluted capital city in the world. It is the among the world’s worst cities in terms of air pollution, with an unhealthy Air Quality Index (AQI) for the majority of the year. Thus, pollution of various types is one of the biggest threats to the welfare of the people. The level of carbon monoxide in Delhi is around 6,000 micrograms per cubic metre, which is much more than the safe level. Delhi’s average AQI is 121; that is, categorised as Poor (Ministry of Earth Sciences). PM2.5 pollution levels in Delhi are the second highest in the world, followed by Beijing, leading to high prevalence of respiratory diseases, lung cancer, etc. (Ambient Air Pollution Report, 2016). Measuring health is a difficult task. It is a wider term with several indicators, a lot of which cannot be quantified. Sometimes, quantifying the indicators does not give in-depth information. Due to the paucity of comparable data, this book analyses the health of Delhi by selecting five broad indicators: 1. 2. 3. 4. 5.

Life expectancy and infant mortality rate Environmental and lifestyle diseases Health challenges Going green for health Health satisfaction level

Life expectancy and infant mortality rate Life expectancy is the average age an individual is expected to live from the year of birth. Life expectancy is the key indicator of the health conditions and environmental conditions of the area. It is also linked to the income and resources at disposal. The Infant Mortality Rate (IMR) is the number of deaths per thousand live births of children under 1 year of age. The IMR also reflects the effectiveness of the health services and healthcare available

Health challenges  91

to the mother and her newborn. In developing countries like India, a number of deaths still occur at the time of birth due to unprofessional care and non-institutional deliveries. Poverty and lack of awareness are the two major causes of high IMR or neo-natal deaths. According to the HDI Report published in 2011, Delhi has a life expectancy at birth of 73 years, which is the second highest in India after Kerala. The life expectancy of a male is 72 and of a female is 74 years. Children between the ages of 5–10 years have a life expectancy of 70 years at the age of birth. This higher life expectancy is more linked to better health facilities available in Delhi rather than the quality of life, especially with reference to food, water, air and shelter. However, in comparison to the life expectancy of more than 80 years in several other global megacities, the life expectancy level of Delhi is very low. In recent studies, researchers and scholars have been trying to link pollution with health in the cities. In one such study conducted by the Institute of Information Technology and Management (IITM), scientists in collaboration with the National Centre for Atmospheric Research (NCAR), Colorado, pinpoints that Delhi might be paying the steepest price for its air pollution, with life expectancy dropping by 6.4 years (The Times of India, 7 June 2016). The study also shows that due to high levels of PM2.5, nearly 10,000 premature deaths occurred in Delhi. Delhi’s IMR has improved over the years. It has declined from 33 in 2002 to 18 in 2016. This is far lower than the Indian average of 34. This situation again can be credited to better health facilities. However, comparing Delhi to the other global megacities implies that Delhi has to travel a long way to catch up with the other global cities as per Table 4.2.

90 80 70 60 50 40 30 20 10 0

life expectancy

Figure 4.1  Life expectancy in megacities of the world. Source: compiled by authors

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30 25 20 15 10 5 0 number of deaths per 1,000 live births of children under one year of age.

Figure 4.2  Infant mortality rate in world megacities. Source: Compiled by authors

Environmental and lifestyle diseases Many diseases in the cities have been labelled as urban environmental diseases. In one of the publications of the National Institute of Environmental Health Sciences (NIEHS) in the United States, allergies, asthma, cancer, heart diseases, fertility problems, osteoporosis, pneumonia, etc., are considered to be environmental diseases. It is very difficult to link any disease or ailment with a single cause. These diseases emerge due to multiple environmental problems (although some of them can be biological or genetic too). However, a sudden rise in the number of people affected by a particular disease or a rural–urban variation in type of disease and their number of patients can reflect on the prevalent urban environmental diseases. The London Public Health Observatory highlights that most of the deaths in London are due to cancer, cardiovascular failure, diabetes and respiratory diseases. According to a report released by the Beijing Health and Family Planning Commission, 2016, the chronic diseases responsible for premature deaths in Beijing are cancer, cardiovascular failure, diabetes and respiratory problems. Similarly, various studies in Tokyo and New York too confirm that these four diseases as prominent in these cities. According to a report by Down to Earth magazine, at least one in every 10 asthma cases of the world live in India. Further, in a report published by a diagnostic centre of India, around 90 per cent of childhood asthma and 50 per cent of adult asthma is caused due to a reaction to environmental allergens like dust, pollen, insects and domesticated animals. In a paper published in Journal of Association of Physicians in India by Salvi et al., it was found two-thirds of adults and adolescents with current asthma reported that shortness of breath during the day was extremely (25%) or moderately

Health challenges  93

(41%) bothersome and that being awakened as their triggered factor. 49 per cent of the asthmatics in the study reported that dust and air pollution were the most common asthma triggers. Fumes or odours, iced drinks and changes in weather were reported to trigger asthma in 30 per cent, 29 per cent and 27 per cent of the asthmatics, respectively, while chemicals, tobacco smoke and perfumes triggered asthma symptoms in 24 per cent, 23 per cent and 17 per cent, respectively. Every fifth asthmatic perceived food (20%) to be a trigger factor for their symptoms, while only 1 in every 20 reported pollen as their trigger factor. Other than these, physical activity (14%), viruses and colds (12%), stress (11%) and animals (9%) were also perceived as triggers for asthma (Salvi et al., 2015). With Delhi, the asthma patients are on rise every year as Delhi adds some 1,400 vehicles every day to its roads, which are mainly responsible for polluting air. A study conducted by HEAL Foundation and Breathe Blue suggest that four out of every 10 children in Delhi suffer from severe breathing problem. According to Dr. Preetaish Kaul, representative of the HEAL Foundation, ‘poor results on LHST (Lung Health Screening Test) mean compromised lung function and high possibilities of contracting pulmonary diseases’ (Delhi's children have the weakest lungs as compared to kids from other metros, 2015; Mail Today Bureau, 2015). The LHST result suggests that 21 per cent of the children surveyed have poor lung condition and 19 per cent have bad lung conditions. This is an alarming figure as bad to poor lung conditions determine high possibilities of pulmonary diseases (Life Expectancy Drops 6 years in Delhi Due to Pollution, 2016). A report on the AQI for Delhi on November 8, 2017 indicated an AQI level of 484 on a scale of 500, entering the ‘Severe’ category, which is causing a number of health problems to the people of Delhi, as per Table 4.1. Table 4.1  R eport on National Air Quality Index and health impact, Central Pollution Control Board AQI

Remark

Possible Health Impacts

0–50 51–100 101–200

Good Satisfactory Moderate

201–300

Poor

301–400

Very Poor

401–500

Severe

Minimal impact Minor breathing discomfort to sensitive people Breathing discomfort to the people with lung, asthma and heart diseases Breathing discomfort to the people on prolonged exposure Respiratory illness to the people on prolonged exposure Effect even on healthy people and serious health impact on people with lung and heart disease

Source: Modified by authors from health statements for the Air Quality Index (AQI) categories, Report of Central Pollution Control Board, Ministry of Environment, Forest and Climate Change.

94  Health challenges Table 4.2  Details of vector-borne diseases in Delhi, 2010–2018 Year

Suspected cases of dengue

Suspected cases of malaria

Suspected cases of chikungunya

2010 2011 2012 2013 2014 2015 2016 2017 2018

6,259 1,131 2,093 5,574 995 15,867 4,431 4,726 2,798

251 413 882 514 201 311 454 577 473

120 110 06 18 8 64 7,760 559 165

Source: Compiled by authors from Economic Survey of Delhi, 2017–2018 data of 2017 and 2018 taken from Annual Report (2018–2019) Directorate General of Health Services.

Alarming pollution levels in Delhi are leading to a sharp rise in the cases of vector-borne diseases like dengue, malaria and chikungunya, as shown in Table 4.2. Vector-borne diseases are human illnesses caused by parasites, viruses and bacteria that are transmitted by mosquitoes, sandflies, triatomine bugs, blackflies, tsetse flies, lice, etc., and are responsible for a number of deaths in Delhi, as shown in Table 4.3. Table 4.2 shows that dengue cases were extremely high in 2015, the worst outbreak since 1996. The year 2016 saw a record high of 7,760 cases of chikungunya. Evidently, vector-borne diseases have been increasing over the years in Delhi. According to the WHO, distribution of vectorborne diseases is determined by complex demographic, environmental and  social factors. Global travel and trade, unplanned urbanisation and

Table 4.3  Major cause of death in Delhi, 2018 S. No

Causes of death

1. 2 3 4 5 6 7 8 9 10 11 12

Hypertension Ischemic heart disease Diabetes (I and II) Bronchitis and asthma Cancer Lung cancer Oral cancer Road accidents Acute diarrhoeal infection Acute respiratory infection Whooping cough Pneumonia

Cases

Deaths

97,797 45,434 93,937 48,731 66,777 1,485 1,089 6,501 547,187 361,306 17 19,848

14 17 35 55 8 92 20 576 1,701 263 2 624

Source: Annual Report, 2018, Directorate General of Health Services Govt of NCT

Health challenges  95

environmental challenges such as climate change can affect pathogen transmission, making the transmission season longer or more intense, and causing diseases to emerge in countries where they were previously unknown. Changes in agricultural practices due to variation in temperature and rainfall can also affect the transmission of vector-borne diseases. The growth of urban slums, lacking reliable piped water or adequate solid waste management, can render large populations in towns and cities at risk of viral diseases spread by mosquitoes. Together, such factors influence the reach of the vector population and the transmission patterns of disease-causing pathogens (WHO, 2016). Table 4.3 shows the major causes of death in Delhi. The major causes of death can be attributed to heart attacks, followed by cancer, tetanus, tuberculosis and anaemia. Many studies have clearly linked diseases like heart attacks, cancer and tuberculosis with pollution, contamination of consumable eatables and stress in the cities. The report by the State of Health of Delhi shows that diarrhoea, hypertension and diabetes were more prominent during 2014–2016. Dengue and tuberculosis were the highest in 2015. According to Annual Report (2018–2019) Directorate General of Health Services (2018), acute diarrhoeal diseases caused highest deaths, that is, 1,701. This is followed by pneumonia (624), acute respiratory disorders (263) and diphtheria (156). Seasonal influenza (H1N1) reported 2,948 cases in 2019 which was 151 in 2018.

Health challenges: A survey Most of the studies conducted for health in Delhi are based on a sample survey; therefore, it becomes difficult to assess the real picture. Moreover, the residents of Delhi use both formal (by visiting doctors) and informal medication (self-medication) for various diseases. Some patients suffering from asthma and bronchitis attempt to be cured by taking homeopathic, ayurvedic or naturopathy treatment. Therefore, it becomes difficult to acquire authentic data on health, diseases and healthcare cost. It is thus important to study the health conditions in Delhi by incorporating the perspective of the key stakeholder, that is, the residents of the city. To understand the health perspective, the authors conducted a survey using a structured questionnaire in all nine districts of the city, with a sample size of 100 each. The respondents were people from different age and income groups, selected on a random basis. The study assessed both curative and preventive means of healthcare. The preventive aspects included visits to fitness centres, yoga classes, walking in green spaces, vaccinations, consuming vitamin supplements or preventive medication and organic food. The curative aspect included visits to a doctor and the type of medication used. To understand the health status and healthcare aspects, various parameters were taken into account.

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Presence of diseases Urban environments are often poorly equipped to provide stable sources of food for sustaining a massive population. In low-income and middleincome megacities such as Dhaka (Bangladesh), food shortages and poverty result in increasing food prices and malnutrition. Additionally, many megacity inhabitants exhibit a shift towards more sedentary lifestyles and a western diet, leading to increased body-mass indices (BMIs) and instances of obesity and diabetes. As urban residents transition from diets sustained on home gardens to rely on cheaper, processed foods, they are at a greater risk of developing obesity and other non-communicable diseases (Jowell et al., 2017). As mentioned earlier, Delhi is a hub of various diseases such as cardiovascular, respiratory and cancer. Besides these diseases, flu, cough and cold and stomach infections also occur frequently. Nearly 20 per cent of the respondents admitted that their problems occur frequently, 20 per cent said moderately and only 12 per cent said the health problems occurred rarely in their family. In addition, there is seasonal fluctuation in the type of some environmental problems. Diseases like dengue, chikungunya and malaria spread mainly in the monsoon season (July–September), while respiratory patients increase significantly during November to January. Type of diseases The respondents were questioned about the type of pollution and type of diseases prevalent in their area. They were also asked about the kind of health issues their family members faced last year. Air pollution was a common problem almost all respondents mentioned. Table 4.4 lists the environmental problems other than air pollution. Nearly 48 per cent respondents found noise pollution to be the most common problem in their area, mainly due to traffic and various cultural and religious activities. About 28 per cent of the respondents mentioned the solid waste disposal and sanitation problem. Hospital waste (4.7%), burning of waste (2.9%) and industrial waste (0.9%) Table 4.4  Major environment problems in your area Types of environment problem

Per cent of respondents

Burning waste Solid waste disposal and sanitation problem Sound pollution Hospital waste Industrial waste All Total

2.9 28.2 47.6 4.7 9 15.8 100.0

Source: Primary survey

Health challenges  97 Table 4.5  Disease that family members suffer from Per cent of respondents Diarrhoea Respiratory disease Dengue Malaria Deficiency diseases Heart disease Eye infection Jaundice Typhoid Any other disease Blood pressure (high or low) No disease Total

6.2 13.8 11.1 4.2 4.0 3.1 4.7 3.6 2.9 2.2 20.2 24 100

Source: Primary survey

were next in the respondents’ list. Almost 16 per cent of the respondent felt that all of these environmental challenges were prevalent in their area. On enquiring about the diseases that family members suffered from, 13.8 per cent respondents cited respiratory diseases, 11 per cent mentioned dengue and 4.2 per cent pointed at malaria (Table 4.5). About 3.1 per cent of the respondents mentioned heart problems, while a significant 20 per cent listed fluctuating blood pressure, due to sedentary lifestyle or eating habits. Figure 4.3 shows that environmental diseases like respiratory diseases are common in south, northwest and northeast Delhi. Dengue is more common

Respondents in Percent to total

100% 90%

No problem

80%

Blood Pressure

70%

Any Other

60%

Typhoid

50%

Jaundice

40%

Eye Infecon

30%

Heart Disease

20%

Deficiency disease

10%

Malaria

0%

Dengu

North Central Delhi East Delhi

East Delhi

North West

North Delhi

New Delhi

West Delhi

South west Delhi

Districts

Figure 4.3  Diseases in Delhi (Zonewise) in per cent. Source: Primary Survey

South Delhi

Respiratory disease Diarrhoea

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in southwest, east and New Delhi. High or low blood pressure is more of a lifestyle disease common in almost all the administrative divisions of Delhi but more prominent in west Delhi, followed by south Delhi. Heart diseases were more reported in west Delhi, followed by south and northwest Delhi, respectively. Visit to doctors Most of the respondents opt for a formal method of visiting a doctor for any health issue other than cold and cough. Although cough is a common health issue, it can have varied intensity, from flu to bronchitis, TB or cancer. Mostly respondents said if the cough remains persistent for a week or so, they visit a doctor. When enquired about the type of healthcare centre they visit, it was found that nearly 27 per cent visit local clinics, 6 per cent go to nursing homes, 31.5 per cent visit government hospitals and the rest 35.5 per cent go to private hospitals. Regarding the frequency of visits, 35 per cent of the families visited a medial practitioner more than 15 times a year, while nearly 15 per cent of the families visited about 10–15 times a year. This shows a high frequency of visit to the doctors. Preventive healthcare options ‘Prevention is better than cure’, almost all respondents believe in this phrase. They all mentioned taking some or the other precautions to prevent health problems. Some people invest a lot of money in healthcare, while people in the low-income group also take small steps. Masons and carpenters, for example, take jaggery to prevent cough. Due to increasing health issues in the city, people prefer going for walks, yoga or other exercises. Some people pay a huge amount to go to gymnasiums, hire dietician services, or participate in aerobics and dance classes. Many people are shifting to ayurvedic and organic range of food products, toiletries, etc. Table 4.6 shows that almost 80 per cent of the population takes some preventive measure. Nearly 15.3 per cent respondents opt for walks or Table 4.6  Types of preventive healthcare Per cent of respondents None at all Gym/aerobics/yoga/dance/walks/dietician Organic food Vaccinations/vitamin supplements All of the above options Total Source: Primary survey

19.6 15.3 8.7 17.1 39.3 100.0

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some form of physical exercise. About 17 per cent take vitamin supplements and vaccinations (which is mainly for kids, but in a few cases, adults have also started taking vaccination for flu and typhoid). Organic food is also becoming popular. Since it is more expensive than the generally available food products in the market, only 8.7 per cent respondents buy organic products. These preventive healthcare measures are becoming popular and a habit. This is because the constantly occurring diseases affect people both in physical and monetary terms.

Going green for health: People’s perception The people of Delhi may not be very emotionally attached to the green spaces, but they do feel the need to have open areas and green spaces for health reasons. Nearly 41 per cent of the respondents believe that numerous diseases spread due to the depletion of green cover or cutting of trees. They believe that since air pollution can be addressed by planting more and more trees, the government should take a conscious and well-directed effort in this direction. Green spaces are precious spaces in the city.

Ecosystem services Ecosystem services are the services that people gain for free from the nature. As one of the respondents of Rajouri Garden mentioned: ‘If we have enough green spaces and open gyms, we would save lot of money that we spend on going to the gym or other exercise classes’. Nearly 54 per cent of the respondents hold the opinion that green spaces are mostly required because they give fresh air. About 30 per cent feel they are needed mostly for morning and evening walks. They are lifelines of especially the elderly and the children. Table 4.7 given above shows that more than one-tenth of the people feel that green spaces are mostly for aesthetic purposes, and some believe they are needed to have plenty of rain and cool temperature in the city. Table 4.7  Ecosystem services derived from green spaces Per cent of respondents Fresh air Morning and evening walks Fresh food items Maintains aesthetic and beauty of the area Rainfall and temperature control Any other Total

54.2 22.9 3.6 11.1 3.1 5.1 100.0

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Level of environmental awareness The level of awareness about the environment among the people is the significant factor that helps to understand their choice for eco-friendly products (EFP). There are a large number of products we use in our everyday lives that harm the environment directly or indirectly. The study also aimed to determine the awareness of the people for EFP, impact of education on the choice of the people for these products, use of EFP for the conservation of green belt and protection of environment by keeping the surroundings clean. a) Willingness to pay (WTP) for EFP: About 58 per cent of the total respondents in Delhi expressed their willingness to buy EFP. Since EFP are expensive in comparison to the traditional products, even people who feel like buying the product are not willing to pay a higher price. A zonewise analysis shows that the preference to buy EFP is the highest in the New Delhi zone, followed by the northwest, while it is the lowest in the northeast Delhi zone (Figure 4.4). Therefore, green products can be introduced in areas where people are showing willingness to buy EFP. On the other hand, awareness programmes can be conducted in areas where people are showing a low preference to buy EFP. b) EFP and educational level: Education is one the indicators of awareness. Preference for EFP is very significantly related to the level of education. As the level of education increases, so does the preference for EFP. Illiterate people have very low preference for EFPs; this might be because of lack of awareness and knowledge about how the environment and pollution affect our health. It can also be because of the higher cost of the EFP. Preference for EFP is the highest among graduates than post-graduates and other groups such as diploma holders (Figure 4.5).

South Delhi

46%

South west Delhi

56%

West Delhi

56%

New Delhi

72%

North Delhi

58%

North West

70%

East Delhi

68%

Central Delhi North East Delhi

56% 36%

Figure 4.4  Preference for environment friendly products. Source: Primary survey

Health challenges  101

Respondents in percent

25 20 15 10 5 0

Illiterate

Primary

Secondary

Sr. Graduate Secondary

Post Graduate

Other

Educaonal level

Figure 4.5  Preference of ecofriendly products and educational level.

