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(Foot)paths to health a call for institutional initiative J. K. Lakshmi Indian Institute of Public Health, Hyderabad, Public Health Foundation of India Plot # 1, A N V Arcade, Amar Co-operative Society Kavuri Hills, Madhapur, Hyderabad- 500081 91-40-49006015 / 91-9618261526 jklakshmi@iiphh.org 91-40-49006060

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(Foot)paths to health a call for institutional initiative

Health is well known to be influenced by genetics, and personal choices in lifestyle, including diet, substance-use, stress and exercise. Another factor that exerts considerable impact on health but is largely out of individual control is the physical, including built, environment. This jurisdiction lies with institutions, particularly the government. There is much to lament in the construction and maintenance of the urban built environment, such as the network of paths, and the appalling neglect of one of their features - the footpath. Deficiency of quality footpaths paves the way to poor personal and public health. What's the problem with footpaths? Either they were never built, or they existed at first and were later sacrificed in the interest of wider roads dedicated, de facto, to vehicular traffic. There are practically no pedestrian-only pathways or safe footpath-flanked streets as alternatives. This ends up forcing people to use the increasingly dangerous roads. The overwhelming majority of road traffic fatalities are in middle- and lowincome countries.1 Road traffic accidents are predicted to rise in the ranks of causes of death over the next two 1 India demonstrated a worrisome surge, of decades. Accidents close to 80 per cent, in traffic fatalities over the years Road traffic accidents, from 1980 to 1998,2 and continues to show a rising trend in the background of increasing population, responsible for much urbanization and motorization, and dated or mortality, morbidity, ineffectively implemented traffic rules. The World disability, economic Banks Traffic Fatalities and Economic Growth (TFEC) loss, and lowered model projects that the rising trend of traffic deaths in India will not ease till the year 2042.2 Indias annual quality of life, are on traffic fatalities were costed at 55,000 crore INR in the the rise. year 2000,3 and the toll is rising steadily over the years. Urban India is fast becoming unfit for elderly persons, children, the sick, the disabled, and anyone who wishes to use non-motorised transport to get around. According to the 2001 Census of India,4 35.3 per cent of the population is below the age of 15 years. The

Vulnerable populations abound in developing countries.

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absolute numbers, as well as the relative proportion, of older individuals are on the rise in India as elsewhere in the world: The segment of the population above the age of 59 years, 7.5 percent in 20014, is projected to increase progressively. Accurate data on persons with disabilities are unavailable on a national scale; however, it is understood that disabilities are underreported, and safe facilities for persons with disabilities scarce. These statistics translate to a considerable segment vulnerable to injury. Road traffic accidents are among the top three causes of death among persons aged 5 to 44 years.1 A high proportion of victims are male,3 young adults, and earning members of families. Also, the segments of the road-user population most affected in road traffic accidents are pedestrians3 and two-wheeler users. A determined effort to ensure footpaths on every street would surely go a long way to obviate the prodigious loss of life and limb, and the decimation of productivity that road accidents lead to. While bad road surfaces and poor lighting are clearly inconvenient, it is disquieting to consider that these ills may actually be preventing other graver ones by acting as an inbuilt check to high speeds. A smooth road sans supportive elements is not merely inadequate, it is perilous. To go with the improved quality of the road surface, with the current mushrooming of automobiles, we need a host of safety features such as medians, smooth speed-breakers, safe pedestrian crossings, good lighting, and, perhaps most important, footpaths. The lack of a level difference between the footpath and the road, testimony to thoughtless road-laying without the preliminary stripping of old roads, allows easier access to the footpath to bicycles and motor vehicles from the Misuse road and facilitates chaos, negating the safety features of the footpath. Pavement (mis)users, who do not merely traverse the pavement but stay put on it for extended periods, inconvenience others who would like to use it as a safe path. However, the footpath is essential to the trade of street food and artifacts, and the elimination of footpaths puts out both peddlers and their customers. The 2001 Census of India4 places the
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Hawkers, and homeless persons, are forced to use the footpath for want of appropriate arrangements for commerce and housing respectively.

houseless urban population at close to 1.4 per cent of the total urban population: With the torrent of economically backward migrants to cities, this proportion could well have risen. Many members of this disadvantaged group perform services that other residents value, e.g. manual labour, fabrication of handicrafts, and trinket-sales. Street-dwellers are subject to almost universal disdain, but part of society nevertheless. The solution is a complex, systemic one, including bettering the conditions of employment and sanitation in rural areas, and providing basic amenities for migrants to urban areas. But until improved conditions are in place, houseless persons have no recourse but public land, including pavements. What's bad about having no footpaths? A high level of discomfort and danger, from physical obstacles and traffic, for pedestrians using the streets; Impediments to smooth vehicular traffic flow caused by the presence of pedestrians in the path of traffic; High levels of short term stress caused by erratic traffic bearing down on people, especially those who are sick, disabled, or very young or elderly; Lack of environmental support for walking for exercise or leisure-time physical activity for people of all ages. Besides walking for transportation, an activity increasingly abandoned these days is walking for pleasure, what with the hazards and discomfort attendant on negotiating the suboptimal physical structures, pollution and traffic, which put personal safety at risk; and Far too often, cutting down of trees, short-changing roadusers and the planet, to make space for a widening road, and forcing lampposts, if any, onto the street proper, resulting in disruptions of traffic flow. Is there anything good about having no footpaths?

