How Smart Urban Design And Walkable Streets Could Be India's Master Plan For Healthcare

When Edwin Lutyens and Herbert Baker drew up plans for New Delhi in 1912, they imagined a capital that would showcase imperial grandeur rather than human vitality.

Walking was never at the heart of this design. It was incidental, relegated to clerks on errands or servants on foot. The architecture itself embedded fatigue into the daily lives of the many, privileging distance and separation over proximity and connection.

This spatial logic endured long after the Union Jack came down. The Delhi Master Plan of 1962 reinforced it by borrowing suburban zoning models from the West, separating work, housing, and commerce into distinct zones, linked not by shaded streets or walkable corridors but by highways.

The outcome was predictable: long commutes, dependence on vehicles, and an urban landscape that sapped incidental activity out of daily routines. In such a city, exhaustion is built not from physical exertion, but from the grind of immobility, hours lost in traffic, coupled with systematically limiting opportunities for walking.

Once India went through economic liberalisation in the 1990s, there was a visible impact on urban life.

Rising incomes and easy car loans put millions of middle-class Indians on the road. Delhi alone now counts more than 12 million registered vehicles, exceeding the population of many countries. The city is built for speed but delivers only gridlock and smog, where cars rule and pedestrians are sidelined.

In this landscape, India's cities have quietly engineered what scholars call an "obesogenic environment": designed for vehicles rather than people, and fast food rather than healthy living.

Obesity: The Urban Design Side Effect

Urban form is never neutral; it scripts how we live, move, and even eat. In India's metropolitan cities, that script is increasingly tilting toward expanding waistlines.

According to NFHS-5 (2019–21), 24% of Indian women and 23% of men (aged 15–49) are overweight or obese. But Delhi stands out alarmingly: 41.3% of women and 38% of men fall into that category, pulling the capital closer to the obesity trajectory of the United States than to its Asian peers.

Japan, with compact cities that encourage walking and a food culture rooted in portion control and balance, keeps obesity under 5%. The United States, shaped by suburban sprawl, car dependency, and supersized portions, has reached 42%.

Disturbingly, Delhi's obesity profile now mirrors the American end of the spectrum, even as childhood obesity in India has nearly doubled in just five years (NFHS data).

Blaming "bad diets" or "individual willpower" misses the point. Life in cities like Delhi and Mumbai often leads to lethargy. Long commutes drain energy, leaving little time for exercise. Safe, shaded sidewalks are scarce; pedestrian crossings are hostile and vehicle-oriented. Public parks and open spaces are shrinking under relentless urban expansion, replaced by highways and flyovers.

The risks are not theoretical; 32,825 pedestrians were killed on India's roads in 2022, making walking in Indian cities not just inconvenient but dangerous. This is why walkability is not merely about the presence of a sidewalk. It is about connectivity, safety, comfort, and proximity.

Urban design scholar Jeff Speck's "general theory of walkability" makes the case that a neighbourhood becomes truly walkable only when it is useful, safe, comfortable, and interesting.

Delhi fails across the board.

Many sidewalks are broken, blocked by vendors or parked cars, or interrupted by open drains. Where they exist, they often lack trees, benches, or shade, rendering them unusable in Delhi's 45°C summers. Crossings on arterial roads are engineered for traffic flow, not human beings, forcing pedestrians to risk their lives. Even block sizes in planned colonies are so large that a short errand becomes a circuitous trek.

The predictable outcome is that residents default to motorised transport, even for 500–800 metre trips that, in Tokyo, Barcelona, or Amsterdam, would be a quick stroll. This erosion of incidental activity, the low-intensity walking that once shaped healthier urban life, creates fertile ground for obesity and its associated diseases.

If Delhi's streets discourage movement, its food environment compounds the problem. Over the past two decades, fast-food chains like McDonald's, Domino's, and KFC have blanketed the city, while food delivery platforms have turned high-calorie meals into an on-demand service.