Linear regression analysis for preference of EFP In the regression model, 14 independent variables have been taken into consideration for identifying the determinants for preference for EFP of the people in Delhi:



Preference for EFP  f  X1  X 2  X3  X 4  X5  X6  X7  X8  X9  X10  X11  X12  X13  X14 

Dependent Variables = Preference for EFP Explanatory variables are defined as below: X1 X2 X3 X4 X5 X6 X7 X8 X9 X 10 X 11 X 12 X 13 X 14

= Age of the respondent in years = Gender (male = 1, female = 0) = Level of educational attainment = Marital status (married = 0, unmarried = 1 = Family type (nuclear family = 0, joint family = 1) = Number of family members = Own house of the household (No = 0, Yes = 1) = Household monthly income = Number of earning members in the family = Environmental pollution in your area (Yes = 1, No = 0) = Is there existence of disease in your area (Yes =1, No = 0) = Frequency of occurring of disease (frequently = 1, moderately = 2, rarely = 3, not at all = 4) = Hospital type (government hospitals = 1, private hospital = 0). = Interest in conservation of green belt (high or moderate interest = 1, no interest = 0)

The main objective of this study was to partial out the independent effect of each variable, while controlling the other factors. Table 4.8 shows the results of the Ordinary Least Square model.

102  Health challenges Table 4.8   Test statistics for the regression model for the preference for EFP R R square Adjusted R square F Significance of F Degree of freedom Std. error of the estimate Durbin–Watson

0.735 0.540 0.533 74.184 0.000 14 0.338 1.867

Source: Primary survey

Table 4.8 illustrates the test statistic of regression result for the determinants of the WTP for EFP. The model is quite robust with an F statistic value of 74.184 with over 99 per cent level of confidence. The value of R-square (coefficient of determination) is estimated to be 0.735, that is, a 73 per cent variation in the dependent variable is explained by the variations in the independent variables. An adjusted R square value of 0.533 gives us the idea of how well our model generalises. Ideally, we would like the adjusted R value to be the same or very close to the value of R square, which is 0.540. R is the multiple correlation coefficient that tells us how strongly the multiple independent variables are related to the dependent variable. The regression coefficient R value of 0.735 shows that there is a high positive correlation between the dependent variable preference for EFPs and all independent variables in the model. The standardised beta coefficient of the regression model for WTP for EFP compares the strength of the effect of each individual independent variable to the dependent variable. It also shows which of the independent variables have a greater effect on the dependent variable in a multiple regression analysis, especially when the variables are in different units of measurements. The higher the absolute value of the beta coefficient, the stronger the effect. The variance inflation factor (VIF) value is less than 10 and the tolerance level is more than 0.1 in the model, which shows that the given model is free from the problem of multicolinearity as shown in the Table 4.9. Conclusion from the regression analysis is as follows: • Preference for EFP is positively related to the age of the respondents. As the age increases, people become more environment conscious and their choice for EFP also increases. • Male respondents show more interest for purchasing EFP than female respondents, and the result is significant. • There is a significant positive relationship between the preference for EFP and the level of education of the respondents.

Table 4.9  Test statistics of the regression model of choice for EFP Coefficients Model

* Note: p < 0.01; ** p < 0.05;

*** p < 0.1Source: Computation by authors

B

Std. Error

−0.035 0.020 0.058 0.053 0.033 0.056 −0.057 −0.001 0.020 0.030 0.058 0.014 −0.004 −0.063 0.349

0.119 0.014 0.025 0.013 0.027 0.038 0.020 0.027 0.012 0.017 0.047 0.040 0.011 0.026 0.041

Standardised coefficients Beta 0.044 0.056 0.195 0.030 0.055 −0.106 −0.001 0.051 0.045 0.059 0.014 −0.008 −0.059 0.346

Collinearity statistics

t

p-value (Sig.)

Tolerance

−0.290 10.420 20.350 40.144 10.206 10.458 −20.883 −0.051 10.658 10.822 10.234 0.348 −0.358 −20.441 80.538

0.772 0.156 0.019** 0.001*** 0.228 0.145 0.004*** 0.959 0.098* 0.069* 0.217 0.728 0.721 0.015** 0.001***

0.554 0.917 0.234 0.850 0.364 0.385 0.781 0.558 0.849 0.228 0.312 0.962 0.899 0.316

VIF 1.806 1.091 4.275 1.176 2.748 2.601 1.280 1.791 1.178 4.392 3.205 1.040 1.113 3.161

Health challenges  103

(Constant) Age of respondent Gender Educational level Marital status Family type Number of family members Own house Monthly family income Number of earning members in a family Environmental pollution in your area Existence of disease in your area Frequency of occurrence of disease Hospital type Interest in conservation of green belt

Unstandardised coefficients

104  Health challenges

•

Nuclear families have more preference for EFP than joint families. There is a significant negative relationship between the number of members in the family and their choice for EFP. As the number of members of the family increases, the preference for EFP decreases. • There is a significant and positive relationship between the monthly family income and the number of earning members in the family and their preference for EFP. As the income of the family increases, so does the preference for EFP. • The result shows that if there is a higher frequency of occurrence of disease, the family’s choice for EFP also decreases. This might be because the families have to spend a significant amount of money on doctors, medicines and health check-ups. • With regard to the hospital type, respondents who visit government hospitals show a relatively less interest in EFP. On the contrary, there is a significant relationship between the respondents who visit private hospitals and their preference for EFPs. This might be because the relatively high-income group that visits private hospitals tries its best to restore the health of its family members by minimising the use of products that are not healthy for them or the environment. • Interest in conservation of green belt shows that respondents who are more interested in conservation of the green belt show a higher interest in EFP.

Health satisfaction level Cities provide significant economic opportunities but mostly create an environment of mental stress. A city can be a hotbed of unhealthy and stressful people. Stress is a consequence of threat and fear. Fear of losing or failing or not coping. Due to the high density of population, cities portray the best example of ‘survival of the fittest’ while trying to accommodate all. Daily survival is an expensive affair. Like unsustainable growth leads to pollution in the environment, it also leads to pollution (stress) of mental health. People look less happy and content than the ones living in rural areas. To assess the health satisfaction level, both physical conditions and mental stress were taken into consideration, as perceived by the people. The health satisfaction level of residents was assessed on the basis of the following indicators: Health services in your area, preventive health services, government health centres/services, local environment and cleanliness. It can be seen from Table 4.10 that nearly 30 per cent of the people are satisfied with the health services available in their locality, about 40 per cent are satisfied with the government health centres, but only 20 per cent are happy with the cleanliness in their locality. Most of the people feel that there is a huge scope for improvement. Nearly 80 per cent of the respondents believe that there is a lot of waste and litter around their localities. The problem aggravates in the rainy season when the pits on the roads and

Health challenges  105 Table 4.10  Assessing the health satisfaction level (percentage of respondents) Health conditions

Stress

Parameters Health services in your area Preventive health services Government health centres/ services Local environment and cleanliness Economic opportunities Quality of life Safety and security

Yes

No

Don’t know

30 19.3 40

55 44.5 35

15 36.2 25

20

80

NIL

64 45 25

25 23 44

11 32 31

garbage on the street become a breeding ground for mosquitoes and other disease-spreading organisms. The residents of Delhi need a solution to tackle air pollution and waste disposal. Some residents of Model Town mentioned that health in Delhi can improve if these two problems are taken care of. Looking at the mental status of the respondents, three broad indicators were assessed (Table 4.10), namely economic opportunities, quality of life and safety and security. If people are fearful, they are bound to feel stress and will lead unhappy and unfulfilling lives. Nearly 64 per cent of the people are satisfied with their jobs as they believe they are earning more than in their previous jobs. About 45 per cent of the respondents feel satisfied with their quality of life. Most of the respondents feel that they are able to meet their basic needs; however, they are prone to falling ill frequently because food, water and air are contaminated. Safety and security are also a key concern of Delhi’s residents. Despite a lot of effort invested by the government and the police, the residents of Delhi do not believe they are safe. They are fearful of moving outside at night. Because of the dynamic and uncertain economic conditions, they are fearful of losing their job and house and therefore potential inability to support their daily needs. Social security is also a great matter of concern as there is no monetary assurance to people with inadequate, no income or job insecurity. Therefore, in case of health emergency, people incur huge out-of-pocket expenditure (explained in next chapter). Delhi is characterised by a high risk to various major diseases and the high cost of treatment, which is worrisome for its residents. Data on the cause of death are crucial to understand the extent through which various diseases pose a threat to public health. There has been rapid increase in healthcare cost as well; government hospitals are severely constrained while private healthcare services are very expensive to afford for the majority of the residents. It needs stringent laws and policies to handle the environmental challenges and improve the health conditions of its inhabitants. According to the Asthma and Allergy Foundation of America (AAFA), top three risk

106  Health challenges

factors for asthma are poverty, lack of health insurance and poor air quality (AAFA, 2019). This book, in its following chapters, further explores the out-of-pocket expenditure and need of health insurance in Delhi.

References AAFA, 2019, Asthma Capitals 2019: The Most Challenging Places to Live with Asthma, Asthma and Allergy Foundation of America publication asthmacapitals. com Annual Report, 2017–2018, Directorate General of Health Services, Government of Delhi published in Economic Survey of Delhi, 2017–2018. http://health.delhigovt.nic.in/wps/wcm/connect/47ea02004b6bf0c682decb7 Annual Report, 2018–2019, Directorate General of Health Services, Government of Delhi. http://health.delhigovt.nic.in Delhi's children have the weakest lungs as compared to kids from other metros, 2015, Published in Mail Today Bureau, New Delhi, May 5, 2015. Jowell, A. et al., 2017, ‘The impact of megacities on Health: Preparing for a resilient future’, The Lancet Planetary Health, 1(5), 176–178. Life Expectancy Drops 6 years in Delhi Due to Pollution, 2016, June 7, publishes in The Times of India. https://timesofindia.indiatimes.com/life-style/health-fitness/ health-news/Life-expectancy-drops-6-years-in-Delhi/articleshow/52631220.cms Mail Today Bureau, 5 May 2015, Nearly Half of Delhi's children suffer ‘severe’ lung problems due to air pollution, https://www.dailymail.co.uk/indiahome/indianews/ article-3067818/Nearly-HALF-Delhi-s-children-suffer-severe-lung-problems-airpollution.html National Air Quality Index, Control on Urban Pollution Series CUPS/82/2014-15, 2015, Published by Central Pollution Control Board, Ministry of Environment, Forest and Climate change. https://app.cpcbccr.com/ccr_docs/FINAL-REPORT_ AQI_.pdf Report on ‘Ambient (outdoor) Air Quality and Health’, 2018, World Health Organization pubication. http://www.who.int/en/news-room/fact-sheets/detail/ ambient-(outdoor)-air-quality-and-health. Report on the State of Health of Delhi, 2017, Delhi Counsellor Hand book Vol. 1 Making Democracy Work by https://praja.org/, Making Democracy Work. www. praja.org/praja_docs/praja_downloads/DELHI COUNCILLOR H Salvi, S.S. et al., 2015, Asthma Insights and Management in India: Lessons Learnt from the Asia Pacific – Asthma Insights and Management (AP-AIM) Study published in The Journal of The Association of Physicians of India 63(9), 36–43. WHO, 2016, Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease, WHO publication, Switzerland. ISBN 978 92 4 151135 3. https://www. who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health

Chapter 5

Healthcare management Investment and expenditure

Healthcare in India: Availability and affordability Healthcare is one of the most important determinants for strong human capital in the country. Endogenous growth theory holds that investment in human capital, knowledge and innovation are significant contributors to economic growth. Investment in human capital has spillover effect on the economy (Barro and Xavier, 2004). Economic theory has given emphasis to physical capital accumulation as the most robust source of economic growth, at least in the short run, with exogenous technical progress being the long-run determinants of economic growth and have identified that the long-run growth is endogenous rather than exogenous (Lucas, 1988). Mincer and Gary Becker of Chicago School of Economics also focused on the role of human capital comprising health, education and skills as indispensable factors for growth and economic development. Human capital is similar to ‘physical means of production’, for example, factories and machines. One can invest in human capital (via medical treatment, education, training) and one's outputs depend partly on the rate of return on the human capital one owns. Therefore, according to Becker, human capital is a means of production into which additional investment yields additional output. Human capital is substitutable, but not transferable like land, labour or fixed capital (Becker, 1964). Inefficient and poor quality of health investment and management lead to increase in out-of-pocket expenditure and unmanageable health conditions which will be responsible for loss of productive labour and cost escalation in healthcare. It further leads to inequality of opportunity, suboptimal development of human capital, lower productivity and increased poverty which results in a vicious circle of lower growth and lower economic development as well, as shown in Figure 5.1. Therefore, in order to control the vicious circle of health investment and management as discussed in Figure 5.1, efficient and good quality health investment and management are required which will lead to reduce out-ofpocket expenditure and enhance good quality and manageable health conditions which will be responsible for increase in productivity and efficiency

108  Healthcare management

Inefficient and poor quality of Health Investment and Management

Lower growth and economic development

Increase out of pocket expenditure , unmanagable health condions

lower producvity and increase poverty

Loss of producve labour and cost escalaon in healthcare

Inequality of opportunity and subopmal development of human capital

Figure 5.1  Vicious circle of health investment and management Source: Author

of labour. It will further help to provide equal opportunity and optimal development of human capital which will increase productivity and income and reduce poverty. This results in a virtuous circle of higher growth and economic development as shown in Figure 5.2. Sustainable Development Goals (SDGs) target at universal health care for all and leaving no one behind by 2030. SDG-3, aims at the promotion of healthy lives and well-being for all. It focuses on strong and resilient health systems, making bigger and smarter investments in health for achieving the target of universal health coverage and thereby moving the world closer to universal health care by 2030. Health is a human right and all countries need to prioritise efficient and cost-effective healthcare to achieve universal health coverage and the SDG (WHO Report, 2019). Universal access to healthcare is a major target for both global institutions and national governments. National Health Policy of India 2017 also aims at universal access to good-quality healthcare services without

Healthcare management  109

Efficient and good quality of Health investment and management

Higher growth and economic development

Reduce out of pocket expenditures, managable health condions

Increase producvity, income and reduce poverty

Improve producvity and efficiency of labours

Equal opportunity and opmal development of human capital

Figure 5.2  Virtuous circle of health investment and management Source: Author

financial hardship to the citizens. Therefore, health financing systems are important factor for meeting the target of universal health coverage. Health financing systems have three interrelated areas, namely raising fund for health, reducing financial barriers to assess through prepayments and pooling of funds in preference to direct out-of-pocket payment. However, health spending in India is made up of government expenditure, out-of-pocket (OOP) payments and other sources, such as voluntary health insurance, employer-provided health programmes. Healthcare services provided by the government aim at providing healthcare infrastructure to the public free of cost, while healthcare services provided by private sectors charge directly from households for their services, which are often very expensive. It is believed that public spending on health is essential for achieving the SDG. Health system that relies mainly on high levels of government funding provides better and more equitable access to services and better financial protection. For achieving the goal of universal health coverage of SDGs, there is a strong need to increase domestic spending on health,

110  Healthcare management

which should be seen as an investment in productivity, jobs, poverty reduction, safer and healthier society with inclusive economic growth. According to the new report of World Health Organization (WHO) on global health expenditure, the global spending on health is undergoing a transformation. The spending on health is growing faster than the rest of the global economy. It accounts for 10 per cent of global gross domestic product (GDP). A swift in the upward trajectory of global health spending is particularly noticeable in low- and middle-income countries where health spending has increased by 6 per cent and in high-income countries by 4 per cent, respectively. But, people are still paying too much out of their own pockets which is very burdensome and a matter of great concern. As per the recent findings, reliance of people on public funding has increased and in most regions, the reliance on OOP spending is gradually going down. Whereas the total amount of aid which middle-income countries are receiving has increased, their aid per capita has fallen. In 2016, lower-income countries and upper-middle-income countries received aid close to 57 per cent of the global aid and certain middle-income countries received large amounts of aid in absolute terms. Therefore, there is an inverse relationship between a country’s income levels and the share of external aid as a health-funding source (WHO Report, February 20, 2019, News release, Geneva) https://www.who.int/news-room/detail/ 20-02-2019-countries-are-spending-more-on-health-but-people-are-stillpaying-too-much-out-of-their-own-pockets. Therefore, healthcare is one of the most essential sectors of any nation’s development process. Providing healthcare facilities at a reasonable cost to the citizens is the state’s responsibility. In India, the private health sector has grown rapidly. To a large extent, this is a reflection of the inadequate public spending that has been a constant and unfortunate feature of development in India in the past half a century. This is particularly because spending on health has large positive externalities which make health spending a clear merit good. A greater reliance on private delivery of health services therefore means that these will be provided by private agents and also denies adequate access to the poor. This will further have adverse outcomes not only for the affected population but also for society as a whole (Economic Research Foundation 2006). Healthcare providers There are numerous healthcare providers in India. Households receive healthcare services from the public as well as private healthcare providers, depending on their accessibility and affordability of these facilities. As per the National Health Account Estimates for India (2014–2015) report published in October 2017, the contributions of various healthcare providers in India show that private hospitals contribute more than 25 per cent of healthcare services in India. Pharmacies are contributing as the largest

Healthcare management  111

28.90%

25.90% 14.30% 6.80%

5.30%

4.60%

4.70%

5.30%

2.60%

1.60%

Figure 5.3  Healthcare providers in India Source: National Health Account Estimates for India (2014–15), compiled by authors

healthcare providers, that is, about 29 per cent, while government hospitals cater to about 26 per cent of the healthcare services to the people, as shown in Figure 5.3. According to the National Sample Survey Report 2014, healthcare services provided by the government covers only 21 per cent of urban India and 28 per cent of rural India. The private sector provides healthcare services to the remaining 79 per cent of urban India and 72 per cent of rural India (Figure 5.4). Data show that private healthcare providers are playing a major role in the healthcare infrastructure of India, even though private hospitals are Public health

Private health

79%

72%

21%

28%

Urban

Rural

Figure 5.4  Healthcare providers in urban and rural India Source: NSS 2014, Ministry of Statistics and Programme Implementation

112  Healthcare management

more expensive than government hospitals. According to an estimate, private hospitals charge about three times more than public hospitals; yet, the majority of all cases in India are treated by private healthcare providers. Private hospitalisation costs have been increasing continuously. The only reason people go to private hospitals is that government hospitals are so few in number and under so much pressure (The Times of India, July 9, 2015). The poor have no choice but to queue outside the government hospitals, because they do not have enough money to go to the private hospitals. Government healthcare providers should be in proportion to the population. Densely populated areas should have a greater number of government hospitals or healthcare centres. According to the National Health Profile 2017, there is one government allopathic doctor for every 10,189 Indians, one government hospital bed for every 2,046 Indians and one staterun hospital for every 90,343 Indians. This shortage is acute in rural areas. Healthcare investment and expenditure by the government The healthcare sector of any country is one of the most important sectors for human development and welfare of the people. This should be given the maximum preference under the social sector expenditure of the government. Healthcare expenditure is a very necessary social expenditure for a country. As per a report of the National Health Accounts, government expenditure on health out of the total planned expenditure has been always very less than required in India. At present, health accounts for only 5.1 percentage points expenditure out of the total of 24.9 percentage points expenditure on social services. As a proportion of GDP, the Indian government spends only 1.1 per cent on health. Centre–state share in total public expenditure on health in India Healthcare expenditure is a very necessary social expenditure for any country. Under the constitution of India, health is largely the responsibility of the states. It comes in the ‘State List’ of Constitution of India. Therefore, state role in developing a good health infrastructure and assuring good health to everyone becomes very crucial and important. At the same time, Union Government finance national public health programmes which have high social returns and are characterised as public goods. For most of the national health programs, government’s expenditure are jointly shared by the central and state governments. Health utilities like public health, hospitals and dispensaries are included in state list of functions, while others like population, medical education, medical profession, registration of births and deaths are under the concurrent list. Central government efforts at influencing public health in its five-year plans require coordinated planning with the state for sponsoring major health programs. The centre–state share in total public

