India’s cities have undergone a significant transformation in how urban health and development are understood. Sanitation was once viewed primarily through the lens of toilets, drainage, and waste disposal. Today, the idea of a healthy city extends much further, encompassing clean air and water, responsible waste management, green spaces, sustainable transport, mental well-being, and inclusive urban planning. India’s journey from sanitation-focused interventions towards broader sustainability reflects a growing understanding that the health of people and the health of their environment are deeply connected. Building healthier cities therefore requires infrastructure, public participation, education, responsible governance, and long-term planning.
Why Is Sanitation Important for Healthy Cities?
Sanitation is one of the fundamental foundations of public health. Unsafe water, inadequate toilets, poor hygiene, and unmanaged wastewater can increase exposure to infectious diseases. The World Health Organization notes that contaminated water and inadequate sanitation are associated with diseases including diarrhoea, cholera, dysentery, hepatitis A, typhoid, and polio.
India’s sanitation journey received considerable momentum through the Swachh Bharat Mission, launched in 2014. The initiative placed sanitation and cleanliness at the centre of national development efforts and encouraged toilet construction, behavioural change, waste management, and community participation.
WHO reported that the Swachh Bharat initiative was expected to generate substantial health gains by reducing exposure to unsafe sanitation. Its assessment estimated that the rural component could avert more than 300,000 deaths related to diarrhoea and protein-energy malnutrition between 2014 and October 2019.
How Has India’s Urban Sanitation Journey Evolved?
India’s urban sanitation challenge has gradually shifted from simply providing access to sanitation facilities towards ensuring that sanitation systems function safely and sustainably.
Urban programmes increasingly need to consider the complete sanitation chain, including:
- Access to toilets and safe sanitation facilities
- Sewerage and wastewater treatment
- Faecal sludge management
- Scientific solid waste disposal
- Safe water supply
- Drainage and hygiene
- Behavioural change and community participation
A 2024 Bulletin of the World Health Organization article highlighted both the progress and remaining challenges in urban India. It noted major gains from the Swachh Bharat Mission while also pointing to gaps in wastewater treatment and sewerage infrastructure.
This demonstrates why sanitation cannot be treated as a one-time infrastructure project. Cities need systems that remain functional, adequately maintained, environmentally responsible, and accessible to different sections of the population.
What Makes a City Truly Healthy?
A healthy city is more than a clean city. It is a place where urban planning actively supports physical, social, and psychological well-being. WHO identifies several factors that shape urban health, including housing, transportation, water and sanitation, waste management, air quality, green spaces, and opportunities for physical activity.
For residents, these factors can influence Overall bodily well-being in everyday ways. Clean neighbourhoods, reliable water supplies, safer roads, accessible parks, reduced pollution, and well-managed waste systems can make healthy choices easier. Urban planning can therefore function as a form of preventive public health. When cities provide safe walking spaces, public transport, green areas, and clean environments, they can support healthier lifestyles while reducing environmental pressures.
How Are Environmental Conditions Connected to Mental Well-Being?
Urban environments influence mental as well as physical health. Traffic congestion, noise, overcrowding, pollution, long commutes, limited green spaces, and uncertainty about daily living can contribute to psychological strain. For individuals, developing practical coping skills can complement improvements in the physical environment. Techniques for Managing anxious thoughts can help people respond more constructively to worries, while Coping with everyday pressures may involve healthy routines, social connection, physical activity, relaxation, and professional support when required.
Spending time in green and open spaces can also provide opportunities to pause from constant stimulation. Present-moment awareness practices can encourage individuals to pay attention to their surroundings and current experiences rather than remaining focused entirely on past or future concerns. Psychological interventions can also teach Awareness-based therapeutic practices that help individuals recognise thoughts, emotions, and behavioural patterns. These skills do not replace improvements in urban infrastructure, but they can complement broader efforts to promote healthier communities.
Why Are Sustainable Cities the Next Step?
Sanitation is an essential starting point, but sustainable urban development requires a much wider approach. Cities must address environmental protection, resource efficiency, climate resilience, mobility, housing, public health, and social inclusion together.
The WHO describes sustainable cities as places where people have access to clean water and sanitation, safe waste collection, public transport, green spaces, and healthier ways of moving around.