According to a 2023 NielsenIQ report, 65% of online food orders in Indian metros are for fried or heavily processed foods. The convenience economy has eliminated the last remnants of activity tied to food procurement: no more walking to the market, browsing shops, or carrying groceries home. Now, food arrives at the doorstep within 20 minutes, deepening the cycle of inactivity.

This shift is not only about consumer choice but also about time poverty. In households where both adults work, or where women juggle paid work with unpaid household duties, processed snacks, sugary drinks, and delivery meals are quick fixes that get normalised. A 2022 BMJ Open study found that urban Indian households where all adults were overweight or obese were nearly twice as common as rural households.

The combination of poor walkability and calorie-dense convenience creates what public health scholars call an "obesogenic environment", a setting that makes unhealthy lifestyles the default. Urban design, in other words, makes weight gain not a personal choice but the path of least resistance.

A 2025 international study tracking two million smartphone users found that residents of more walkable cities consistently logged 1,000–1,500 more daily steps than peers in car-centric environments, enough to reduce long-term health risks dramatically. The evidence is clear: when the city moves, its people move. When it sprawls and stalls, they sit, drive, and swell.

Obesity is not simply a function of individual choices; it is patterned by the physical and social fabric of cities. Globally, the sharpest contrasts appear when one compares places that are designed for movement against those that are not.

Take Tokyo, often cited as the healthiest megacity in the world. Its adult obesity rate is just 4.9%, a figure made possible not by gyms or diets but by urban form.

Neighbourhoods are dense and mixed-use, meaning daily needs, schools, clinics, convenience stores, and workplaces are typically within a 10–15 minute walk. Public transportation is ubiquitous, and the metro system alone carries over 8 million passengers daily.

Car ownership is low, about 0.32 vehicles per household, not because of bans but because parking is scarce, expensive, and tightly regulated. Walking and stair-climbing are woven into the fabric of everyday life: commuters walk to stations, climb stairs, transfer between lines, and walk again to their final destination. The cumulative effect is incidental activity built into routine.

Across Europe, urban planning traditions reflect measurable health dividends as seen in the following cases:

• In Copenhagen, where adult obesity is just 19%, over 60% of residents commute to work or school by bicycle, supported not just by 400 km of segregated cycle tracks and dedicated bridges, but by policies that treat cycling as a mass-transit priority, snow is cleared from bike lanes before roads in winter.

The basic observation from the steps taken in Europe is that infrastructure alone is insufficient; pricing signals, governance structures, and visible civic programming are equally critical.

For Indian cities, this points toward a pragmatic framework: pair physical redesign (continuous sidewalks, shaded bike lanes, mixed-use zoning) with fiscal tools (parking caps, congestion fees), and cultural programming (open streets, active commute campaigns).

That combination, not piecemeal footpaths or ad hoc bike tracks, is what makes walking and cycling part of a city's metabolism rather than a lifestyle niche. Many cities in Asia provide lessons for India to learn:

The result: obesity prevalence of just 8.7%. Importantly, Singapore combines infrastructure with active public-health policies, such as calorie labelling and school-based exercise programs, showing how urban form and governance can act together.

Shanghai has taken this to the next level with a licence plate auction system, modelled on Singapore's COE, where a new plate can cost more than the car itself. This not only throttles uncontrolled motorisation but also generates revenue that can be reinvested in public transit and walkable infrastructure.

In Beijing, a lottery-based plate limit has been experimented with since 2011 to manage congestion and curb emissions, though it has illuminated challenges like cross-city evasion and enforcement leaks.

The turnaround was astonishing: urban temperatures dropped by up to 3.6 °C, air pollution fell by 35%, and the area's biodiversity exploded, boasting over 666 documented species of plants and animals. Equally important, walking became a pleasure again; the stream now draws over 12 million visitors annually.

What these global examples make clear is that walkability isn't just a design challenge; it is a governance one. It demands hard choices: allocating scarce street space, deploying fiscal deterrents like COEs or congestion pricing, investing in walkable infrastructure, and sometimes, even dismantling roads that encourage driving.