Healthcare management  113 Table 5.1  Trends in centre–state share (per cent) in total public expenditure on health Year

State (%)

Centre (%)

2010–2011 2011–2012 2012–2013 2013–2014 2014–2015 2015–2016 2016–2017 (RE) 2017–2018 (BE)

65 65 67 66 67 69 71 63

35 35 33 34 33 31 29 37

Source: Health Sector financing by centre and states/UTs in India, National Health accounts cell, Ministry of Health and Family welfare, 2017.

expenditure on health was 37:63 in 2017–18. Trends in percentage share of centre–state in total public expenditure on health is given in the Table 5.1. Table 5.1 shows that state governments have a higher share in the expenditure on health as compared to the central government in total public expenditure. A study conducted by McKinsey and Company shows that during the period 2001–2010, India’s investment on health declined in comparison to the increase in GDP. During 2001–2010, India’s GDP grew by 14.2 per cent but the expenditure on health grew only by 12.4 per cent. According to the National Health Accounts, the difference between the compound annual growth rate of the economy and health expenditure was −1.7 per cent (National Health accounts cell, Ministry of Health and Family welfare, 2017). Statistics show that expenditure on health by the Government of India under the various five-year plans has been very disappointing and has shown a decreasing trend since the first Five-Year Plan of 1951–1956, as shown in Figure 5.5. The National Health Policy of India, 2017, targets to increase health expenditure to 2.5 per cent of GDP by 2025, which is still considered to be very low as compared to the growth in population. Figure 5.5 shows the investment on health in all the five-year plans in India. It can be seen that investment in health declined from 1951 to 1997. The subsequent period of 2007–2012 shows a rise of about Rs. 15 billion. This could imply a sudden realisation and shift to health care investment, although it looks like a nominal increase in relation to inflation. The 12th Five-Year Plan (2012–2017) recommended to increase public expenditure on health to 2.5 per cent of GDP by 2017. The actual government expenditure on health as percentage of GDP in the 12th Five-Year Plan period has been almost below 1.5 per cent, as shown in Figure 5.6. In comparison to the rising population and inflation in healthcare cost and medicines, the rise has been just an eyewash. The health sector should have been expanded and easy availability of medicines and medical

114  Healthcare management

Investment on Health

3.3

3

3.15 2.6 2.1

2.1

1.9

2.31 1.8

1.8

1.7

1.6

1.6

1.7

2.09

Figure 5.5   Investment on health in different plan periods (percentage of total plan investment)

Government expenditure on health as% of GDP

Source: Compiled from various reports of the Planning Commission

1.3

2012-13

1.5 1.2

2013-14

1.2

2014-15

1.4

1.1

2015-16

2016-17RE

2017-18BE

Figure 5.6  G overnment expenditure on health as percentage of GDP in 12th Five-Year Plan Source: Economic Survey (2017–18)

facilities should have been provided to people through various schemes. The scarcity of funds in the health sector has given a huge opportunity for the private sector to boom and capture the growing market. On the one hand, the Government of India’s expenditure on healthcare has been stagnated over the past few decades and on the other hand, there has been a rapid increase in demand for healthcare services in the country due to increase in population and environmental externalities that are causing various health issues. This has given the opportunity for private entrepreneurs to tighten their hold on the healthcare industry. The latest report of National Health Accounts, 2017, shows that there is a prominence of private hospitals and clinics among healthcare providers in India. The expenditure on pharmacies accounted for 29 per cent of the current health

Healthcare management  115

Others 17%

Pharmacies 29%

Government 23%

Private 31%

Figure 5.7  Health expenditure by healthcare providers in India Source: Data on National Health Accounts estimates for India, Ministry of Health and Family Welfare (2017), compiled by authors.

expenditure by both the government and private healthcare providers. Private expenditure includes general and specialised hospitals and clinics. Government expenditure includes general and specialised hospitals, family welfare and primary healthcare centres (Figure 5.7). As per the Economic Survey (2017–18), expenditure by the government healthcare providers accounted for about 23 per cent of current health expenditure, whereas private healthcare providers accounted for about 31 per cent of the current health expenditure. International comparison of healthcare financing As per data provided by World Bank, there has been a large gap in public expenditure on health as a percentage of GDP across World Bank income groups (2015). High-income countries are spending 5.2 per cent of GDP on health whereas lower-income countries are spending only about 1.4 per cent of GDP on health, which is shown in Table 5.2. If we compare the current health expenditure per capita in USD in 2015, we will find a great disparity in health expenditure per capita in different countries of the world as shown in Table 5.2. The per capita expenditure on health in India was USD 63.32 in 2015, which is very low as compared to the developed and developing countries of the world. It is USD 9,535.95 in the United States, USD 7,464.12 in Norway, USD 4,591 in Germany, USD 4,507 in Canada and USD 4,355.81 in the UK. In Asia, Japan has the highest per capita expenditure on health, at USD 3,732.56, followed by Thailand, Sri Lanka, Indonesia, Bhutan and India, respectively as shown in the Table 5.3 given below WHO report has highlighted that around 80 per cent of the world’s population spent only 10 per cent of their total expenditure on health. This

116  Healthcare management Table 5.2  P ublic expenditure on health as percentage of GDP across World Bank income groups (2015) High-income countries Upper-middle income countries Lower-middle income countries Lower-income countries India

5.2 3.8 2.5 1.4 1

Source: Global Health Expenditure Database, published by World Bank Group (2015), compiled by author.

Table 5.3  C urrent health expenditure per capita (USD), 2015 United States Norway Germany Canada United Kingdom Japan United Arab Emirates Saudi Arabia Mexico Russian Federation South Africa Malaysia Thailand Sri Lanka Indonesia Bhutan India Myanmar Nepal Pakistan Bangladesh

9,535.95 7,464.12 4,591.85 4,507 4,355.81 3,732.56 1,401.97 1,194.1 535.81 524 471 385.62 217 118 112 99.11 63.32 59.12 44.42 37.99 31.84

Source: Global Health Expenditure Database, World Bank Group (2015), compiled by author.

includes people in the Asia-Pacific as well as African and Latin American countries. Africa accounts for about 25 per cent of the global burden of disease but only about 2 per cent of global health spending (World Health Report, 2003). Figure 5.8 shows that per capita expenditure on health in India is significantly less as compared to other BRICS nations, that is, Brazil, Russia and China. According to the World Bank, India spends only 1.3 per cent of its GDP on healthcare. This figure is much lower as compared to the other

Healthcare management  117

Naon's Health Expenditures

1101.96

780.4

524

63.32 Brazil

Russian Federaon

India

China

Figure 5.8  BRIC countries health expenditure per capita (US$, 2015) Source: Global Health Expenditure Database, World Bank Group (2015), compiled by author

BRICS countries. Brazil spends around 8.3 per cent, the Russian Federation 7.1 per cent and South Africa around 8.8 per cent. Among the SAARC countries, Afghanistan spends 8.2 per cent, Maldives 13.7 per cent and Nepal 5.8 per cent of their GDP on healthcare. This abysmally low spending by India has been a major cause for growing inequities, insufficient access to health, poor quality of healthcare services and a very large out-ofpocket expenditure on healthcare. Table 5.4 shows public expenditure on health as percentage of GDP for South East Asia Regional office of WHO consisting of 10 countries namely, Maldives, Thailand, Bhutan, Timor-Leste, Sri Lanka, Indonesia, Myanmar, Nepal, India and Bangladesh. Table 5.4   Public expenditure on health as per­ centage of GDP for South East Asia Region (SEAR) Countries, 2015 Maldives Thailand Bhutan Timor-Leste Sri Lanka Indonesia Myanmar Nepal India Bangladesh

9.4 2.9 2.5 1.9 1.6 1.1 1.1 1.1 1 0.4

Source: Global Health Expenditure Database, World Bank Group (2015)

118  Healthcare management 18 16 14 12 Percentage of GDP

10 8 6 4 2 0

Government Health Expenditure

Voluntary Health Expenditure

Figure 5.9   G overnment and voluntary health expenditure as percentage of GDP, 2017. Source: Health Expenditure and Financing: Health expenditure indicators, OECD data, 2017, compiled by author.

Figure 5.9 shows that developed nations like the United States, Sweden, Norway and Switzerland spend double-digit figures of government expenditure on health as percentage of GDP, while developing countries like India, which has the second largest population of the world, government spends only one percentage points of GDP on health as shown in Table 5.5. Less investment in the healthcare sector by the government leads to a heavy burden of healthcare expenditure on the general public in the form of OOP expenditure. On comparing the percentage of public and private expenditure on health with the developed and developing countries, we find that the percentage of private expenditure on health in India is much higher than many other countries. The UK has 81.7 per cent public expenditure on health and 18.3 per cent private expenditure. Thailand has 73.2 per cent public expenditure in health while Canada has around 70 per cent. Among the South Asian countries, Sri Lanka shows 47.5 per cent of public expenditure on health. In India, the public expenditure contribution is only 26.2 per cent. The high share of private expenditure on health is a matter of great concern for a country like India, where 22 per cent of its population is still below the poverty line.

Out-of-pocket expenditure on health OOP expenditure is the expense that the patient or the family pays directly to the healthcare provider, without a third party (insurer or state). These expenses could be medical as well as non-medical. OOP medical expenditure

Healthcare management  119 Table 5.5  G overnment and voluntary health expenditure as percentage of GDP, 2017

United States Germany France Sweden Japan Norway Denmark Switzerland United Kingdom Canada New Zealand Czech Republic Greece Korea Brazil South Africa China Russia Mexico Indonesia India

Government Health Expenditure

Voluntary Health Expenditure

14 9.6 9.5 9.1 9 8.8 8.6 7.7 7.6 7.3 7.1 5.8 5.1 4.4 3.9 3.5 3.1 3 2.8 1.1 1

3.1 1.7 1.9 1.8 1.7 1.6 1.6 4.6 2.1 3.1 1.9 1.3 3.2 3.3 5.1 4.7 1.9 2.3 2.6 2.3 2.9

Source: Health Expenditure and Financing: Health expenditure indicators, OECD data, 2017, compiled by author

could be payments towards doctor’s fees, medicine, diagnostics, operations, charges for blood, ambulance services, etc., while non-medical expenditure includes money spent towards travelling expenses, lodging charges of escort and attendant charges. OOP expenditure on healthcare forms a major barrier to health-seeking behaviour. It is the amount of money people pay on their own, rather than being covered by insurance or health benefits. OOP payments in both public and private healthcare facilities are driving hundreds of thousands of households into poverty and further deepening the poverty levels of those already below the poverty line. According to the Global Health Expenditure Atlas (2014), 100 million people in the world are pushed into poverty every year because they have to pay directly for their healthcare. The close link between poverty and health is explained by the medical poverty trap phenomenon, which arises due to increasing dominance of OOP payment for healthcare in the developing countries like India. OOP spending is inefficient and inequitable for the poor, who are more susceptible to disease and likely to be pushed into the poverty trap. OOP healthcare expenditure has been identified to generate four major effects, namely

120  Healthcare management

reduced access to healthcare, untreated morbidity, long-term impoverishment and irrational drug use. This reinforces the ‘vicious circle of poverty’. The situation becomes more devastating for patients and their families when households do not have the capacity to meet medical expenditure from their own resources, which further results in denial of treatment, incomplete treatment or treatment at the cost of financial and social wellbeing. Many times, households curtail spending on food, children are pulled out of school and forced to work, adults are pushed into labour and people are made to work longer and harder than usual. Such payments are called 'catastrophic', or leading to impoverishment. Thus, access to healthcare becomes a double-edged sword. Not having it amounts to a denial of one's rights, but having it, under these conditions, is detrimental to the well-being of the household. Such a situation is called the 'Medical Poverty Trap Phenomenon' (Whitehead et al., 2001). Households have to pay heavy OOP expenditure to procure health services. The poor do not have any form of financial protection and are forced to make OOP payments when they fall sick. Heavy OOP expenditure on healthcare is a major area of concern, especially for financially weaker families. This expenditure exceeds some fixed proportion of household income or the household’s capacity to pay. High levels of OOP expenditure on healthcare adversely affects the poorer sections and widens inequality. As per the National Health Accounts of India (2014–2015), 67 per cent of the total health expenditure in India is considered to be OOP expenditure. Analysing further, Table 5.6 shows that 43 per cent of the total OOP expenditure is spent on medicines and pharmacies, 28.5 per cent is spent as payment to private hospitals and 7.42 per cent goes to government hospitals. Table 5.6  B reakdown of out-of-pocket payments by Indian households on healthcare (in percentage) Out-of-pocket payments by Indian households on different healthcare services

Percentage

Pharmacies General hospitals – Private General hospitals – Public/government Medical and diagnostic laboratories Providers of patient transportation and emergency rescue Offices of general medical practitioners Providers of preventive care All other ambulatory centres Other healthcare providers not elsewhere classified Retail sellers and other suppliers of durable medical goods and medical appliances Other healthcare practitioners

43.0 28.50 7.42 6.81 6.26 5.21 1.40 0.54 0.40 0.18

Source: National Health Accounts, 2017

0.14

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According to the Union Health Ministry, pharmacies or expenditure on medicines comprise a major share of total OOP payments on health, which is the biggest financial burden on Indian households. In 2014–2015, of more than three lakh crore rupees that households spend on health, around 43 per cent of total out-of-pocket spending went in buying medicines. According to National Health Policy 2017, much of this problem can be solved if medicines are made available to people at affordable price, providing free medical facility by stepping up funding, improving drug procurement and supply chain mechanism. Experts believe that a high OOP expenditure on health brings a heavy financial burden on families and discourages people from seeking timely healthcare. WHO's health financing profile for 2017 shows 67.78 per cent of total expenditure on health in India was paid out-of-pocket which is one of the highest OOP expenditures in the world, while the world average is just 18.2 per cent. Figure 5.10 shows that OOP expenditure as percentage of current health expenditure is 18.15 per cent on average for the world. North America, Organisation for Economic Co-operation and Development (OECD) and the European Union spend less than the world average, while third-world nations spend a significantly higher amount compared to the world average. Comparable data from the WHO’s Global Health Expenditure Database show that India’s OOP spending as a proportion of total health expenditure is extremely high when compared with that of other developed and

Sub Sahara Africa

36.25

South Asia

64.85 31.52

Arab World 26.11

East Asia Pacific European Union OECD Members North America World

15.53 13.75 11.26 18.15

Figure 5.10  O OP expenditure (as percentage of total current health expenditure) of major regions of the world, 2015 Source: Global Health Expenditure Database, World Bank Group (2015), compiled by author

122  Healthcare management 90 80 70 60 50 40 30 20 10 0

OOP Expenditure on Health in %, 2015 Government Health Expenditure as % of Current Health Expenditure, 2015

Figure 5.11 Percentage of OOP expenditure and percentage of government expenditure on health, 2015. Source: Global Health Expenditure Database (2015), World Bank Group, compiled by author

developing countries of the world. It is even higher than that of the neighbouring countries like Nepal, Sri Lanka, Thailand and China. However, this high OOP expenditure is not the only problem. A major problem lies in the fact that public spending on health is very low. International experience indicates that low public spending is the major cause of high OOP expenditure on healthcare in India. Figure 5.11 shows that countries where the governments spend a large percentage of expenditure on health – whether developed or developing countries like Brazil, China or even neighbouring countries like Sri Lanka, Malaysia and Thailand – also show a lower percentage OOP expenditure on health. In India, one can observe a huge gap between government health expenditure and OOP expenditure by individuals. As observed from past experience, whenever there is little change in government spending, there is a significant change in OOP expenditure. The Government’s share in total health expenditure increased slightly, from 22.5 per cent in 2004–2005 to 29 per cent in 2014–2015. In the same period, the OOP expenditure share decreased from 70 per cent of the health spend to around 63 per cent. This indicates that a further rise in public spending may decrease the OOP burden of the people in India. The Government of India aims to invest 2.5 per cent of the country's GDP on healthcare by the year 2025, which is much lesser than the global average of about 6 per cent.

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Therefore, in order to improve the healthcare sector and reduce the high OOP expenditure on health in India, there is a strong need to increase government spending on health as a priority sector of the country for its human resource development.

Healthcare financing schemes in India There are various healthcare financing schemes in India under the union government, state government, local bodies, public and private health insurance schemes. As per the National Health Accounts estimates for India (October 2017), the union government’s healthcare financing scheme accounts for only 7 per cent, state government schemes 11.7 per cent and local bodies schemes only 1.5 per cent of the total healthcare finance, while government and private health insurance schemes together account for 7.7 per cent of health finance. The major share of healthcare finance in India comes from OOP expenditure, which is almost 67 per cent of the total healthcare finance in India, as shown in Table 5.7.

Table 5.7  O OP expenditure (as percentage of current health expenditure in different countries) in 2017 Countries

OOP expenditure as percentage of health expenditure, 2015

Percentage of government expenditure on health, 2015

Pakistan India Nepal Guatemala Ukraine Sri Lanka Malaysia China Brazil Austria United Arab Emirates Iceland Sweden United Kingdom Canada Japan Denmark Germany Thailand United States South Africa

66.49 65.06 60.14 55.77 47.18 38.43 36.67 32.39 28.29 17.92 17.79 17.02 15.19 14.79 14.58 13.10 13.72 12.53 11.77 11.08 7.7

27.45 25.59 18.13 32.03 46.41 53.72 52.07 59.78 42.75 75.58 71.25 81.48 83.66 80.35 73.55 80.43 84.14 84.47 77.08 50.36 53.55

Source: Global Health Expenditure Database (2017), World Bank Group, compiled by author

124  Healthcare management Table 5.8  Healthcare financing schemes, 2014–2015 (percentage of total) Union government schemes State government schemes Local bodies schemes Government health insurance schemes Private health insurance OOP expenditure Other schemes Other schemes include the following: Transfers distributed by union government from foreign origin Transfers distributed by state government from foreign origin Voluntary payment from employers Social insurance contributions from employers Other revenue from corporations NPISH (Non-Profit Institutions Servicing Households ) All direct foreign financial transfers

7 11.7 1.5 3.8 3.9 67 5.1 0.3 0.1 0.5 1 3 1.6 0.4

Source: National Health Account Estimates for India 2014–15, Report published in October 2017.

In India, low health budget and low insurance coverage lead to high OOP expenditure which has largest share among all healthcare financing schemes as shown in Table 5.8. Out-of-pocket expenditure constitutes 67 per cent of the total expenditure on health financing scheme in India. There has been a continuous increase in the OOP expenditure on health. Many studies have shown that OOP spending on healthcare is one of the major reasons for pushing households into poverty. In 2011–2012, OOP expenditure on medicines pushed about 3.8 crore persons into poverty, 5.5 crore were impoverished due to total health costs, including lab tests, diagnostics, doctor and surgeon fees. A report by Maitri Porecha states that rising healthcare costs push 5.5 crore Indians below the poverty line (published on June 8, 2018). Another report on ‘India’s Health Crisis’ by Lalit Maurya and Joyjeet Das mentioned that insufficient allocation of resource in health sector is pushing 7 per cent of Indians below the poverty line and about 23 per cent of sick in India can’t effort healthcare (Down to Earth, Report January 10, 2019). A study by Indrani Gupta states that OOP expenditure accounts for an increase in poverty by as much as 3.6 per cent and 2.9 per cent for rural and urban India, respectively (Gupta, 2009). According to the National Health Policy, about 63 million people are pushed into poverty every year due to heavy healthcare costs, thus causing further economic disparity. Thus, heavy financial burden of healthcare cost, especially to the economically weaker households, can lead to debt, use of ineffectual treatments or neglect of health and other needs. As a result, the cost of healthcare can become out of reach for them. Given the inability of the state to provide healthcare of reasonable quality to all sections of the population, especially the poor, health insurance should be promoted as one of the important ways of healthcare financing. Therefore, seeing the government’s fiscal

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constraints, there is a need for health insurance to manage healthcare finance. Converting this OOP expenditure or user fees on healthcare into a prepayment scheme is a big challenge for the country at present. One important way of converting health expenditure is health insurance.