Consequences For pedestrians: discomfort, vulnerability to injury, exposure to vehicular exhaust and noise, lack of support for streetside recreational activity For vehicular traffic: disruptions in traffic flow For all: less space for trees and streetlamps

Elimination of makeshift dwellings by the road for want of any real estate to support them; Diminished opportunity for encroachment upon public space by unscrupulous parties it is easier to make inroads on a footpath than on a traffic-filled street; Less space for unsightly heaps of garbage or stray animals to accumulate and raise the
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risk of adverse traffic events and potentially the spread of disease; and Freedom from pavement stalls and peddlers, and the organic and plastic waste that their transactions frequently generate. While having no footpaths may seem to obviate misuse, it does so at a very high price, ruling out the many safety and recreational features offered by well-maintained footpaths, and leaving people vulnerable to risks of injury, disease, and death. How may street-use be optimised and public health promoted through footpaths?

Current needs Let water through: pervious paving facilitates the recharging of ground water, and prevents water-logging. Plant trees. Establish public toilets, and convert waste to fuel. Improve public transportation. Provide recreational facilities.

Introducing or reinstituting footpaths as designated pedestrian-paths; Keeping pavements in good repair to facilitate safety for users and to support the practice of walking for pleasure and exercise, besides for utilitarian purposes; Ensuring a clear level difference between the footpath and the street, and ideally creating an additional barrier of shrubs between them; Using pervious materials in paving to facilitate the percolation of rainwater and waste water into the ground, to prevent water-logging; Building covered drains flanking streets, to obviate flooding and facilitate the harvesting of rainwater runoff, keeping at bay a potential disease- and death-trap; Nurturing trees along the pavements to mitigate the adverse effects of a warming planet and facilitate greater comfort on a daily basis; Setting up public toilets, paired with biogas plants, at busy spaces such as markets and bus termini, to both obviate the befouling of the streets, and to harness the energy from human and market waste to provide better lighting of streets for greater safety; Checking unauthorised occupation of pavements for storage, residence and commerce. Ideally, demarcated small bays at intervals along the pavement should be designated for hawkers, rest-stops, dustbins, and well-maintained public toilets to ensure that streets and footpaths are not misused
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and unduly dirtied; and

Judicious urban planning to mitigate pollution and alleviate traffic congestion by enhancing public transportation, providing environment-friendly alternatives to private vehicles with the co-benefit of drastic reduction of accident-risk. The future a fantasy waiting to be realised? Bicycle lanes between streets and footpaths to encourage bicycling as a safe mode of transportation, while not impeding either motorised or pedestrian traffic; Repurposing certain 'waste' materials to pavement construction rather than useless accumulation in dumps, e.g. shredded discarded rubber for the pavement surface; Future directions discarded plastics for pavement structures; Extract resources from Solar panels at regular intervals to receive and store energy for public good; waste. Technological innovations such as pervious concrete,5 an eco-sustainable6 material that allows rainwater and Use technological run-off to percolate into the ground and replenish innovations for safer groundwater in place of waterproof surfaces that roads. encourage waterlogging and make no contribution to much-needed groundwater; and Harness renewable Piezoelectric pavements that convert the mechanical solar and mechanical stress generated by users to electrical energy that can be energy for public good. used for street-lighting, putting into place a virtuous circle of encouraging pavement use and harnessing it for public services. This would be a remarkably eco-friendly, sustainable, low-carbon energy-generation technique, apt for our human-resource rich country. Collaboration and cooperation are key to the optimal construction, maintenance and use of the built environment. Ideally, a coalition of the government and private bodies could construct and maintain pavements, and users cooperate in their upkeep, to yield the diverse health benefits of greater safety from injury, reduction in exposure to vehicular exhaust, diminution of (urban) heat islands, and an environment supportive of healthy behaviours such as physical activity, and smoother social interaction. The manifold advancements in health and well-being that can be achieved by the diligent maintenance of well-made footpaths, an aspect of the urban built environment, is displayed in the figure below.
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Safety from injury Smoother traffic flow

Support for outdoor physical activity & active transport

Well-designed, wellmaintained footpaths

Opportunities for outdoor social interaction & community activities

Protection from air pollution Reduced noise pollution

Opportunities for employment & recreation

Figure 1. Public health benefits associated with well-designed, well-maintained footpaths

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References 1. World Health Organization. Global status report on road safety: time for action. [Internet] 2009 [Cited September 21, 2011] Available from: http://whqlibdoc. who.int/publications/2009/ 9789241563840_ eng.pdf. 2. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, and Mathers C. World Report on Road Traffic Injury Prevention: World Health Organization. [Internet] 2004 [Cited September 19, 2011] Available from: http://whqlibdoc.who.int/ publications/2004/ 9241562609.pdf 3. World Health Organization, Regional Office for South-East Asia. Regional Report on Status of Road Safety: the South-East Asia Region. [Internet] 2009 [Cited September 21, 2011] Available from: http://www.searo.who.int/LinkFiles/Publications_report-status-road-safety.pdf 4. Office of the Registrar General & Census Commissioner, India. Statistics on Demographic & Socio-Economic Characteristics [Internet]. 2007 [Cited October 12, 2009] Available from: http://www.censusindia.gov.in/Census_Data_2001/ India_at_glance/glance.aspx 5. National Ready Mixed Concrete Association. Pervious Concrete Pavement: An Overview [Internet]. 2009 [September 14, 2011]Available from: http://www.pervious pavement.org/ 6. Obla K. Pervious Concrete for Sustainable Development. Recent Advances in Concrete Technology [Internet]. 2007 Sep [Cited September 14, 2011]Washington DC. Available from: http://www.nrmca.org/research/Pervious% 20recent%20advances%20in%20concrete%20technology0707.pdf

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