For India's cities, the lesson is both aspirational and urgent: an urban form that prioritises people over vehicles, combined with policy tools that nudge behaviour, can create cities that walk, rather than ones that make us stop.

The common thread across these global cases is unmistakable: obesity rates remain low where cities provide continuous, safe, and attractive walkable infrastructure, integrated mass transit, and proximity to daily needs. These cities prove that health can be an emergent property of design.

By contrast, Indian cities occupy a paradoxical position.

They are already dense by global standards; Delhi's density is higher than Tokyo's, but density without walkability is wasted. Mixed-use zoning exists informally, but without safety and accessibility for pedestrians, proximity does not translate into activity. The result: urban Indians live in environments that should encourage walking but instead discourage it at every turn.

In effect, Delhi and Mumbai are dense but hostile, while Tokyo and Hong Kong are dense but humane. The lesson is clear: density alone does not deliver health benefits; design determines whether density breeds vitality or obesity.

Policies That Talk, but Rarely Walk

• Fragmented Governance. In Delhi, road ownership is divided among the Public Works Department, the Municipal Corporation of Delhi, the Delhi Development Authority, and the National Highways Authority of India. No single entity is accountable for pedestrian infrastructure.

Contrast this with cities like Barcelona, where the "Superblocks" programme reorganises traffic by restricting through-traffic within clusters of nine city blocks, reclaiming inner streets for pedestrians, cyclists, and community spaces.

Another notable example would be from Bogotá, where the "Ciclovía" event, launched in the 1970s, closes over 120 km of streets every Sunday as well as on public holidays, transforming them into car-free corridors for walking, cycling, skating, and socialising, and presently draws nearly a quarter of the city's population each week.

Both initiatives embody the spirit of "open streets" (which has inspired multiple open street programmes in cities worldwide, from Mexico City to Los Angeles), temporary or permanent reallocation of road space to people instead of cars, making active mobility not only safer but also a cultural norm.

Together, they have led to measurable increases in physical activity and reductions in traffic injuries, offering lessons for cities struggling with car dependence.

Building on EMBARQ's Transit-Oriented Development (TOD) principles from the World Resources Institute, three key design strategies emerge as vital to reshaping India's urban fabric:

• Connected Streets. Cities should shun disconnected hierarchies that force long trips and concentrate traffic. Instead, well-linked grids with short blocks and frequent intersections promote walking and distribute traffic more evenly.

The Stakes: Health and Economics

Obesity is not just a personal health issue; it's a macroeconomic problem. In 2019, the economic cost of obesity in India was estimated at $28.95 billion (₹1,800 per capita), about 1.02% of GDP. By 2030, that could rise to ₹4,700 per capita and 1.57% of GDP.

Non-communicable diseases (NCDs), heart disease, diabetes, and certain cancers account for 60% of deaths in India. Physical inactivity, fuelled by poor urban design, is a key risk factor. WHO estimates that low- and middle-income countries bear 82% of premature NCD mortality globally. In the WHO Southeast Asia Region, India alone contributes 67% of NCD deaths.

What Needs to Change and Way Forward

To reverse India's urban obesity trend, policy must move beyond rhetoric to embed health by design in city planning.

This means mandating Complete Streets standards with continuous shaded sidewalks, safe crossings, and last-mile walkability around transit; tying central grants to measurable walkability and safety outcomes.

Land-use and zoning laws should enable mixed-use neighbourhoods to cut commute distances while restricting fast-food density near schools and incentivising fresh produce markets.

Building codes must adopt active design features (visible stairs, shaded courtyards, open corridors), particularly in public buildings, schools, and transport hubs.

Education and transport ministries should jointly promote school-based mobility programmes such as walking school buses, and integrate routine obesity awareness into school and workplace health checks.

Finally, governance needs a multi-sector Healthy Urbanism Task Force, coordinating transport, health, housing, and municipal agencies, with annual reporting on mobility, food access, and child activity indicators.

In short, embed walkability, food access, and active living into the very metrics of urban development, treating health as an outcome of infrastructure, not just healthcare.