Health insurance in India Health insurance is an integral part of the financial sector. It is a tool to hedge against the risk of financial losses cause due to heavy OOP expenditure. Health insurance in India is a growing segment. Health insurance schemes available in India can be classified as 1. Mandatory Health Insurance Scheme or Government Run Schemes (CGHS, ESIS) 2. Voluntary Health Insurance Scheme or Private-for-Profit Scheme 3. Insurance offered by NGO or Community-Based Health Insurance, for example, Self Employed Women Association(SEWA), Action for Community Organization, Rehabilitation and Development (ACCORD) 4. Employer Based Scheme, for example, Railways and defence have their own health service for their employ. Employees’ State Insurance Scheme (ESIS) is a self-financing social security and health insurance scheme. It is managed by the Employees' State Insurance Corporation (ESIC), as per the ESI Act 1948. The ESIC is an autonomous corporation by a statutory creation under the Ministry of Labour and Employment, Government of India. Similarly, the Central Government Health Scheme (CGHS) is a comprehensive medical care scheme for pensioners and employees of the central government. The Government of India liberalised the insurance sector in the year 2000, which allowed private players into the insurance sector of the country. Up to 2016–2017, around 43 crore individuals were covered under health insurance which accounts for 34 per cent of population of India. Out of 437,457 persons covered under insurance, 79 per cent are covered by public insurance companies. People who buy insurance have to pay periodical insurance premiums which are calculated according to the total insurance amount. Some of the popular health insurance companies in India are Apollo Munich Health Insurance Company Limited, Star Health Allied Insurance Company Limited, Max Bupa Health Insurance Company Limited, SBI Health Insurance Company Limited, Religare Health Insurance Company Limited, Cigna TTK Health Insurance Company Limited, Bajaj Allianz General Insurance Company Limited, New India Assurance Company Limited, Oriental Insurance Company Limited and National Insurance Company Limited. It is important to know that health insurance in India is paid only for inpatient hospitalisation and for treatment at hospitals.

126  Healthcare management

The potential of the insurance sector is assessed by the following two parameters: 1) Insurance penetration: It refers to premiums as a percentage to a country's GDP. In India, insurance penetration is only 3.49 per cent of GDP, which is considered to be very less, even though it increased from 2.71 per cent in 2001 to 3.49 per cent in 2016–2017. 2) Insurance density: It refers to per capita premium or premium per person. According to the Insurance Regulatory and Development Authority of India (IRDAI), 2017 Report, the insurance density in India increased from USD 11.5 in 2001 to USD 59.7 in 2016. Life insurance density is USD 46.5, while the general insurance density is USD 13.2. Non-life insurance density increased from USD 2.40 in 2001 to USD 13.20 in 2016. There are various health insurance scheme run by the Government of India. Latest scheme named Ayushman Bharat – National Health Protection Mission is the world’s largest health scheme launched in 2018. This scheme also subsumes the ongoing centrally sponsored schemes named Rashtriya Swasthya Bima Yojna and the Senior Citizen Health Insurance Scheme. The policy aims to cover over 10 crore poor and vulnerable families which is approx 50 crore beneficiaries in India. Ayushman Bharat Policy is providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalisation. Beneficiaries covered under this scheme are entitled to take cashless benefit from any public and private empanelled hospitals across India. States are also directed to have State Health Agency to implement the scheme.

Healthcare in Delhi Delhi has one of the best health infrastructures in India. It offers sophisticated medical care with the latest technology for treatment and the most qualified doctors in the country. It attracts patients not only from other states of India but also from all over the world. Delhi has a large number of public and private hospitals, compared with other states and union territories of India. Government hospitals in Delhi are run by both central and local governments, which provide a range of services such as diagnosis, medical care, surgical services and physiotherapy. The Government of the National Capital Territory (NCT) of Delhi has been providing accessible and quality healthcare services through primary, secondary and tertiary facilities. Primary healthcare is delivered through dispensaries, secondary health care through multispeciality hospitals and tertiary healthcare services through super-speciality hospitals. Government agencies such as the Municipal Corporation of Delhi, New Delhi Municipal Corporation (NDMC), Railways Cantonment Board, Employ State Insurance (ESI) and central government hospitals are also integral part of Delhi’s healthcare

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system. The Government of Delhi also has network of its own dispensaries and hospitals to provide healthcare services to the people. In addition, the Government of Delhi has also started Mohalla Clinics in many unserved and underserved areas, especially in slums, unauthorised colonies and rural areas, where the poor and vulnerable population has limited or no access to primary healthcare services within their reach. Mohalla Clinics were started as a mechanism to provide quality primary healthcare services accessible within the communities in Delhi at their doorstep. As per Economic Survey of Delhi 2017–18, the investment in the health sector by the Government of Delhi has significantly increased, from Rs. 8,616.6 million in 2007–2008 to 20,953.6 million in 2016–2017, recording a compounded annual growth rate (CAGR) of 10.38 per cent. Per capita expenditure on health in Delhi has increased to Rs. 2,233 in 2016–2017 from Rs. 1,548 in 2011–2012, an increase of 44 per cent during the two periods. Total expenditure on health, taking into account the expenditure incurred under establishment and scheme programmes (Plan Head and Non-Plan Head) of the Government of Delhi and the local bodies (MCDs) with reference to the Gross State Domestic Product (GSDP) of Delhi is seen hovering around 1 per cent only during 2011–2012 to 2016–2017, which is very less and a matter of great concern. Table 5.9 shows that although the GSDP in health has risen from Rs. 340,000 in 2011 to about 610,000 in 2017, the percentage of total GSDP on health has fallen from 0.91 per cent to 0.85 per cent, which is extremely low. Table 5.9 shows that the percentage of growth in plan expenditure on the health sector by the Government of Delhi has been increasing continuously but at a slower pace and it is almost less than 15 per cent of the total plan expenditure. According to an estimate by Raizada, in a report published on February 24, 2015, in The Indian Express, the Government of Delhi spends about 10 per cent of its Rs. 400 billion annual budget on healthcare. It runs 39 hospitals and about 300 allopathic dispensaries. Delhi health department

Table 5.9  Expenditure on health with reference to GSDP Year

GSDP at current price (in Rupees millions)

Per cent of GSDP on health

2011–2012 2012–2013 2013–2014 2014–2015 2015–2016 2016–2017

3,437,970 3,913,880 4,439,600 4,948,850 5,480,810 6,168,260

0.91 0.82 0.79 0.84 0.77 0.85

Source: Economic Survey of Delhi, 2017–18

128  Healthcare management Table 5.10  Percentage of plan expenditure on health sector by Government of Delhi Five-Year Plans

Percentage of total plan expenditure

6th Five-Year Plan (1980–1985) 7th Five-Year Plan (1985–1990) 8th Five-Year Plan (1990–1995) 9th Five-Year Plan (1997–2002) 10th Five-Year Plan (2002–2007) Annual Plans 2003–2004 2004–2005 2005–2006 2006–2007 2007–2008 2008–2009 2009–2010 2010–2011 2011–2012 2012–2013 2013–2014 2014–2015 2015–2016 2017–2018

7.40 7.87 6.56 7.62 10.35 8.67 11.03 12.69 14.17 9.85 11.19 10.24 14.05 12.11 11.55 11.54 14.88 14.57 14.2

Source: Data compiled by author from Economic Surveys of Delhi, 2017–2018.

also runs mobile dispensaries, a school health scheme, the Centralized Accident and Trauma Services (CATS). In addition, its AYUSH department administers Ayurveda, Unani and homeopathic dispensaries and hospitals. The department is also responsible for executing several public health programs. There are also many big and small thriving private health centres, clinics and hospitals in Delhi. Healthcare services in Delhi are provided by the central and state governments. Agencies like the Ministry of Health and Family Welfare, ESI, CGHS, and Railways operate hospitals and dispensaries that fall under the central government. At the state level, the Ministry of Health of the NCT of Delhi is also a major healthcare provider. At the national level, the Government of India spends a measly 4 per cent of its budget on health. Although Delhi’s 10 per cent allocation on health looks healthier, it still leaves a lot to be desired. Given Delhi’s burgeoning population including the large clusters of slums (5 million population), the state’s healthcare system remains overwhelmed. If you visit any hospital in Delhi, you will see lack of resources, overcrowding and lack of cleanliness which are very common feature for all governments hospitals in Delhi. Inefficient management, poor political will and bureaucratic apathy are responsible for this sorry state of affairs to a large extent. Many of the rural

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healthcare facilities are dysfunctional and a burden on the state exchequer because of gross underutilisation (The Indian Express, May 1, 2019). During the period 2001–2011, the population of Delhi increased by more than 21 per cent, exceeding the national average of about 17 per cent. On the other hand, the percentage of growth of plan expenditure on health by the Government of Delhi was less than 15 per cent. Delhi presents a high risk to various major diseases and charges a high cost of treatment, which is a worrisome situation for the people. It is a city struggling from communicable and infectious diseases, especially during seasonal change. It is predicted that in another 10 years, Delhi will experience the world's largest number of premature deaths due to air pollution among all the megacities of the world (The Times of India, September 17, 2015). Air pollution, coupled with various other environmental problems has led to a sharp increase in demand for healthcare in Delhi. However, government financial constraints have provided an opportunity to private hospitals in Delhi to grow rapidly with advanced medical equipment and renowned medical experts for catering healthcare services to the people. These hospitals are also superspeciality hospitals. As compared to public healthcare services which are affordable, the cost of private healthcare services in Delhi are exorbitant and patients have to pay a huge OOP expenditure for the treatment of diseases.

Healthcare management in Delhi: A primary survey Healthcare surveys are important for any city in order to develop a comprehensive plan of action. The need is to meet the challenges by providing resources at an affordable cost. This survey tries to analyse the situation of people’s healthcare choices and its economics. It also tries to find out the psychological behaviour of people and their willingness to pay for health insurance. It has been done on two broad parameters: 1) Choice of hospitals and 2) willingness to pay for health insurance. These two parameters are then related to various socio-economic indicators like income, family size, educational level and occurrence of diseases. Choice of hospitals for healthcare services in Delhi In the survey conducted in nine districts of Delhi, it was found that 68.7 per cent people of Delhi visit private hospitals for healthcare and only 31.3 per cent visit government hospitals (Figure 5.12). There is a dominance of choice of private hospitals in Delhi. The prominent reasons for this are the smaller number of government hospital available and long queues for the patients. Most of the respondents mentioned that due to lack of time, they prefer seeing nearby doctors for small health issues and go to private hospitals only for severe problems.

130  Healthcare management

Private Hospitals 68.70%

Govt. Hospitals 31.3%

Figure 5.12  Choice of hospitals for healthcare service by the people in Delhi Source: Primary survey

Family income and choice of hospital

Percentage of Respondents

The survey shows that families with high income prefer to visit private hospitals for healthcare services rather than going to public hospitals. This might be because their ability to spend on healthcare services increases with higher income and they want to minimise the opportunity cost in terms of waiting time, which is very long in public hospitals. Good management and super speciality hospitals under the private sectors are attracting them. Meanwhile, a large number of low-income families in Delhi still rely on government hospitals for healthcare services because the cost of treatment in private hospitals are very high and beyond their reach. Figure 5.13 shows that around 86 per cent of respondents with a monthly income level more than Rs. 50,000 prefer going to private hospitals and

90 80 70 60 50 40 30 20 10 0

Private Hospitals Government Hospitals

Monthly Income, Rupees

Figure 5.13  Income levels and choice of hospitals (percentage of respondents). Source: Primary survey

Percentage of Respondents

Healthcare management  131 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Government Hospitals Private Hospitals

1

2

3

More than 3

Number of Earning Members in the Family

Figure 5.14  Number of earning members and choice of hospital. Source: Primary survey

clinics. It can be seen that people with a monthly income less than Rs. 10,000 also mostly prefer to visit a private hospital or clinic for treatment, although the percentage of such people is lower than 55 per cent. Figure 5.14 shows families with more earning members choose private hospitals rather than government hospitals to meet their healthcare needs. They can afford the cost of private hospitals because of the collective financial support of all earning members of the family. Level of education and choice of hospital Educated people are considered to be more aware and rational. At the same time, they are involved in qualified and professional jobs. These people also mostly prefer private hospitals due to their ability to afford the treatment and lack of time. Figure 5.15 shows that as the level of education increases, so does the probability of choosing a private hospital. Technically professional people employed in good jobs have less time and comparatively more money, so they can afford the treatment of private hospitals. The study shows that 68.7 per cent of people in Delhi visit private hospitals for the treatment of disease. They spend a huge amount of money on curative healthcare. They pay a high cost for every single episode of hospitalisation that is considered OOP expenditure. At the same time, heavy OOP expenditure on health is one of the important causes of poverty that adversely affects access to healthcare and is catastrophic not only for poor households but also for the middle- and high-income groups as well.

132  Healthcare management 100% 90% 80% Percentage of respondens

70% 60% 50% 40% 30% 20% 10% 0% Illiterate

Primary

Secondary

Private Hospitals

Senior secondary

Graduate

Post graduate

Technical diploma

Government Hospitals

Figure 5.15  Level of education and choice of hospital. Source: Primary survey

Expenditure on preventive or curative healthcare in Delhi In order to stay fit and healthy and avoid the heavy burden of OOP expenditure on curative healthcare, people in Delhi are spending a considerable amount of money on preventive healthcare measures like going to the local gym, aerobic or yoga classes, eating organic food; taking vitamin supplements and vaccination. The survey indicates that 65.3 per cent of the people in Delhi spend varying amounts of money on preventive healthcare. This shows that more than 60 per cent of the people in Delhi are health conscious. They opt for preventive healthcare practices to remain healthy and avoid heavy OOP expenditure on curative healthcare. Figure 5.16 shows the amount of monthly expenditure on preventive healthcare by the people in Delhi. It can be seen that nearly 25 per cent of respondents in Delhi pay up to Rs. 500 per month for gym or fitness classes. Only 1.6 per cent of the people of Delhi pay more than Rs. 10,000 per month. The preventive healthcare amount includes the amount being spent on gym, fitness classes, supplements, organic food, etc. Willingness to pay for health insurance in Delhi The survey shows that more than 60 per cent of people are not willing to pay for health insurance (Figure 5.17). The main reason for this is the lack of health insurance awareness. Most of the people are daily wagers or employed in small private enterprises that do not provide employee benefits in terms of health and hospitalisation. Uneducated or less educated people

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Percent of Respondents

25.30%

16.90%

8%

Up to 500

501-1,000

6.20%

4.40%

2.90%

1,001-2,000 2,001-4,000 4,001-8,000 8,001-10,000

1.60% 10,000 or more

Monthly Expenditure in Rupees

Figure 5.16  Monthly expenditure on preventive healthcare (rupees) Source: Primary survey

Yes 39% No 61%

Figure 5.17  Willingness to pay for health insurance. Source: Primary survey

are also not much aware about the concept and benefits of health insurance. Many people do not have health insurance because they cannot afford to pay high regular premiums. The study also shows that 77 per cent of people in Delhi who visit private hospitals showed their interest to purchase health insurance. This might be because the cost of treatment in private hospitals is very high. Health insurance is purchased as a tool for healthcare management to insulate people from heavy financial burden.

134  Healthcare management

Family size and willingness to pay More than 60 per cent of males and 40 per cent of females in Delhi are ready to purchase health insurance. This shows that insurance is still not an acceptable choice or priority among females in Delhi. However, educated working women in Delhi are aware of health insurance and understand its importance. The study attempted to determine the correlation between family size and willingness to pay for health insurance. The present study shows that nuclear families are more likely to purchase health insurance policies than joint families. About 68 per cent of health insurance policies are purchased by nuclear families, while only 32 per cent are purchased by joint families in Delhias shown in Figure 5.18 given below.

Occurrence of diseases and willingness to pay Figure 5.19 shows that people who are frequently suffering from a kind of disease are more willing to pay for health insurance. Nearly 58 per cent of respondents who are frequently affected by diseases are willing to pay for health insurance. On the other hand, 44 per cent of respondents who do not suffer from diseases are also willing to pay for health insurance. This shows that people in Delhi are aware about the benefits of health insurance and are willing to pay for insurance if the premium is low. 100%

WTP for Health Insurance in %

90% 80% 70% 60% 50% 40%

No

30%

Yes

20% 10% 0%

Less than 4 members

4-6 members

6-9 members

Number of Family Members

More than 9 members

Figure 5.18  Number of family members and WTP for health insurance. Source: Primary survey

Healthcare management  135 100% Percentage of Respondents

90% 80%

42.85

31.39

41.17

44.22

58.82

55.77

Rarely

Not at all

70% 60% 50% 40% 30% 20%

57.14

68.6

10% 0%

Frequently

Moderately

Frequency of Occurrence of Disease Yes No

Figure 5.19  Frequency of occurrence of disease and WTP for health insurance. Source: Primary survey

Educational level and willingness to pay for health insurance The survey shows that education has direct positive relation with willingness to pay for health insurance. All the respondents who have acquired higher education are willing to pay for health insurance in Delhi. People who are less educated and not much aware of health insurance are not willing to pay for it. Many of such people are either jobless or are daily wagers. Figure 5.20 shows that 97 per cent of illiterates are not interested to pay for health insurance, while all graduates and post-graduates are willing to pay for it.

Family income and willingness to pay The survey also shows a direct link between family income and willingness to pay for health insurance. Families with income of more than Rs. 40,000 per month are willing to pay for health insurance. At the same, it is noticeable that only 22 per cent of the families with a monthly income level of less than Rs. 10,000 are also willing to pay for health insurance, while 42 per cent of the families with monthly income level between Rs. 10,000 and Rs. 20,000 are willing to pay for health insurance. This shows that as the family income increases, willingness to pay for health insurance also increases as shown in Figure 5.21.

WTP for Health Insurance

136  Healthcare management 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

No Yes

Level of Educaon

Figure 5.20  Level of education and WTP for health insurance

WTP for Health Insurance

Source: Primary survey

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

No Yes

0-10,000

10,000-20,000 20,000-40,000 40,000-50,000 Family Income (Rupees)

>50,000

Figure 5.21  Family income and WTP for health insurance. Source: Primary survey

Conclusion Decrease in public healthcare spending on the one hand and a rapid increase in private healthcare cost on the other hand is majorly responsible for the increase in OOP expenditure on health. Since healthcare costs or the cost of treatment of diseases is increasing at a faster rate, it is resulting in a heavy

Healthcare management  137

financial burden on the people. There are no large-scale surveys conducted by national statistical agencies, which could form the basis for policy making in this area. It thus becomes relevant to conduct surveys and make people aware about various health insurance schemes and make these schemes available at lower premium rates for the poor or lower-middle-class group. The next chapter of this book tries to find out how to convert the OOP expenditure on health into a health insurance scheme on the basis of willingness to pay of the people in Delhi by applying the Contingent Valuation Method (CVM).

