The interconnection between city, citizen’s health and city government is very curious. A recent revelation of the decision taken by the city government of Philadelphia in America proves the point. The city council had added an additional tax of 1.5 cents per ounce on all sweetened drinks, including diet sodas. And the results are amazing.

The study published by the Journal of the American Medical Association (JAMA) found that there was a 51 per cent reduction of sales of sweetened products within the city. How this reduction in sale has affected the health of its citizens, probably, a further study will reveal.

The hard fact, however, remains that the cities across the world are facing the challenge of increasing health problems which is linked to their dietary habits. Of course, sedentary life style is another major contributor. Better health outcomes are linked to reduction in obesity, diabetes and cardio-vascular diseases. Reducing the intake of added sugar is one of the first steps in this direction.

In Indian cities, all of the above issues pose a phenomenal challenge.

According to the International Diabetes Foundation, India had more diabetic patients than any other country in the world until recently. More than 62 million Indians, which is over 7.1 per cent of the adult population, are diagnosed with diabetes. The same study suggests, there will be 109 million individuals with diabetes by 2035. Intake of high calorie food, low-activity lifestyle, especially by the growing middle class, is attributed to such a high incidence.

Out of 10 diabetic individuals, seven are from the cities in India. However, only 33 per cent Indians live in the cities. This figure reveals the urgency in which the cities have to act.

The National Urban Survey conducted across the metropolitan cities of India reported high incidence of diabetes: 11.7 per cent in Kolkata (Eastern India), 6.1 per cent in Kashmir Valley (Northern India), 11.6 per cent in New Delhi (Northern India), and 9.3 per cent in Bombay (West India) compared with (13.5 per cent in Chennai (South India), 16.6 per cent in Hyderabad (South India), and 12.4 per cent Bangalore (South India).

The moot question, in the Indian context, is that even if the city government and the city thinks intone to other cities of the world, do they have the ability to implement even an iota of what they think.

The hard fact remains that the governance in cities in India and for that matter in South Asia is very limited in the hands of city governments.

In India, the cities are more like adjuncts of the state (province) governments. The city council has completely lost its ability to tax after the new Goods and Services Tax (GST). The city governments’ role has been reduced to smaller responsibilities, giving it lesser chance to intervene. Moreover, public health does not come in the domain of the city government as the parastatals in various state governments are responsible for public health.

While Philadelphia is a sweet reminder of what the city government can do to ensure a quality life for its citizens, it is also a reminder of the role that the city governments must perform in the future. And, that role is not just limited to providing the basic utilities to its citizens but also to ensure a livable city.