A sustainable development environment therefore requires coordinated action rather than isolated projects. For example, improving public transport can reduce dependence on private vehicles, while better waste management can reduce environmental contamination. Expanding green spaces can support recreation, cooling, biodiversity, and healthier urban lifestyles.
The Sustainable Development Goals, particularly SDG 6 on clean water and sanitation and SDG 11 on sustainable cities and communities, provide an international framework for connecting these priorities.
How Can Education and Community Participation Improve Urban Sustainability?
Infrastructure alone cannot create lasting change. People need knowledge, opportunities, and incentives to participate in healthier urban practices.
Community-based education programs can help residents understand waste segregation, water conservation, hygiene, recycling, responsible consumption, and environmental protection. Schools, resident associations, workplaces, local organisations, and municipal bodies can all contribute to these efforts.
Practical participation may include:
- Separating waste at the household level
- Reducing unnecessary consumption
- Conserving water
- Supporting neighbourhood cleanliness
- Using public transport or walking when practical
- Protecting trees and community green spaces
- Reporting sanitation or waste-management problems
- Participating in local environmental initiatives
When residents understand how individual actions connect with community outcomes, sustainability becomes a shared responsibility rather than only a government responsibility.
What Role Can Organisations Play in Healthier Cities?
Non-governmental organisations, community groups, educational institutions, businesses, and public agencies can complement government programmes by addressing local needs and encouraging participation.
A well-designed project for development can combine sanitation, environmental awareness, education, community engagement, health promotion, and livelihood support. Such initiatives can be especially valuable when they involve local communities in identifying problems and developing practical solutions.
Urban health also requires attention to vulnerable groups. WHO emphasises that sustainable urban development needs to address inequalities and ensure that health considerations are integrated across sectors such as housing, transport, land use, energy, and waste management.
This broader approach recognises that healthier cities are built not only through infrastructure but also through inclusion, participation, and access to essential services.
What Does the Future of Healthier Indian Cities Look Like?
India’s sanitation journey has created an important foundation for the next stage of urban development. The future challenge is to connect cleanliness and sanitation with wastewater treatment, circular resource use, cleaner transportation, climate resilience, green infrastructure, public health, and social inclusion.
For individuals, participating in sustainable communities can also contribute to Building emotional strength and Personal growth and development by creating opportunities for social connection, purposeful participation, and responsible action.
Ultimately, healthier cities require a long-term perspective. The goal is not simply to make neighbourhoods cleaner today but to create urban systems that remain healthy, inclusive, resilient, and environmentally responsible for future generations.
Conclusion
India’s journey from sanitation to sustainability shows how the meaning of a healthy city has expanded. Clean toilets and effective waste management remain essential, but they are only part of a larger picture that includes clean water, safe mobility, green spaces, environmental responsibility, mental well-being, and community participation.
Organisations such as Global Development Foundation can contribute to community-focused development and awareness initiatives, while Psychowellness Center can support psychological well-being through counselling and mental health services. TalktoAngel, an online platform for counselling, can provide access to professional psychological support online. Together, such efforts can complement broader public initiatives and contribute to healthier, more informed, and more resilient communities.
Building healthier cities is a shared responsibility. Governments, organisations, businesses, communities, and individuals all have a role to play in turning sanitation gains into lasting sustainability.
Contributions: Dr. R. K. Suri, Clinical Psychologist & Life Coach, and Ms. Mahima Mathur, Counselling Psychologist
References
- World Health Organization. (2018, July 27). Health gains from Swachh Bharat initiative. https://www.who.int/india/news-room/detail/27-07-2018-health-gains-from-swachh-bharat-initiative
- World Health Organization. (n.d.). Water, sanitation and hygiene (WASH) – India. https://www.who.int/india/health-topics/water-sanitation-and-hygiene-wash
- World Health Organization. (2019, August 8). Sustainable cities: Health at the heart of urban development. https://www.who.int/publications/m/item/sustainable-cities
- World Health Organization. (n.d.). Providing cross-cutting solutions to improve health in urban areas. https://www.who.int/health-topics/urban-health/providing-cross-cutting-solutions-to-improve-health-in-urban-areas