References Barro, R.J., & Xavier, S.M., 2004, Economic Growth (2nd ed.). New York: McGraw-Hill. Becker, G., 1964, Human Capital Theories Business, Economics, Financial Sciences and Management. Springer. pp. 437–439. https://izajole.springeropen.com/articles/10.1186/s40172-014-0012-2. Economic Research Foundation, New Delhi, 2006, Report on Government Health Expenditure in India: A Benchmark Study. Undertaken for the MacArthur Foundation, Economic survey of Delhi, 2017–18, Report on Healthcare Expenditure of Delhi, Planning Department. Government of NCT of Delhi. https://delhiplanning.nic.in/ content/economic-survey-delhi-2018-19 Gupta, L., 2009 ‘Out of Pocket Expenditure and Poverty: Estimates from NSS 61st round’, Paper presented for consideration of the expert group on Poverty, Planning Commission. Lucas, R.E., 1988. On the mechanics of Economic Development. Journal of Monetary Economics, 22(1), Pages 3–42, https://www.sciencedirect.com/science/article/pii/0304393288901687 Maitri, P., 2018, ‘Report on Healthcare Costs’, New Delhi, The Hindu, Published on June 08, 2018. https://www.thehindubusinessline.com/economy/rising-healthcare-costs-push-55-cr-indians-below-poverty-line/article24116816.ece. Ministry of Health & Family Welfare, Government of India in, 2017, Report on National Health Account Estimates for India 2014-15, National Health Mission Report published by National Health Accounts Technical Secretariat, National Health Systems Resource Centre, Raizada, M.K., 2015,‘Healthcare challenges to new government in Delhi’, The Indian Express Published on February 24, 2015. https://indianexpress.com/article/blogs/healthcare-challenges-to-newgovernment-in-delhi/. Whitehead, M., Dahlgren, G., & Evans T., 2001, Equity and Health Sector Reforms: Can Low-income Countries Escape the Medical Poverty Trap? The Lancet, 358(September), 833–836. WHO Report, 2019 ‘Countries are spending more on health, but people are still paying too much out of their own pockets’, News release, Geneva. https://www. who.int/news-room/detail/20-02-2019-countries-are-spending-more-onhealth-but-people-are-still-paying-too-much-out-of-their-own-pockets

138  Healthcare management World Bank Group, 2015, Reporton Health statistics and information systems, ‘Tracking universal health coverage: First global monitoring report’ Published by Joint WHO. World Health Organisation, 2018, report on Global Health Expenditure Database, 2018, World Bank Group. https://apps.who.int/nha/database. World Health Organisation report, 2014, on Global Health Expenditure Atlas, September 2014, http://www.who.int/health-accounts/atlas2014.pdf.

Chapter 6

Green health insurance for urban areas Willingness to pay

Introduction The rapid escalation in the cost of healthcare services in terms of both medical and non-medical cost and heavy Out-of-Pocket (OOP) expenditure on healthcare are major areas of concern, especially for the economically weaker families. The heavy burden of healthcare cost, especially for the economically weaker households, can lead to debt. Increasing incidence of rising environmental and lifestyle diseases, ineffectual treatments, neglect of health and other requirements of the people in the cities perpetuate the need for financial management. Therefore, health insurance is seen as a promising option of healthcare financing across the world. It reduces the financial burden for the payment of healthcare services at the time of actual need. Pre-payment for healthcare financing may take different forms; this can be broadly classified as compulsory or statutory and voluntary. Compulsory health service is one in which legislations define the population, benefits covered, eligibility and source of funding for the scheme. An example would be health insurance that offers tax benefits, that is, premiums paid for health insurance policies are eligible for tax deductions under Section 80D of the Income Tax Act. In the voluntary scheme, people who are able and willing to pay may join the scheme. Community-based health insurance is a voluntary type of insurance that has gained popularity among the people in many developing countries. It is presumed that health insurance through community participation can bring in more to pay for better use of health services by all. In this way, more people can use health services through health insurance, leading to reduced burden on public health facilities. Moreover, if the government joins hands with the community to pay for a viable health insurance scheme, it would help the government to provide quality healthcare services without any undue financial burden (Bhat and Babu, 2003).

140  Green health insurance

The aim of this study is to estimate the willingness to pay (WTP) for health insurance, coined as ‘Green Health Insurance’, in order to finance the treatment of diseases caused due to environmental pollution. It recommends payment of green insurance by households in Delhi as part of a health insurance program and to understand the factors that contribute towards households' WTP for health insurance.

Willingness to pay – Methodology WTP is a widely applied measure in the valuation of health benefits. It is consistent with the principles of welfare economics and cost--benefit analysis. WTP is the maximum amount a person would be willing to pay, sacrifice or exchange, in order to receive goods or services or to avoid something undesirable, such as diseases related to pollution. WTP questions can be used in the analysis of both private and public decision making (Gafni, 1991). The WTP technique requires each of the subjects to respond to hypothetical and conditional questions. What is the maximum amount a person would be willing to pay to access a service? Such a question elicits a monetary valuation of the merit, worth or benefit which each subject associates with the specific services under consideration. In actual markets, individuals make a purchasing decision based on the relationship between the prevailing market price and the services offered. In existing markets, no inference of valuation needs to be made, because valuations are implicit in purchasing decisions and are revealed by consumer behaviour. In circumstances where markets do not yet, or will never exist, stated WTPs can therefore be interpreted as shadow reservation prices. The use of the WTP demand curve to predict the variations in the rates of intervention taken up to different level of charges and based on the costs of provision, thereafter estimates the required degree of public subsidy to ensure the pre-specified minimum takeup levels. Much of the WTP analysis in developing countries appears to be undertaken specifically to inform price-setting; for example, studies of reproductive healthcare programmes (Foreit and Foreit, 2008), communitybased insurance (Dong et al., 2003).

Contingent valuation method In the present study, Contingent Valuation Method (CVM) has been applied to study the WTP by the people of Delhi for the proposed Green Health Insurance Programme. The CVM circumvents the absence of the market by presenting consumers with a hypothetical market in which they have an opportunity to buy the good in question, therefore providing information of how much they are willing to pay to obtain the good (Mitchel and Carson, 1989). Therefore, it is one of the non-market valuation methods

Green health insurance  141 U (Ulity)

U1 U0

U

Y1

Y0

Income

Figure 6.1  Individuals’ WTP for an improvement in health status from U 0 to U 1 while still maintaining the same level of well-being. Source: Johannesson, M. et al., (1996)

commonly used to find the economic value of a non-market environment commodity. Survey questions can be used to elicit people’s preference for public goods for finding out what they are willing to pay for specified improvement in them. In this study, the questions are in hypothetical form because the goods in the focus are not normally traded in the market and because actual payments are not made. Consequently, they have no actual market value. Unlike other commodities, one cannot obtain valuation of WTP for health directly; hence, the CVM is applied to measure healthcare financing. A study by Johannesson, M., et al. (1996) discussed the improvement in utility in WTP for health with the help of Figure 6.1. In the above figure, Johannesson showed that the maximum amount of WTP for the improvement in the health status of an individual is measured as Y0–Y1. The curve U0 denotes the original level of health status and U1 denotes the improvement in health status. By paying health insurance, an individual will be at the higher utility curve U1, which reflects an improvement in the health status from U0 to U1, still maintaining the same level of well-being. If the individual pays higher than the amount Y0−Y1, then the loss in income will be more than offset the increase in well-being. This implies that the WTP amount for an individual determines the level at which the individual values the health in relation to the income and how serious the case of ill health may be (Johannesson, M., et al., 1996). The CVM study involves finding the individual’s WTP for insurance by constructing a hypothetical market. The CVM circumvents the absence of the market by presenting the consumer with a hypothetical market in which

142  Green health insurance

they have the opportunity to buy the good, therefore providing information about how much they are willing to pay to obtain the good (Haab and McConnall, 2002). The WTP technique is used to obtain information when goods and services are not available in the market; therefore, there is seldom actual data regarding cost and sales. The respondents are asked to reveal their preferences, which are contingent upon the hypothetical market presented in the survey. The CVM may be used for assessing WTP for private and public goods and services, and produced estimates might be included in market analysis, cost – benefit analysis and judicial processes (Portney, 1994; Diener et al., 1998; Kling et al., 2012; Tawab, 2005; Tenkorang, 2001). The following points should be taken into consideration while using the CVM: •

A hypothetical description of the terms under which the services are to be offered should be discussed with the respondents in detail. • The respondents are asked questions to determine how much they are willing to pay in order to obtain the service under specified terms. • The response validity should be tested by relating the WTP response to the respondent’s socio-economic and demographic characteristics. The CVM information can be analysed in three different ways to determine the WTP: •

Examining the frequency distributions of the responses to the valuation questions. • Analysing the cross tabulations between the WTP of the respondents and socio-economic characteristics of the respondents. • Using the multivariate statistical technique to estimate a valuation function relating the respondents’ answers to their socio-economic characteristics. These analyses are used to see if the respondent’s answers are consistent with the theory and to establish statistical relationships that can be used in the aggregation of sample responses to the overall population under study. The current study aims to find out the WTP for green health insurance and the variables or factors that affect the WTP of the people. The basic idea behind the study of WTP for healthcare services is to determine innovative methods of financing the healthcare services and reduce the one-time heavy OOP expenditure of the household on healthcare services. It aims to get the maximum benefit of healthcare services without facing financial burden. Thus, the study employs the CVM to elicit the individual’s preferences for green insurance. Respondents are asked to

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pay insurance premiums on a periodical basis to obtain financial support from the available health insurance schemes in the given hypothetical situation. Contingent valuation survey A primary survey was conducted in the nine administrative divisions of Delhi. Prior to answering the questionnaire, the respondents were provided basic information concerning various benefits. The respondents were briefed about the hypothetical market for a green insurance scheme, its advantages, the scheme administration and the service providers, that is, an agency or an organisation. The scheme would have a provision to finance the treatment of diseases caused due to environmental pollution or change of season. An insurance premium would be charged at regular time intervals on the basis of the individual’s WTP for financing their total cost of healthcare service in the form of green insurance. CVM was applied to create a hypothetical market for the services. Respondents were then asked to state their maximum WTP for green insurance scheme. Primary survey of Delhi For conducting the primary survey, a total of 900 households were interviewed, taking 100 households from each nine zones or administrative divisions of Delhi, on the basis of random sampling by taking into consideration the different socio-economic background of the respondents. Since the sample size was not based upon any pre-hoc power calculations, this was a sample of convenience. The questionnaire included various questions on age, socio-demographic and economic background. The questions in the survey consist of both multiple-choice and open-ended form. The questionnaires were given to the educated respondents, while illiterate respondents were asked to give the answers verbally. Respondents were given 15–20 minutes to answer the questions. The content of the questionnaire was common for all the samples. The form was configured in a way that made it impossible to move on to the next question if the previous question was left unanswered. This made it possible to acquire completely valid responses with no missing data in all the samples. One of the relevant sections of the questionnaire was based on healthcare cost, health insurance and WTP study. All the answers were kept confidential, processed statistically and used only for scientific study. Bidding format There are number of ways to obtain the respondents’ WTP, using the CVM, such as a bidding game, payment cards and open-ended

144  Green health insurance

questions. The method chosen for this study was a bidding game and open-ended question. Valuations using the bidding format (BID) were elicited by face-to-face negotiations. All respondents were asked whether they would be prepared to pay at least some amount (payment principle question). Those who responded positively were asked to state the maximum amount they would be WTP per month on the basis of the BIDS given to them. In the present study, five WTP BIDS were given for purchasing green insurance – bids of Rs. 200, Rs. 500, Rs. 1,000, Rs. 2,000 and Rs. 2,500. Total 900 questionnaire was equally divided into five WTP BIDS, that is, each WTP BID had 180 questionnaire to be answered. Respondents were faced with one bid value to which they could respond with either a ‘Yes’ to accept their WTP the proposed amount or ‘No’ to indicate their refusal to pay the proposed amount. Each individual was given one bid chosen randomly. Responses were discrete for this dichotomous-choice question was applied. In this case, Logit model was used  for computational ease. Such discrete choice models can be used to  derive estimation of the economic value of the good and find out the  socio-economic determinants influencing the individual WTP. Information provided by WTP surveys improves the accuracy of predicting responses to price change. In case of ‘No’ where they refuse to pay the bid amount given to them randomly, respondents were then directly asked to state their maximum WTP to get the benefit, by using an open-ended question. In the study, the open-ended questions give a continuous measure of WTP for the good or services in question. The validity of the WTP estimate in response to the open-ended question can be checked by using regression analysis, by taking into account the monthly WTP as the dependent variable and finding the direction and magnitude of the determinant WTP by using multiple regression analysis.

Description of variables WTP is assumed to be influenced by the age, socio-economic and healthrelated characteristics of the respondents. Descriptions of variables under the study of WTP for green insurance were listed in Table 6.1. Variables in the model are as follows:

Dependent variables = WTP for green insurance

The explanatory variables are classified into four categories: The first category consists of the individual-specific characteristics, such as age of respondent, gender, education and marital status.

Green health insurance  145 Table 6.1  Descriptions of variables for the study of WTP for green insurance Variables

WTP (binary) WTPA (quantitative variables)

AGE NOFM FY NOEMF BID

GEN MARRIED FT OWN H EPYA ICGB DUHI DISYA HOSPITAL EDU PHKEC DISFREQ DISEFMS

Description of the variables Dependent variables Are you willing to pay a premium for green insurance on a monthly basis? 1 for a positive responsive and 0 for a non-response What amount are you willing to pay (WTP amount in rupees)? Independent variables Quantitative variables Age of the respondent (in years) Number of family members Family income Number of earning members in the family Bids given for regular and timely premium that the respondent is willing to pay for green insurance on monthly basis to finance healthcare cost Binary variable Gender Marital status Family type Own house Is there environmental pollution in your area? Do you have an interest in conservation of the green belt? Do you have health insurance? Does disease exist in your area? Hospital type Categorical variables Educational level Do the people in your locality help in keeping the environment clean? What is the frequency of disease occurring in your family? Is any family member suffering from a disease?

The second category includes family-specific characteristics, such as family type and number of members in the family. The ‘third category’ includes economic factors, such as, ownership of house, monthly income of the respondent’s family, number of earning members and insurance awareness. The forth category includes pollution, environment problem and diseases, types of hospital services used and interest in conservation of green belt.

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Explanatory variables were defined as: X1 X2 X3 X4 X5 X6 X7 X8 X9 X9 X 10 X 11 X 12 X 13

= Age of the respondent in years = Gender (Female=0, Male=1) = Educational qualification of the husband (Illiterate = 0, Primary school=1, High school =2, Graduate=3, More than graduate=4) = Marital status (Unmarried =0, Married = 1) = Family type (Joint family=0, Nuclear family=1) = Number of family members = Own house (Own house =0, Rental house=1) = Family income = Number of earning members in the family = Environment pollution in your area (No=0, Yes=1) = Existence of disease in your area (No=0, Yes=1) = Frequency of diseases occurring (Frequently=1, Moderately=2, Rarely = 3, Not at all=4) = Hospital type (Private hospitals =0, Government hospitals=1) = Interest in conservation of green belt (No=0, Yes=1)

Statistical analysis The statistical analysis for the survey study was done in two parts: The first part include conducting the binary logistic regression analysis where the responses were ‘Yes’ or ‘No’ for WTP for health insurance and the variables influencing the decision (Bandara et al., 2013). In the second part, respondents who refused to accept the offered BID for green insurance were asked to state the maximum amount in rupees that they were willing to pay to obtain for health insurance, by using an open-ended question. This indicated a continuous measure of WTP for the goods or services, taking into account the monthly WTP as the dependent variable and finding the direction and magnitude of the determinant by using the multiple regression analysis. Therefore, the logistic regression and linear regression techniques were applied in the study to test the WTP for green insurance. Linear regression and a general form of logistic regression were used to study the influence of the set of predicator variables on the WTP for green insurance.

Statistical analysis I Part I: Binary logistic regression Logistic regression is a common method to estimate WTP. This method was chosen because the response variable was in binary form and the predictor variable was a mix of continuous variables, binary variables and categorical variables. Since some of the respondents were not willing to pay the offered bid amount and their WTP becomes zero, which means that they did not

Green health insurance  147

want green insurance and had rejected the scenario. Therefore, the study aimed to identify the determinants of decision-making, that is, whether to pay for green insurance or not and what determinants helped respondents in decision-making, which was an insight research question. This part describes the method (Logit model) used to identify the determinants of participating in the green insurance scheme (Bandara et al., 2013). It provided an overview of the WTP, focusing on the CVM. The specified model is given below. The empirical model, measuring the probability of WTP for green insurance by the people of Delhi, is as follows:

Pi  F  WTPi   F  X i B  E i 

Pi is the probability of function and WTPi is the WTP for green insurance, where 1 indicates that the individual is willing to pay for green insurance and 0 indicates otherwise. Xi is the vector of the observed characteristic of demand, which includes socio–economic, attitudinal and behavioural variables; B is the vector with the corresponding estimated variable coefficient and the error vector Ei consists of the unobserved random variable. Binary logistic model:



log  p / 1  p   b0  b1  X1  b2  X 2  b3  X3  b4  X 4  b5  X5  .  bn  X n

where, p is the probability of WTP for green insurance (Yes = 1, No = 0). Explaining the predictive capacity of the logistic regression model The given logistic regression is run in two steps. The initial step can be called the beginning block or Step 0 or Block 0. It is considered as a nonmodel and it only gives the value of the constant. Block 0 or the initial step output is for a model that includes only the intercept (which is taken as constant). It includes no predictors and just the intercept. The final step, or Step 1, includes all the predictors/independent variables (Table 6.2). Table 6.3 describes the variables for the intercept (constant) for binary logistic in Step 0 (initial step). Under the variables in the equation, we see that the intercept (only) model is in (odds) = 369. If we exponentiate both sides of this expression, we find that our predicted odds [Exp(B)] = 1.446. That is, the predicted odds of deciding the WTP monthly premium for green insurance are 1.446.

148  Green health insurance Table 6.2  Classification table for binary logistic in Step 0 (initial step) Classification Table a,

b

Predicted WTP premium for green insurance on monthly basis Observed Step 0 a b

No Yes Overall percentage

WTP

No

Yes

0 0

368 532

Percentage correct 0.0 100.0 59.1

Constant is included in the model. The cut value is. 500.Source: Primary survey

Table 6.3  Variables in the equation

Step 0

Constant

B

S.E.

Wald

df

Sig.

Exp(B)

0.369

0.068

29.548

1

0.000

1.446

Source: Primary survey

Variables not in the equation Table 6.4  Variables not in the equation Variables

Step 0

AGE GENDER EDUCATION MARRIAGE FAMILY TYPE NOFM OWN HOUSE FAMILY INCOME NOEMF EPYA DYA DISEFREQ HOSPITALTY ICGB WTPBID Overall Statistics

Source: Primary survey

Score

df

Sig.

366.959 48.860 664.433 50.286 388.936 365.071 120.714 311.185 12.131 526.823 424.690 2.339 42.679 626.394 15.873 763.113

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15

0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.126 0.000 0.000 0.000 0.000

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Step 1 (model) omnibus tests of model coefficient is the final step which includes all variables together in the study Table 6.5 shows Step 1 (model) omnibus tests of model coefficient

Block 1 : Method = Enter

Now at the Block 1 (final step) output, SPSS has added the variables as a predictor. The omnibus tests of model coefficients give us a chi-square of 1,150.585, significant beyond the.001 level. The given logistic regression is run in two steps (Table 6.5). The initial step, called Step 0, includes no predictors and just the intercept. The final step, called Step 1, includes all the predictors/independent variables. As we move from the initial step to the final step, which includes all variables, predictive accuracy moves from 59.1 per cent in the initial step (Step 0) to 99.1 per cent accuracy in the final step (Step 1), when the full regression model is applied to the data. This 40 per cent jump represents a major improvement in the predictive capability of the model. The best level of predictability is now 99.1 per cent. Therefore, there is an improvement of 40 percentage points in the predictive capacity by using the logistic regression model (Table 6.6).

