Role Of Cities in NCD Prevention and Management: A Qualitative Research Study among Doctors

Abstract

Background: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases are major global health concerns, surpassing the mortality rates of communicable diseases. These conditions pose significant challenges to global development, particularly in low- and middle-income countries where two-thirds of NCD-related deaths occur. In Pakistan, NCDs account for nearly 25% of all fatalities. The prevention of NCDs requires continuous lifestyle modifications, and evidence suggests that the physical environment and urban design play crucial roles in influencing health behaviors and outcomes. Objective: This study aimed to assess doctors' perspectives on the role of cities in the prevention and management of NCDs in Pakistan, and to identify barriers and enablers to the development of healthy city policies. Methods: This descriptive exploratory study employed a qualitative approach, conducted at various private hospitals in the Twin Cities. A purposive sample of approximately 20 doctors from medical units and outpatient departments participated in focus group discussions (FGDs). Data were collected using a semi-structured interview guide, and the FGDs were audio-recorded with participants' consent. Thematic analysis was performed to identify major themes and subthemes related to the role of urban environments in NCD prevention and management. Results: Participants recognized the importance of physical activity, healthy environments, and lifestyle modifications in preventing NCDs. Key barriers to physical activity included socio-cultural norms, environmental limitations, and political/legislative challenges. Facilitators included individual willpower, health-seeking behavior, supportive policies, and perceived benefits. Poor air quality and the lack of green spaces were significant contributors to the increased prevalence of NCDs. Participants emphasized the need for government intervention to improve urban infrastructure, promote physical activity, and enhance public health initiatives. Conclusion: Well-planned cities can significantly reduce the burden of NCDs by addressing modifiable risk factors. Governments must prioritize the development of infrastructure that promotes physical activity, improves air quality, and increases access to green spaces. Comprehensive multisectoral strategies are essential to combat the rising threat of NCDs, particularly in rapidly urbanizing areas.