Table 6.5  Omnibus tests of model coefficients

Step 1

Step Block Model

Chi-square

Df

Sig.

1,150.585 1,150.585 1,150.585

15 15 15

0.000 0.000 0.000

Source: Primary survey

Table 6.6  Classification table for binary logistic WTP for green insurance Predicted WTP Observed Step 1

No Yes Overall percentage

WTP

a. The cut value is. 500 Source: Primary survey

No

Yes

366 6

2 526

Percentage correct 99.5 98.9 99.1

150  Green health insurance Table 6.7  Model summary of binary logistic regression Model summary Step

−2 Log likelihood

Cox & Snell R Square

Nagelkerke R Square

1

67.028 a

.722

.973

E stimation terminated at iteration number 11 because parameter estimates changed by less than .001. Source: Primary survey a

Model summary of the binary logistic model result The result shows that the −2 Log Likelihood statistic measures how poorly the model predicts the decisions. The smaller the statistic, the better the model. In this model, we see that the −2 Log Likelihood statistic is 67.028, which is quite satisfactory. The Cox & Snell R square can be interpreted like R square in a multiple regression; its maximum value is .75. In the given model, Cox & Snell R square is .722, which is acceptable for the model. The value of Nagelkerke R square is on a scale of 0–1. This value can reach a maximum of 1 and is an indication that the regression model constructed has added a major contribution to the prediction of WTP for green insurance or not. Here, the Nagelkerke R square figure for the 'goodness of fit' of the model is good at .973; this suggests that the model is strong and it improves the level of predictability of the given model. In the study, the given binary model the value of Nagelkerke R square is .973, which implies that 97 per cent of the variability in dependent variable WTP for green insurance is explained by the independent variables. Determinants for participating in the green insurance scheme: Binary logistic regression approach The logistic regression model is used to identify the determinant/variables for the WTP for green insurance. The respondents were asked to reveal their preference/WTP for a hypothesised scheme of health insurance on a voluntary basis, given their budget constraints. The coefficients of the logistic regression for identifying the determinants for green insurance are presented in the Table 6.8. The logistic regression model is used to identify the determinant/variables of the WTP for green insurance. The respondents are asked to reveal their WTP for a hypothesised scheme of green insurance on a voluntary basis, given their budget constraints. The coefficients of the logistic regression model for identifying the determinants for health insurance are the age of the respondent, marriage, number of family members, own house, respondents visiting government hospitals and WTP bids are showing the negative

Green health insurance  151 Table 6.8  Variables in the equation showing the determinants for participating in the green insurance scheme Variables in the equation B AGE GENDER EDUCATION MARRIED FAMILY TYPE NOFM OWN HOUSE FAMILY INCOME NOEMF EPYA DYA DISEFREQ HOSPITALTY ICGB WTP BID Constant

−.807 1.108 3.350 −.510 1.699 −2.674 −1.440 1.636 .804 .590 3.920 1.144 −1.533 3.070 −.003 −8.973

S.E. .375 .862 .720 .948 1.386 .920 .871 .489 .586 1.242 1.448 .489 .892 .946 .001 4.073

Wald

df

Sig.(P)

Exp(B)

4.633 1.652 21.649 .289 1.503 8.454 2.734 11.206 1.881 .226 7.333 5.472 2.958 10.530 16.827 4.853

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

.031** .199 .000*** .591 .220 .004*** .098* .001*** .170 .635 .007*** .019** .085* .001*** .001*** .028**

.446 3.030 28.512 .601 5.469 .069 .237 5.136 2.235 1.805 50.415 3.140 .216 21.544 .997 .000

a. Variable(s) entered in Step 1: AGE, GENDER, EDUCATION, MARRIED, FAMILY TYPE, NOFM, OWN HOUSE, FY, NOEMF, EPYA, DYA, DISEFREQ, HOSPITALTY, ICGB, WTPBID * indicates 10% level of significance, ** indicates 5% level of significance, *** indicates 1% level of significanceSource: Primary survey

probability related to WTP for green insurance. The current study reveals that the age of the respondents shows a significant negative relation with the probability of accepting the insurance scenario for green insurance, which implies that relatively older respondents are not willing to buy health insurance as compared to younger respondents. It might be because with the increase in age, cost of premium for insurance also increases. This is in line with the findings of the earlier studies of Bandara et al., 2013; Horton et al., 2003, and Mandy, 1994. The negative value of the coefficient of the age of respondent shows the probability of willingness to participate in a green insurance scheme decreases with the increase in age of the respondents. Meanwhile, male respondents, levels of education (this is in line with findings of earlier studies such as Ali et al., 2004 and Horton et al., 2003), family income (Horton et al., 2003; Blaine et al., 2006), number of earning members in the family, environment pollution in your area, diseases in your area, frequency of occurrence of diseases, interest in conservation of green belt also show the positive relation with the probability of accepting the insurance scenario for green insurance. Thus, out of the 15 variables, 10 variables are found to be significant in the study of the determinants for participating in the green insurance

152  Green health insurance

scheme in Binary Logistic Regression Approach. Levels of education, family income, number of family members, diseases in your area, interest in conservation of green belt and WTP bids are highly significant variables in the study of WTP for green insurance. Derivation of demand curve for given BIDS for WTP for green insurance There are five bid values – of Rs.200, Rs.500, Rs.1,000, Rs.1,500 and Rs.2,500. Respondents are asked whether they are willing to pay the bid offered to them randomly as a premium on timely basis for purchasing green insurance. The study shows that 59.11 per cent of the respondents in Delhi are willing to pay for green insurance. Out of these, 25 per cent of the respondents are willing to pay Rs.200, 20 per cent are willing to pay Rs.500, 19 per cent are willing to pay Rs.1,000 and Rs.1500, respectively and only 17 per cent are willing to pay Rs.2,500, as shown in Table 6.9. Table 6.10 shows that WTP for green insurance is the highest at the lowest bid of Rs.200. 74.44 per cent of respondents are WTP for the proposed BID of Rs.200 given to them in the questionnaire. But the WTP gradually decreases with the increase in the bid value. WTP for green insurance is the lowest at Table 6.9  Percentage of respondents willing to pay the proposed BID amount for green insurance in Delhi BID amount in Rupees

Percentage of respondents willing to pay for green insurance (%)

200 500 1,000 1,500 2,500

25 20 19 19 17

Source: Primary survey

Table 6.10  Willingness to pay for green insurance for proposed BIDs BID Amount (Rs.)

200 500 1,000 1,500 2,500 TOTAL Source: Primary survey

Are you willing to pay for green insurance? NO (in %)

YES (in %)

Total

46 (25.56) 74 (41.12) 78 (43.34) 82 (45.56) 88 (48.89) 368 (40.88)

134 (74.44) 106 (58.88) 102 (56.66) 98 (54.44) 92 (51.1) 532 (59.11)

180 180 180 180 180 900

Percentage of Respondents WTP

Green health insurance  153

80 70 60 50 40 30 20 10 0

200

500

1000

1500

2500

Total

WTP BIDS

Figure 6.2  Demand curve showing WTP for green insurance for given BIDS. Source: Primary survey

the highest bid of Rs.2,500. This is in line with the findings of earlier studies by Ali et al., 2004; Halvorsen et al., 2004; Bala et al., 1999; Whynes et al., 2005. The findings give the shape of the demand curve for WTP for green insurance, which is a downward sloping curve as shown in Figure 6.2. Thus, around 59.11per cent of the respondents are willing to pay the BID amount for green insurance, while the rest have rejected the proposed bid in the survey. The demand curve showing the WTP for green insurance is a downward sloping curve for the given BID amounts in rupees, as shown in Figure 6.2. The downward sloping curve shows that the WTP for green insurance decreases with the increase in the values of BIDS proposed to the respondents randomly. Statistical analysis part II: Multiple regression analysis The current study reveals that about 59.11 per cent of the respondents have accepted the BID amount offered to them randomly, showing their WTP for green insurance. The remaining 40.89 per cent of the respondents decline to pay the BID value offered to them. The latter group are asked in the form of an open-ended question to specify the maximum amount they are willing to pay for the proposed scheme. Thus, in the open-ended question, the respondents are asked to state the maximum amount of money they are willing to pay to get the benefit of green insurance. That would give a continuous measure of the amount that respondents are willing to pay for green insurance and reveal how the amount of WTP varies with the specified socio-economic and other related determinants. Hence, it would help in finding the direction and magnitude of the determinants by using multiple

154  Green health insurance

regression analysis. This study uses the Ordinary Least Squares regression to determine the relationship between the actual amount respondents are willing to pay for green insurance and their socio-economic determinants. Model specification The empirical specification of the model is:



WTPA  f  X1  X 2  X3  X 4  X5  X6  X7  X8  X9  X10  X11  X12  X13  X14  X15. 

WTPA = Amount respondents are willing to pay The multiple regression analysis (Table 6.11) shows that the maximum amount of money that the respondents are willing to pay is positively Table 6.11  T he amount respondents are willing to pay for green insurance, using the regression model Unstandardised coefficients Model (Constant) Age of respondent Gender Educational level Marital status Family type Number of family members Own house Family income Number of earning members in the family Environment pollution in the area Existence of disease in the area Frequency of occurrence of disease Hospital type Interest in conservation of green belt

Standardised coefficients

B

Std. Error

Beta

T

Sig.

−317.915 −59.065 138.746 152.718 79.427 18.942 −65.508

202.322 23.076 41.135 20.302 45.208 64.166 32.777

−.078 .081 .341 .043 .011 −.074

−1.571 −2.560 3.373 7.522 1.757 .295 −1.999

.116 .011** .001*** .000*** .079* .768 .046**

−47.866 51.977 116.659

45.035 19.867 27.529

−.028 .080 .105

−1.063 2.616 4.238

.288 .009*** .000***

202.539

77.783

.123

2.604

.009***

113.912

67.562

.069

1.686

.092*

35.530

17.564

.047

2.023

.043**

−24.661 7.356

42.599 32.868

−.014 .007

−.579 .224

.563 .823

Dependent variable: Amount respondents are willing to pay (in Rupees) * indicates 10% level of significance, ** indicates 5% level of significance, *** indicates 1% level of significanceSource: Primary survey

Green health insurance  155 Table 6.12  Test statistics of the amount respondents are willing to pay for green insurance, using the regression model R R squared Adjusted R square F Significance of F Degree of freedom

0.733 0.537 0.529 73.254 .000 14

Source: Primary Survey

related to the level of education, family income, number of earning members in the family, existence of disease in their area, frequency of occurrence of disease, number of visits to private hospitals, interest in conservation of green belt and environment pollution in their area. Male members are more WTP for green insurance than female. At the same time it is also found that married people are more WTP than unmarried. In fact, the level of education, marital status, family income, number of earning members in the family and environmental pollution in the area are seen to be positive and highly significant factors in influencing the amount of money respondents are willing to pay for green health insurance. Table 6.12 shows the test statistics. R is the multiple correlation coefficient that tells us how strongly the multiple independent variables are related to the dependent variable. The regression coefficient R value is 0.73, which shows that there is a high positive correlation between the dependent variable and all the independent variables in the model. R square gives the coefficient of determination. It implies that (0.537), that is, 54 per cent variation in the dependent variable (amount respondents are willing to pay for green insurance) is explained by variations in the independent variables in the model. The adjusted R square value is 0.529, which gives us the idea of how well the model generalises. Ideally, we would like its value to be the same or very close to the value of R square, which is 0.537 in the model. The test statistic from the results of the multiple regression model demonstrates that the model is quite robust with F statistic value of 73.254, with over 99 per cent level of confidence. Derivation of demand curve for the amount respondents are willing to pay for green insurance Table 6.13 shows the amount of money respondents are willing to pay for health insurance in the open-ended question. The WTP for green insurance is higher at the lower premium amount of insurance than that of the higher premium amount. This shows that health insurances with lower premium are highly demanded by the respondents for health insurance.

156  Green health insurance Table 6.13  A mount respondents are willing to pay for green insurance, using the open-ended question Amount in Rupees

Percentage of Respondents WTP

1–250 251–500 501–1,000 1,001–2,000 2,000–5,000 Total

28 25.8 23.8 16.2 6.2 100.0

Source: Primary survey

In Figure 6.3, the X-axis represents the percentage of respondents and the Y-axis shows the amount of money that respondents are willing to pay. The demand curve for the amount that respondents are willing to pay for green insurance in the open-ended question is a downward sloping curve with a steep slope. The demand curve is relatively elastic, which shows that respondents’ demand for green insurance is very sensitive to the change in the amount to be paid.

30

Percent of Respondents WTP

25 20 15 10 5 0

1-250

251-500

501-1000

1001-2000

2000-5000

WTP Amount in Rs.

Figure 6.3  D emand curve for amount respondents are willing to pay for green insurance Source: Primary survey

Green health insurance  157

Conclusion The study finds that around 60.7 per cent of the people in Delhi do not have health insurance. They pay high OOP expenses on health. On the optimistic side, the study shows that 60 per cent of the respondents in Delhi are willing to pay for the proposed bid for green insurance, which in turn shows that there is very high probability for penetration of health insurance in Delhi. As per the study, the people of Delhi are very much conscious about health and are ready to purchase health insurance to insulate themselves for the heavy OOP expenditure. Levels of education, family income, number of members in the family, diseases in the area and interest in the conservation of green belts are some variables that are highly significant, showing the very high probability of WTP for green health insurance by the respondents in the current study. Respondents who live in those areas of Delhi where there is widespread environmental pollution and frequency of occurrence of diseases are very high are ready to pay a higher amount for green insurance. On the supply side, there is ample scope for the health insurance industry to spread their business in Delhi. Green insurance products with the lowest premium is the need of the hour. The insurance industry should provide very low premium health insurance products as green insurance to cover diseases caused due to environment degradation, especially to cover the section of the low-income group and make insurance a popular measure to finance healthcare services. At the same time, the burden of payment of regular premium for green insurance would also promote more environmental consciousness among the people to keep it clean for ensuring a healthy life and also provide a good market opportunity for the insurance industry to expand their business, as insurance penetration in India is very low.

References Ali, A. et al., 2004, Estimating rural households’ willingness to pay for health insurance, European Journal Health Economy, 5, 209–215. Bala, M.V. et al., 1999, Willingness to pay as a measure of health benefits, Pharmacoeconomics, 15, 9–18. Bandara, B. et al., 2013, Farmers’ perception and willingness to pay for pesticides concerning quality and efficiency, The Journal of Agricultural Sciences, 8(3). Bhat, R., and Babu, S.K., 2003, Health insurance and third party administrators: Issues and challenges, Economics and Political Weekly, 35(4), January 22–28. Blaine, W. et al., 2006, An assessment of farmers’ willingness to pay for extension services using the Contingent Valuation Method (CVM): The case of Oyo State, Nigeria, The Journal of Agricultural Education and Extension 12(2), 97–108. doi:10.1080/13892240600861567 Diener, A. et al., 1998, Healthcare contingent valuation studies: A review of the literature, Health Economics, 7(4), 313–326.

158  Green health insurance Dong, H.B. et al., 2003, Willingness-to-pay for community based insurance in Burkina Faso, Health Economics, 12, 849–862. Foreit, J.R., & Foreit, K.G., (2008), The reliability and validity of willingness to pay surveys for reproductive health pricing decisions in developing countries. The Population Council, Washington, DC, Health Policy, 63, 37–47. Gafni, A., 1991, Willingness-to-pay as a measure of benefits: Relevant questions in the context of public decision making about health care programs, Med Care, 29(12), 1246–1252. Haab and McConnall, 2002, The benefits and costs of riparian analysis habitat preservation: a willingness to accept/willingness to pay contingent valuation approach, Elsevir, Ecological Economics, 43(1), 17–31. Halvorsen, B. et al., 2004, Willingness to pay for dental fear treatment, European Journal of Health Economics, 49, 299–308. Published Online: August 12 2004. Horton, B., et al., 2003, Evaluating non-user willingness to pay for a large-scale conservation programme in Amazonia: a UK/Italian contingent valuation study, Foundation for Environmental Conservation, 30(2), 139–146. Johannesson, M. et al., 1996, Willingness to pay for reductions in Angina Ptingentctoris Attacks, Med Decis Making, 248–253. Kling, C.L., et al., 2012, From Exxon to BP: Has some numbers become better than no number? Journal on Economic Perspectives, 26(4), 3–26 Mandy, R., 1994, Evaluating Assisted Reproductive Technology Programme: An Australian pilot study using Willingness to Pay, Centre for Health Economics Research and Evaluation, Division of Community Medicine, Westmead Hospital Department of Public Health, University of Sydney. Mitchel, R.C., & Carson, R.T., 1989, Using Surveys to Value Public Goods: The Contingent Valuation Method, Washington, DC: John Hopkins University Press. Portney, P.R., 1994, The contingent valuation debate: Why economists should care, Journal on Economic Perspectives, 8(4), 3–17. Tawab, 2005, Contingent valuation method for health insurance. American Economic Journal, 79(5), 1495–1550 Tenkorang, 2001, To pay for health and health care, Journal of Public Health Economics, 10, Accessed December 10 2001, http://censusindia.gov.in/default.aspx Whynes, K., et al., 2005, Willingness-to-pay and demand curves: A comparison of results obtained using different elicitation formats. International Journal of Health Care Finance and Economics, 5(4), 369–386.

Chapter 7

Conclusion and suggestions

Green spaces: Green belts to kitchen gardens Due to the lack of space in the city, green spaces have to be created by using less space or unused space. Green spaces are required desperately at certain places where concretisation is high and so is the pollution level. Therefore, it is important to build up green spaces as well as small water bodies interspersed or juxtaposed with the urban design. It is also important to work out the man–environment balance sheet. This balance sheet has to focus on the man–tree ratio, the fuel–tree ratio and the fuel–man ratio. A few of the popular measures adopted by the various global cities to increase green spaces and curb air pollution can be adopted and implemented by Delhi too. Afforestation all around Delhi desperately needs afforestation and reforestation of native trees that suits its semi-arid climate. In a recent budget, Rs. 900 billion has been allocated for plantation of trees in the city; however, not much has been used in this context. Delhi has a nearly 40,000-house deficit but a huge 900,000tree deficit. In the process of development, trees and green spaces are almost the last in the priority list of government and planners, as they do not generate direct economic benefits. Delhi did not become a choked city overnight; rather, continuous deforestation and concretisation during the last 50 years has made it so. Unfortunately, the administrators still don’t seem to have learnt their lesson. In June 2018, the government gave an order to cut 17,000 trees in and around Sarojini Nagar area, a residential and market area. The residents of the area protested and took a stay order from the court. The government’s decision to clear away 17,000 trees in the heart of the city to build a commercial complex is worrisome. This shows that the environmental perspective is still not considered while planning any developmental activity. There is a need to plant or compensate trees before cutting them. A healthy tree root system is just as wide as its canopy; therefore, trees should be planted at the appropriate distance apart. Concrete paths or

160  Conclusion and suggestions

pavements should not be allowed on tree tracks, as the rainwater can be absorbed by the unpaved tracks. Delhi now cannot afford having misplaced priority. Cutting trees is harming the entire urban ecosystem. Delhi is heading towards becoming a smart city, but such a city cannot be built in isolation. There is an urgent need for sustainable urban spatial planning by using a green-inclusive approach, where the priority of green areas should be a must for developing any concrete structure. Planting some saplings will not solve the problem. The problem will be solved by identifying the treeless or low-tree-density areas in Delhi and planting the trees accordingly. The plantation of both native as well as new varieties of trees is needed. It is important to keep in mind that trees cannot be replaced by shrubs or herbs. To combat pollution, the city needs to plant and conserve big dense trees with huge canopies. Vertical green walls Delhi can no longer expand horizontally to give sufficient space to develop green areas; therefore, other potential areas can be explored to maintain the man–environment balance. Since horizontal expansion is not possible, some measures can be taken to create vertical expansions. Studies show that parts of the city that have dense huge high-rise buildings with small green spaces have a generally high temperature. Vertical gardens can be a suitable option in such places. The walls along the buildings can be converted into green vertical walls. These can give a cooling effect in summers and also reduce the energy requirement of air conditioners. Green vertical walls give insulation to keep the house/building warm in winters. The living walls are created by attaching green plants to the exterior or interior of a building. To create a vertical garden, a simple MS steel structure is required for the wall that would give support to the vertical garden modules and panels. The plant wall could also function for urban agriculture, gardening or aesthetic beauty. Recently, pillar-based vertical gardens were recommended in Delhi by the Prime Minister’s Office (PMO), the Ministry of Housing and Urban Affairs and the Ministry of Environment to curb air pollution. These gardens are purposefully suggested in order to keep a check on the heat island effect and smog. They can also be helpful in expanding the biotic realm of the city by attracting a different variety of birds and insects. According to the Union Environment Ministry, Delhi generates 131 tonnes of dust every day. Structures like vertical walls can help to curb dust pollution, which is supposed to account for more than 50 per cent of the total PM10 particles and about 38 per cent of the PM2.5 particles. It is considered that a four-storey high vertical garden can remove 130 grams of particulates from the air, filter 40 tonnes of greenhouse gases and process more than 15 kg of harmful heavy metals every day.

Conclusion and suggestions  161

In the initial phase, vertical gardens have been developed at the junction of Sikandra Road, Tilak Marg and Mathura Road as a pilot project in the city. Vertical gardens are also being developed on the Delhi–Meerut Expressway and the Nizamuddin Bridge. The Delhi Metro recently converted pillars along the ‘Blue Line’ between Mandi House and Pragati Maidan stations into vertical gardens. It is proposed that the New Delhi Municipal Council (NDMC) and South Delhi Municipal Corporation (SDMC) will also start developing vertical gardens in their areas in phases. The South Municipal Corporation of Delhi ( MCD) shall also develop vertical gardens under all flyovers. North Municipal Corporation of Delhi (MCD) would also create such gardens at the newly built flyovers. Vertical walls can also be created in the suburbs and satellite towns of Delhi. Green–blue mounds Another way of vertical expansion is the creation and development of green-blue mounds in and around the city. These mounds are artificial mud mounds created to plant trees and develop small water bodies. Such mounds can be built along the Yamuna River and on the periphery of Delhi. These mounds have to be small in size but can have dense tree plantation, especially of the indigenous variety of trees. Like various biodiversity parks, these mounds can have a rich biotic niche. This would attract various birds and insects. Moss induction In a study, Japanese scientists highlighted that mosses are bioindicators and can be an efficient way to monitor pollution. The moss can help to curb excess nitrogen oxides, monitor atmospheric purity and stabilise the heat island effect. This is a cost-effective method and globally applicable for most of the cities. In one of the green city solutions applied in Berlin, it has been tried and recommended to have mobile installations of trees that are 4 metres tall, 3 metres wide and 2.19 metres deep. This is known as a moss culture. It is supposed to have a larger leaf surface area to capture more pollution. Berlin-based Green City Solutions claims that huge surface moss installed in each tree can remove dust, nitrogen dioxide and ozone gases from the air. The installation is autonomous and requires very little maintenance: solar panels provide electricity, while rainwater is collected into a reservoir and then pumped into the soil (https://edition.cnn.com/style/article/citytreeurban-pollution). The company claims to be installing it in a few European cities. In Indian context, however, the cost effectiveness of such a solution needs to be worked out.

162  Conclusion and suggestions

Green indoor spaces Delhi has many different sizes of houses and buildings. There are some buildings with poor ventilation, leading to indoor pollution and also adversely affecting the health of the residents. Air purifiers are in great demand in areas with high pollution, as manufacturers claim these can purify the room air, especially for people with respiratory disorders. According to a study by Indian Institute of Technology (IIT) Kanpur, three indoor plants can solve the problem of indoor pollution. These are the areca palm (Chrysalidocarpus lutescens), mother-in-law tongue plant (Sansevieria) and money plant (Epipremnum aureum). These plants are low maintenance plants and absorb harmful air. They can be kept in sunlight once a week and 5–6 pots of such plants can keep indoor air clean. Beside these plants, aloe vera (Aloe barbadensis), spider plant (Chlorohytum comosum), gerber daisy (Gerbera jameonii), golden pothos (Scindapusus aures) and bamboo palm (Chamaedorea sefritzil) are other indoor plants that can help in curbing indoor air pollution levels. Tree transplantation Recently, the Delhi Government announced its plan to invest in tree transplantation, that is, a technique to move a tree with its roots from one place to another. This is supposed to be an expensive proposition as it can cost somewhere around one lakh rupees, depending on the size of the tree. This technique has become very popular in many countries like China and Singapore. However, on the flip side, not only is the cost of transplantation very high but environmentalists also doubt on the sustainability and age of the tree when transplanted.

Green mobility India plans to convert all vehicles sales to battery electric vehicles (EVs) sales by 2030. It aims to deploy 6–7 million hybrid or EVs by 2020. However, this would build a huge fresh demand for electricity in India. For this, it would be important to develop new energy types that are less polluting and cheap. It’s important to generate electricity with the help of solar power. Electrification of vehicles will lead to less pollution only if the electricity generated for the same is through renewable sources. The National Auto Policy of India has replaced the word ‘electric vehicle’ with ‘green mobility’. Besides the electrification of private vehicles, there is also a need to electrify the public transport like buses and trains. Public transport has to be comfortable and affordable; this would encourage the people to give up their private vehicles. According to a UNFCC study, the Delhi Metro’s daily ridership of 2,700,000 has helped 3,90,971 vehicles off the city roads. This means an annual reduction of 2,76,000 tonnes of fuel consumption

Conclusion and suggestions  163

and 5,77,148 tons of pollutants. The Metro has really combated the situation of Delhi’s pollution to some extent. Diesel and petrol vehicles need to be removed from the roads by offering a better substitute. The plan to shift to electric vehicles would first require planning to convert the energy sector to a pollution-free sector, that is, switching partially to solar power or nuclear power depending upon the possibility. Carpooling is the eco-friendliest way to promote green mobility. This can become more workable and user-friendly by using apps and linking people to find the nearest car pool. Delhi needs to implement stringent rules for diesel and petrol cars, in addition to an effective private vehicle policy. An ‘end of vehicle life policy’ has been framed to implement an NGT directive of 2014, wherein all vehicles older than 15 years should not be allowed to ply on roads or park in public places. Such vehicles will be scraped and dismantled. Here, the thrust should be also on recycling the parts of the vehicles and disposing rest of the scrapped parts in an eco-friendly way. The recently adopted short-term measure of odd and even licence plate vehicles plying on odd and even days, respectively, also became very popular for dealing with the pollution problem during the peak months.

Green energy Coal-fuelled power in Delhi is one of the major culprits of pollution. It is high time to make it mandatory for all official buildings, malls, schools, hospitals and housing colonies to install solar power panels on their roof tops. The government should award benefits for installing and using solar energy. It should also put penalties on excess use and misuse of electricity. Energy management in a sustainable form is definitely the need of the hour and should be taken up seriously by the government. Solar panels should be available at a low cost. It should be made popular by sensitising people with the help of the media. In addition, the government should plan to harness thermal energy and wind energy by putting energy plants and fields to generate electricity.

Recycling agricultural waste Recycling the stubble waste generated by the states of Haryana and Punjab can reduce the air pollution in Delhi in the months of November and December. Dairy farming should be encouraged in these areas so that the agri-residue can be used as fodder for the livestock. According to Jha, an Indian economist and author, the straw and stubble can be gasified in a twostage process that yields a fuel gas that can meet cooking, heating and power generation needs in the village in the first stage, and any type of transport fuel – diesel, aviation turbine fuel, methanol or CNG – in the second stage.

164  Conclusion and suggestions

In India, the large-scale induction of gasification of agricultural residue technology can end the annual invasion of smog, increase farm incomes and save the country’s valuable foreign exchange. Delhi Government in 2020 tested a solution developed by Indian Agricultural Research Institute (IARI) to dissolve residual stubble in farmlands to be converted into manures. The bio decomposer can solve Delhi’s pollution menace.

Innovations in urban farming and terrace gardens (i) Expanded Clay Aggregate (ECA): ECA is a round palette structure produced by firing natural clay at a temperature of 1,200°C. This leads to the formation of a hard, honey-combed structure of interconnecting voids within the aggregate. Round-shaped and small-size particles are formed. These particles are supposed to have efficient water retention and improved drainage characteristics. The ECA technology can be used for roof gardening by water proofing it. The ECA makes agriculture environment-friendly. (ii) Drip farming: Farming on roofs or on land has to be water-efficient in cities. Therefore, drip farming has been suggested as the best alternative. This technique saves 50–60 per cent of water, which is a scarce resource in the cities. Drip farming is a technique of irrigation in which the farm is watered with the help of networks of pipes having emitters at equal spacing. These pipes are attached to the tanks, from where the flow of water is controlled. Fertilisers are fed into the tank and mixed with water instead of being sprinkled on land. The tanks can have fresh water, yellow water or any kind of recycled water. (iii) Pind pipes: Pind pipes have been found to be another important and new innovation that can be adopted for organic farming. Word ‘pind’ comes from the Punjabi word that means “a village”. The pind pipe is a broad small pipe with holes that looks like a flute. This can be halffilled with water with a net put into it in such a way that more than half of it is immersed in water. The clay balls can be placed in the pipe while ensuring that at least ¾ of the pot is filled. The seeds can be sprinkled evenly into the pot. This is based upon a technique called hydroponics. It is a way of growing plants in water without soil. It requires no pesticides, fertilisers or chemicals. One can harvest fresh vegetables and consume them immediately. (iv) Seed balls or seed bombs: Seeds can be kept in seed balls to prevent damage, and can be grown easily with less water. The seed balls are made with mud, clay and compost. They are ball-shaped, and native seeds can be put inside them. They can be planted easily. Just throw it and grow it.

Conclusion and suggestions  165

(v) Composting: The disposal and recycling of waste through composting has become imperative. Only 2 per cent of the municipal solid waste in India is composted. The Supreme Court order of 2006 directs fertiliser companies to co-market city compost with chemical fertilisers. The subsidy provided to fertiliser companies and transportation of fertilisers has no match to the government incentive of market development assistance for city compost at Rs. 1,500 per tonne, which renders compost uncompetitive vis-à-vis chemical fertilisers. Only a few Indian cities are trying biomethanation of waste, as segregation of  biodegradable and non-biodegradable waste at source remains a major challenge.

Green buildings Green buildings are essential in the city environment. In cities, buildings are responsible for a huge share of energy, electricity, water and materials consumption. Buildings account for 18 per cent of global emissions today, or the equivalent of 9 billion tonnes of carbon dioxide annually (Vorsatz, 2007). According to the United Nations Environment Program, if new technologies in construction are not adopted, emissions could double by 2050. Green construction or sustainable buildings should be resource-efficient and environmentally responsible throughout the building's life-cycle, that is, planning, design, construction, operation, maintenance, renovation and demolition (Green Building – U.S. Environmental Protection Agency (US EPA)). Well-designed buildings aim at efficient use of natural resources, generation of renewable energy through solar power like sunlight and photovoltaic equipment, wind power, hydro power, biomass, use of renewable resources using plants and trees through green roofs, rain gardens, reduction of rainwater run-off, use of packed gravel or permeable concrete instead of conventional concrete or asphalt to enhance replenishment of ground water and reduction in the amount of waste generated by the occupants by providing on-site solutions such as compost bins to reduce matter going to landfills, which can significantly reduce the environmental impact of the building. Technologies employed in green buildings are constantly evolving and may differ from region to region. However, the fundamental principles of structure efficiency, design efficiency, energy efficiency, water efficiency, materials efficiency, indoor environmental quality enhancement, operations and maintenance optimisation, waste and toxics reduction are the same everywhere. Green building practices expand and complement the classical building design concerns of economy, utility, durability and comfort (U.S. Environmental Protection Agency, 2009). Green architecture involves designing a building in harmony with the ecosystem, using 'green' building materials from local sources and optimising the system. Delhi needs to construct green buildings to generate significant environmental, economic and

166  Conclusion and suggestions

social benefits, thereby protecting the health of the occupants and reducing level of pollution and environment degradation.

Water harvesting Water harvesting means capturing and storing of rainwater or runoff water. Water harvesting also helps in mitigating floods and promoting plant growth. Delhi desperately needs water harvesting plants throughout the city. The semi-arid climate of the region requires water to be stored in aquifers. Massive concretisation and poor percolation of water in the soil have led to urban floods in some parts of the city during the monsoons. Delhi receives rainfall during both the monsoon (June to September) as well as by western disturbances in winter. Around 80 per cent of the rainfall occurs during the monsoon season. Heavy downpours sometimes lead to floods. Delhi depends massively on ground water, which gets replenished by rainfall. Despite heavy rainfall in certain years, the city was not able to replenish its ground water because of lack of bare open or green land. Water harvesting thus becomes an important requirement for Delhi’s ecology. Very little planning and implementation has been done on this front.

Cloud seeding for artificial rain Recently, Central Pollution Control Board (CPCB), Indian Space Research Organization (ISRO), (IIT Kanpur and Indian Meteorological Department (IMD) have considered the option of cloud seeding to ease the air pollution in Delhi. Cloud seeding is a technology in which the salts (silver iodide or dry ice) are being dispersed in the air to get moisture and formation of clouds for artificial rain showers. This technology is successfully used in several world cities like Beijing, United Arab Emirates and New York to combat the air pollution. Though environmentalists and some scientist believe that it is not a very suitable option for Delhi, but considering an alarming situation, the Delhi Government has given its approval to it.

Carbon engineering Carbon engineering is a new way of dealing with pollution. A Canadian start-up, carbon engineering, captures carbon dioxide directly from the atmosphere and then utilises it to produce fuel. The company assures that the direct air capture can remove far more carbon dioxide per acre of land footprint than trees and plants. The company is already running a demonstration plant in Squamish, British Columbia, that removes one ton of carbon dioxide from the air every day. Meanwhile, a Dutch design company has developed a ‘smog-free tower’ – an air-purifying tower that sucks in pollution and expels clean air. The extracted pollution is turned into pieces of jewellery. The first tower was

Conclusion and suggestions  167

installed in Rotterdam, and the company claims that a single tower can clean 3.5 million cubic metres of air per day. The company plans to roll out smog-free towers across other global cities. Several companies are building computer systems capable of learning to predict the severity of air pollution in the city several days in advance by managing large quantities of data. This is considered to be an extremely complex computational challenge. The systems would eventually offer specific recommendations on how to reduce pollution to an acceptable level. In another development, in China’s most polluted cities, a 60-metre-high chimney stands among a sea of high-rise buildings. The chimney is installed to clear the air. The outdoor air-purifying system is powered by solar energy and it filters out noxious particles and exhausts clean air into the skies. Chinese scientists claim that the system could significantly cut pollution in urban areas in China and elsewhere.

Green health insurance In Delhi, almost 60.7 per cent of the people do not have health insurance. They pay high OOP expenses on healthcare. Insurance penetration in India as a whole is very less. It has been found that once the penetration of health insurance increases, OOP payments will come down. People should consider health insurance as an important financial tool for medical emergencies. Cities are a hub of seasonal diseases that are prevalent as an epidemic, due to heavy pollution and environment degradation. Therefore, they need special attention from the insurance sector. The Insurance Regulatory and Development Authority of India (IRDA) should provide very low premium health insurance products as green health insurance to people covering seasonal diseases caused due to environment degradation, especially targeting the low income group, in order to make insurance a popular measure to finance healthcare services.

Green certification Green certification has been popular in Europe for the past four decades. It is a process to certify that the product manufactured and traded is environmentally friendly and energy-saver. This term has become popular in India from the 1990s. It is a government-operated seal of approval programme for environmentally preferable consumer products. The ‘Ecomark’ programme was launched by the Government of India in 1991 to increase consumer awareness. It is an eco-labelling scheme for easy identification of environment-friendly products or green products, which are less detrimental to environment and human health than the traditional product equivalent. The Bureau of Energy Efficiency (BEE) is an autonomous body under the Ministry of Energy, Government of India, that assists in developing policies and strategies with a thrust on self-regulation and market principles.

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The BEE has developed a star rating for buildings to assess the status of energy efficiency of commercial buildings. Under this system of evaluation, 1–5 stars are awarded to a building, based on the building’s energy usage. The highest rating, that is, a five-star rating, is recognised as the highest state of efficiency. The rating is based upon different criteria, such as the built-up area, conditioned and non-conditioned areas, type of building, hours of operation of building in a day, climatic zone and other miscellaneous information related to the facility. A step towards promoting energy efficiency in the building sector and to provide minimum requirements for the energy efficient design and construction of buildings and their systems, known as the Energy Conservation Building Code (ECBC), was launched by the Ministry of Power, Government of India, in May 2007. The ECBC is a performance-oriented code that forms and ensures norms and standards for energy efficiency of buildings and all service components considering the climatic zones, applications, usage pattern, etc. Many states in India have amended and adopted the code after taking into account their regional and climatic requirements. These norms have been acknowledged as an important tool of the government’s energy efficiency and climate change policy. The ECBC compliances and star ratings are becoming mandatory for the manufacturing sector, that is, buildings and factories. The development of new projects as well as existing projects needs to comply with the guidelines of the accepted level of energy efficiency and performance level. Meanwhile, the Green Business Certification, Inc. (GBCI) and International Finance Corporation (IFC) launched EDGE in India to jumpstart the mainstreaming of resource-efficient buildings across the country in a fast, simple and affordable way. GBCI is the global certification partner for EDGE. It is a certified body for all EDGE projects in India. EDGE is a certification system for new residential and commercial buildings that enables design teams and project owners to assess highly cost-effective ways to incorporate energy- and water-saving solutions in their buildings. Similarly, the CII-Sohrabji Godrej Green Business Centre in Hyderabad, in consultations with stakeholders and experts, has developed the 'Greenco’ rating system for evaluating the 'greenness of companies' in India. The rating system assesses and analyses the environmental impact of a company's activities or operations, defining the path forward to ecologically sustainable business growth. Weightage is given to various parameters like energy efficiency, water conservation, renewable energy, GHG emission reduction, material conservation & recycling, waste management, supply chain management, product stewardship, lifecycle assessment, ventilation, and site selection and innovation, aggregating which leads to a certified (level 1), bronze (level 2), Silver (Level 3), Gold (Level 4) or Platinum (Level 5) rating. In addition, the Green Rating for Integrated Habitat Assessment (GRIHA) evaluates the environmental performance of a building holistically over its

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entire life cycle, thereby providing a definitive standard for what constitutes a green building. The Conserve Team, which comprises of a certified GRIHA trainer and auditors, facilitates in creating sustainable values for the GRIHA, SVA-GRIHA and GRIHA Large Development projects (GIHA, 2010; Air Quality Sciences,2010). The Indian Green Building Council (IGBC) is a part of the Confederation of Indian Industry (CII). It was formed in the year 2001. It aims to enable a sustainable built environment for all and facilitate India to be one of the global leaders in the sustainable built environment by 2025. In July 2011, the International Organisation for Standardisation (ISO) released the ISO 50001 Standard Energy Management System, which provides the essential framework and guidelines for establishing and operating an energy management system in general terms. Implementation of the ISO 50001 standard envisages the systematic management of energy, leading to reduction in greenhouse gas emissions, energy cost, and other related environmental impacts. This structure and functioning of green certification should match universal standards, and substandard products should be removed from the market.

Green mind and green market Environment-friendly products, commonly known as eco-friendly products or green products are the ones that cause minimal harm to the people and the environment, whether in their production, use or disposal. Eco-friendly products help to limit post-consumer waste, reduce the carbon footprint and preserve the environment by significantly reducing the pollution. It helps to reduce air, water and land pollution and aims to achieve the goals of sustainable development to a large extent. These products can help to reduce waste and make this planet a better place to live. Going green is an indication that it is high time the society should develop a perspective that is in harmony with nature and the environment. People need to understand and cooperate by not burning leaves, crackers or wood, because such activities cause a huge amount of pollution in a small span of time. It is important to popularise eco-friendly products as a trend, as a fashion symbol and as a regular habit by spreading environment awareness and consciousness in the day-to-day life. Focusing on the threat to the environment and showing how to protect it by adopting small changes in the lifestyle and habits will motivate people to go green. By the late 1980s and 1990s, the notion of green products became somewhat trendier, and the practice of marketing products as such became more commonplace in niche markets. It wasn’t until the start of the 21st century – when concerns over global warming and natural resource depletion began gaining momentum – that ‘going green’ went main stream and began influencing the practices of product manufacturers (Air Quality Sciences, 2010). In Delhi, green products still have to reach the main stream market as popular choices.

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Each year, there is use of an estimated 500 billion to 1 trillion plastic bags, which leads to a lot of avoidable waste. Replacing plastic items with jute bags, cotton shopping bags, reusable grocery bags, reusable water bottles, reusable straws, biodegradable trash, recycled fabric will help significantly. It is important to regularise the use of LED light bulbs, which are 80 per cent more efficient than traditional lighting options. About 95 per cent of the energy in LEDs is converted into light, and only 5 per cent is wasted as heat. Solar-power products like cookers and phone chargers, natural laundry detergents and natural cleaning products also need to become popular. Green technology does more for the business dynamics than merely helping the environment. From productivity enhancement to financial boosts, we may find numerous benefits by adopting a ‘green platform’. Switching over to green choices and green alternatives like green energy, green travel, and recycling will save energy and money and will provide us opportunity to create useful items out of recycled materials. The need is to be more creative and come up with new ways to be energy- and material-efficient. Buying less and buying used products are also green choices. Switching to green alternatives like renewable energy sources; for example, solar panels, CFLs, LEDs and energy-saving door and window fixtures can save both energy and money. Green technology can also be utilised to reduce the use of water; for example, aerated faucets, efficient toilets and outdoor timing systems could greatly cut into the monthly water bills. Installation of motion-sensing faucets will automatically turn off when no movement is detected, especially in offices and public toilets. Growing and consuming organic food, that is, green and non-chemical food, needs to be pushed and encouraged. Organic farming means responsible land use and farming practices, without using pesticides, harmful chemicals and added hormones. Eating organic food will also make us healthier. In smart cities, a digital and green system of operation will reduce spending on pens, paperclips and markers. It has the potential to save money in hardware expenses, technical support, staff wages and networking maintenance. Moving to a paperless system eliminates a large portion of the waste in the workplace. Storage for these items could be decreased in order to make room for other equipment and needs. Applying cloud-based business services will help in important documents. Customer information, etc., that can be saved online, will enable businesses to immediately get back to work even after a catastrophe. Energy efficiency can be implemented in offices and institutions by insulating the building and using smart windows that offer a shade when the ultraviolet levels increase. Even the thought of working in a better environment could improve employee morale, and also reduce the company’s carbon footprint. If products are eco-friendly, green technology will also lead to an increase in business opportunities. Green companies are sure to attract more customers who are conscious about their health and the environment, by

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marketing their products as green products. Many hotels have seen a significant influx of customers because they advertised their usage of solar panels and water-conscious fixtures.

Green tax Pollution is one of the products the cost of which is not borne by the producer (polluter) of the products. As various studies show, pollution responsible for climate changes, global warming and causing several health problems for flora and fauna, has become a severe threat. Strong regulatory measures should be taken by the regulators to control pollution. According to ‘Polluter Pay Principle’ theory, heavy tax should be imposed on the polluter which will lower environmental damages in a costeffective manner and it would further encourage positive behavioural changes in producers of pollution to large extent. Green tax, also called Environment Compensation Charge (ECC) or Pollution Tax or Eco Tax, is the penalty for creating pollution and disturbing environment which is imposed on all the producers or consumers that cause environmental pollution. The purpose of the green tax is to minimise the negative impact resulting from the use of non-green products and services. These taxes are of wide range of legislative charges on businesses and private individuals. There are many forms of environmental tax. Green tax may be in the form of both direct and indirect taxes. While taxing, some of the taxes aim at directly penalising or taxing those who create pollution and some of the taxes which aim to reward those who employ environmentfriendly practices. Indirect tax or penalty like hiking the price of the products to discourage its production or consumption, increasing the price of fossil fuels or gasoline tax are an effort to lower environmental damage caused due its emissions and switch to renewable sources of energy which are environment friendly. Another fine alternative to emission taxes is a ‘tradable permit scheme’ which is a cost-effective method. These schemes reduce the amount of permissible emissions by issuing a certain emissions permits. These permits can then be traded among polluters. The polluters who find it expensive to lower their emissions have to purchase permits that allow them to continue emitting pollutants while those who can reduce emissions at a lower price can do so before putting up their unused permits for sale (https://web.stanford.edu/class/e297c/trade_environment/law/hpermits.html). Green tax in India Green tax in India is a relatively new concept. It is imposed on older vehicles as their engines are old and generate pollution to the environment. Green tax in India varies from state to state. It is levied on both private and commercial vehicles. Green tax was first introduced in Mumbai which is

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one of the most polluted cities of India. The government of Maharashtra imposed green tax on private vehicles that are older than 15 years and on commercial vehicles which are used for over 8 years will be subject to green tax. The government of Tamil Nadu also directed the transport department to collect green tax from owners of old vehicles. Kerala has also imposed green tax from January 2017. In Delhi, green tax or ECC has been imposed from November 1, 2015. Diesel-guzzling trucks and commercial vehicles entering into Delhi will have to pay green tax. A study conducted by the Centre for Science and Environment found that trucks are mainly responsible for more than onethird of air pollution in Delhi. Around 40,000 to 50,000 trucks enter the capital through 127 entry points every day in Delhi and about 13,000 of them just use Delhi as a transit route and are not destined for the capital. Therefore, on the direction of Supreme Court of India, Government of Delhi introduced green tax which aims at discouraging trucks which are only transiting Delhi. The charge shall be collected by the toll collecting agency of Delhi Municipal Corporation and submit it to the finance department. CCTV cameras and radio frequency identification (RFID) tags are being given at border entry points in Delhi to ensure that commercial vehicles that enter the city will be monitored for emissions. ECC will be imposed on pollutants depending upon the vehicle’s size. The fine is between Rs. 700 and Rs. 1,300 for two-axle trucks and three- and four-axle trucks, respectively. The charges have nearly doubled with light vehicles and two-axle trucks have to pay Rs. 1,400 and three- and four-axle trucks paying Rs. 2,600 every time they pass through the city. The Supreme Court on December 16, 2015 also banned the registration of diesel cars and Sports Utility Vehicles (SUVs) with engines beyond 2,000 cc in Delhi. Large trucks will have to pay Rs. 1,300 as the charge in form of green tax while smaller commercial vehicles will have to pay Rs. 700 per entry (https://www.thehindu/cities/Delhi:12,2015). The Supreme Court has also asked the Delhi Government to use the money for improving roads, particularly for cyclists and pedestrians. The money generated would also be used for implementing air pollution control measures. But emergency services like ambulances, passenger vehicles, vehicles carrying an essential commodity that is food stuffs and oil tankers have been exempted from payment of tax. The business and commercial perspective of development has to be changed. In case of Delhi, it is important to develop an environment-oriented perspective. Incentives should be given to people, companies and organisations who act in an eco-friendly way. Benefits should be awarded to those who plant or adopt trees, preserve or create water bodies, shift to solar energy, etc. At the same time, penalties should be levied for wastage of energy, overuse of resources (especially water), felling trees, faulty disposal of waste, etc. A lot of importance should be given to research and innovation to curb pollution. Not only it is important to do horizontal studies on solutions to air pollution like planting trees

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Green Infrastructure (Tree plantation, Green products, Green energy, Green building and waste management) + Increase in government expenditure on health infrastructure +Insurance Penetration + Green tax Pollution free environment and Health awareness.

Increase Growth and Overall Development

Strengthen the human resources of the county

Good health of labour , Increase labour produc vity

Figure 7.1  Green infrastructure, health economics and development Source: Authors

and expanding green areas, but the studies need to focus on lateral research of understanding air circulation and formation of clouds. Rain not only helps dust to settle but also for trees to grow. On the other hand, cities need to manage heavy rains, which can lead to floods. It is important to have water-harvesting plants to replenish the ground water and save the precious rain water in the cities (Figure 7.1). The authors propose a meaningful holistic investment and expenditure on green infrastructure, insurance penetration and green tax in Delhi. Plantation of trees is the best green infrastructure that can be created in a city. They are the cheapest expenditure, yet one of the best investments for healthy and pollution free environment. It is to understand that trees are not luxury; rather, they have become a necessity in cities like Delhi, where air pollution levels are really high. Tree ambulances and regular surveys to maintain their health is also required. Green energy, that is, one that does not generate pollution like solar and wind or hydro energy can be generated and consumed for various purposes. Green buildings and eco-friendly products can further help to handle the situation. Well-managed and right investment will lead to disease free and pollution free environment. Moreover, insurance penetration will lead to less of outof-pocket expenditure, therefore reduce financial burden on the patients. Good health and health infrastructure would lead to increase in labour productivity. More labour productivity would increase labour efficiency

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and yield growth and higher outputs. Elevated outputs would generate economic development and further investment in health infrastructure and facilities. Delhi needs to have a holistic and pragmatic approach to deal with the alarming levels of pollution. Pollution is slowly and steadily affecting us by entering our lungs, ecosystem, soil, water and food. The disaster of air pollution has to be managed with full willingness and focus. It should no longer be considered an afterthought; rather, it should be given utmost priority. Delhi has a wonderful biodiversity and cultural diversity. With the right thought, willingness and policy administration, Delhi can become a sustainable and liveable city. The historical green treasure of Delhi needs to be preserved, and new modern green spaces need to be built without further delay.

References Jha, P.S., 17 Nov 2017, From Field to Fuel, There is an Easy Solution to India's Air Pollution Problem in Environment, The Wire, Delhi: October 12, 2015. https:// thewire.in/environment/delhi-smog-air-pollution-paddy-burning; https://archive. epa.gov/greenbuilding/web/html/; https://edition.cnn.com/style/article/citytreeurban-pollution; https://web.stanford.edu/class/e297c/trade_environment/law/ hpermits.html; U.S. Environmental Protection Agency (2009) Green Building Basic Information. http://www.epa.gov/greenbuilding/pubs/about.html Accessed December 10 2009 U.S. Environmental Protection Agency (2014) Green Building materials. http:// www.epa.gov/greenbuilding/pubs/about.html Accessed November 28 2009 Vorsatz, D.U., 2007, Climate change mitigation in the buildings sector: the findings of the 4th Assessment Report of the IPCC, UNEP and WMO publication.

Index

Page numbers in italic indicate figures. Page numbers in bold indicate tables. afforestation 42, 44, 159–160 agricultural waste, recycling 163–164 air pollution 1–2, 2, 4; from construction 71–74, 73; effects on flora 62–64, 63–64; from industry 68–71, 69; from power generation 74–75; from solid waste 75–77; sources in Delhi 64–77; and temperature 85; from vehicles 65–68 air purification 18 air quality monitoring see AQM allotments 10 amenity green areas 9 AQM 5, 6 Arbor Environmental Alliance (AEA) 18 Babu, C. R. 55 Baker, Herbert 38–39 Barron, C. A. 43 Biello, David 18 binary logistic regression 146–153 biodiversity 20, 27, 30, 46, 51, 55–56, 161, 174; maintenance of 16, 18–19; see also parks and gardens biophilia 19 Brack 22 buffers see green belts carbon dioxide 60–61, 84; in Delhi 82–83, 83; and temperature 86 carbon engineering 166–167 carbon monoxide 62 carpooling 163 cemeteries 10 Census of India 5 Central Pollution Control Board see CPCB chlorine, effects on flora 63 churchyards 10

Ciais, Philippe 61 city farms 10 climate, micro-level 16–17 cloud seeding 166 composting 165 contingent valuation method see CVM CPCB 5 CVM 140–143 Das, Joyjeet 124 DDA 11, 45–47, 55 Delhi: air pollution 59–88; British green spaces 38–42; choice of hospitals 129–131; and concept of green cities 29–32; deforestation 42; diseases 96–98, 97; early period 35–36; ecosystem services 99; environmental awareness 100–104; first master plan (1961) 45; forest cover 51; green spaces 10–12; health challenges 89–106; health insurance 132–133; history of green spaces in 35–58; IMR 91; life expectancy 91; Master Plan Delhi see MPD; Mughal green spaces 36–38; NDVI 54, 55; Parks & Garden Society 11; parks and gardens 51, 53; policies and laws 47–48; post-independence green spaces 44–48; potential green spaces 56; present-day green spaces 48–57, 49, 50; regreening 42–44; second master plan (1981–2001) 45–46 Delhi Biodiversity Foundation 55 Delhi Development Authority see DDA Delhi Parks and Gardens Society 51 Delhi Preservation of Tree Act see DPTA diseases, environmental and lifestyle 92–95 Donohue, Randall 61

176 Index DPTA (1994) 47–48 drip farming 164 Dunnett et al. 9–10 Dutt, Ashok K. 36 eco-friendly products see EFP ecological corridors 26–27 EFP 100–104, 100, 102, 103, 104; and educational level 101 Environmental Performance Index (EPI) 90 ethylene, effects on flora 64 European Union 9 expanded clay aggregate (ECA) 164 fluorides, effects on flora 63 Food and Agriculture Organization (FAO) 21 forests: protected 11; reserved 11 funtional green areas 10 Gairola & Noresah 15 Gardens: community 25; roof 25–26; vertical 25; see also parks and gardens Geddes, Patrick 44 Geographic Information System (GIS) 5, 6, 23 Global Positioning System (GPS) 5 Goldowitz Jimenez, Ilana 60 grasslands 10 green belts 12, 27, 29, 45, 46, 51, 84, 157 green buildings 165–166 green certification 167–169 green cities 22–24, 28, 32, 39, 161; concept 29 green energy 163 green health insurance 167; WTP 139–158 green indoor spaces 162 green infrastructure 173 green market 169–171 green mind 169–171 green mobility 162–163 green spaces 2–3; see also UGS green strips 12 green tax 171; in India 171–174 green-blue mounds 161 greenhouse gases 75–76 Griessen, A. E. P. 39 Gupta, Indrani 124

Habitat II 13 Harrison & Davies 20 health expenditure, disparities 4 health insurance: in India 125–126; WTP 132–136 health satisfaction level 104–106, 105 healthcare: in Delhi 126–129, 128; expenditure 112–115, 113, 114, 115, 116, 117, 118; financing, international 115–118, 117, 119; financing schemes 124; financing schemes in India 123–125; investment 112, 114; out-of-pocket expenditure 118–123, 120, 121, 122, 123, 131, 139; providers 110–112 healthcare management 107–138; in Delhi 129–136 heat stress 77–81, 78 Hosagrahar, Jyoti 41 incidental green areas 9 Infant Mortality Rate (IMR) 90–91, 92 informal recreation areas 9 institutional grounds 10 Irfan 77 Jorgensen, Erik 12 Kaur, Rajkumari Amrit 44 Konijnendijk, Cecil C. 22 Konijnendijk et al. 13 Land Use and Land Cover see LULC Landsat 5, 48–49 Lefroy, G. A. 43 life expectancy 90–92, 91 linear green areas 10 LULC 5, 48–49 Lutyens, Edwin 38–40 Maconachie, J. R. 42–43 Malesky, M. 60 Maurya, Lalit 124 Mayer, Albert 44 mental health 19 Metcalfe, Charles 41 Metcalfe, Thomas 41 methane 62 Mincer & Becker 107 moors and heathlands 10 moss induction 161 Mougeot 14

Index 177 MPD (2001) 46–47 MPD (2021) 47 multiple regression analysis 153–156 Municipal Corporation of Delhi (MCD) 11 Mustoe, William Robert 39–40 Myneni, Ranga 61 Nath, V. 38 National Center of Biotechnology Information (NCBI) 2 National Health Estimates 5 NDVI 5, 49, 52–54 New Delhi 38–40 New Delhi Municipal Corporation (NDMC) 11 Normalised Difference Vegetation Index see NDVI Obama, Barack 27 Ochterlony, David 41 Old Delhi see Shahjahanabad Organization for Economic Co-operation and Development (OECD) 3 outdoor sports areas 9 oxygen 59–60 ozone, effects on flora 63 parks and gardens 9, 12–13, 19–22, 25, 29; biodiversity parks 27, 30, 51, 55, 161; in British Delhi 41; in Chandigarh 24; in Delhi 51, 53; district 11; in Gurugram 64; national 11; neighbourhood 11; in Rohini and Dwarka 51; urban 15 particle pollution 2, 60 particulate matter 2, 18, 69, 71–73, 84 photosynthesis 59 physical fitness 19 pind pipes 164 Planning Commission of India 5 play areas and playgrounds 9, 10, 12, 19; see also tot lots Porecha, Maitri 124 preventive healthcare 98–99, 98 private domestic gardens 9 Raizada, M. K. 127 remnant farmland 10 respiration 59–60 river and canal banks 10 Roberts, Judith 40–41

Roger et al. 8 Russo et al. 14 satellite imagery 5 school grounds 10 SDGs 3–4, 108, 109 seed balls and seed bombs 164 semi-natural habitats 10 Shah Jahan 36–37 Shahjahanabad 36–38 Siddiqui & Khan 76 soil quality 17–18 Sukoop et al. 21 sulphur dioxide 61–62; effects on flora 63 Sustainable Development Goals see SDGs temperature 18, 21, 99, 160; and carbon dioxide 60, 86; in Delhi 35, 80; and heat stress 77–80; microlevel 16–17; moderating 3; and pollution 5, 79, 84, 85 TOF 25, 29, 50–51, 52, 85 tot lots 11 Towards Sustainable Europe 3 transport corridors 10 trees 8, 12, 31, 159–161, 172–173; benefits of 16–20; in British Delhi 39–41; clearance of 1, 42; impact of pollutants on 63–64; legislation 47–48; outside forests see TOF; and oxygen 60; and sulphur dioxide 61; transplantation 162; urban forestry UGS 3, 4, 159–162; definitions 8–9; ecological benefits 16–19; economic benefits 21; educational benefit 20; health benefits 19–20; in Indian cities 23–24; location 24–29; necessity for 15–21; recreational benefit 20; social benefits 20; terminology 12–15; typology 9–12; in world cities 21–23, 22 United Kingdom sustainable development framework indicator (UKSDI) 3 United Nations Conference on Sustainable Development (UNCSD) 3 United Nations Development Programme (UNDP) 1 United Nations Environmental Protection Agency 9

178 Index United States Geological Survey (USGC) 2 Universal Thermal Climate Index (UTCI) 78 urban agriculture 13–15 urban forestry 12–13 urban green spaces see UGS vertical green walls 160–161 water harvesting 166 Wet Bulb Globe Temperature (WBGT) 78 wetlands 10

WHO 3, 5, 21, 22, 89, 110, 121 willingness to pay see WTP Wilson, Edward O. 19 woodlands 10 World Health Organization see WHO WTP 100, 102; and educational level 135, 136; and family income 135, 136; and family size 134, 134; methodology 140–146; and occurrence of diseases 134, 135; statistical analysis 146–156; variables 144–146, 145; see also health insurance