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As India urbanises, pollution, stress, and processed diets are fuelling autoimmune diseases—demanding policy that links city design to health.
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Autoimmune conditions are rising worldwide. Currently, autoimmune conditions affect one in 10 individuals globally. According to the National Family Health Survey (NFHS), the prevalence of thyroid disorders among Indian women rose from 2.2 percent in NFHS-IV (2015-2016) to 2.9 percent in NFHS-V (2020-2021), marking a notable increase within just five years. A 2020 Thiruvanthapuram study found that thyrotoxicosis affects 2.5 percent of the patient population with thyroid disorders, and identified Graves` Disease, an autoimmune condition, as the main contributor. Several studies suggest a strong association between urbanisation and the increase in autoimmune conditions. Urban areas show a much higher burden of autoimmune diseases compared to rural regions. A 2024 study in Uttar Pradesh reported rheumatoid arthritis to be three times more prevalent in urban areas than rural areas.
Similarly, a 2015 study in Haryana found that type 1 diabetes affected 26 individuals per 100,000 in urban areas, but only 4 per 100,000 in rural populations. However, underdiagnosis outside metros and private labs may bias rural estimates downward to some extent. Notably, the incidence of type 1 diabetes is climbing at about 6.7 percent each year, with more than 800,000 patients currently living in India. The growing gap between urban and rural populations underscores the role of ‘urbanicity’—the degree to which areas exhibit urban characteristics—in influencing autoimmune disease risk and health outcomes. This divide highlights how place-based factors mediate vulnerability and resilience. India’s rapid urbanisation may shape who gets diagnosed, how severe the disease becomes, and who can access care.
Autoimmune diseases arise when the body’s immune system malfunctions and mistakenly attacks its own healthy cells instead of targeting germs or other foreign invaders. These conditions are chronic, without a definite cure, and often require lifelong management. Common examples include rheumatoid arthritis, which causes joint stiffness; type 1 diabetes, which typically develops early in life; psoriasis, a skin disorder; and inflammatory bowel disease, which affects the gut. One of the main things that can set off autoimmune diseases is inflammation.
Urban environments are also linked to reduced microbial diversity, vitamin D deficiency from limited sunlight exposure, sleep and circadian rhythm disturbance due to disruptive schedules, and measurable shifts in the gut microbiome compared to rural settings, all of which contribute to an increased autoimmune risk.
Inflammation is the body’s way of reacting to something that irritates it. It usually shows up as redness, warmth, swelling, and more blood flow in the affected area. Whereas the body reacts the same way to external substances in case of allergies, these symptoms resolve once the allergen is taken away. In case of autoimmune conditions, the symptoms last and often worsen over time. If the body is pushed into this inflamed state again and again over time, it can lead to long-lasting issues. While genes play a big role in making someone more likely to develop an autoimmune disease, constant inflammation often acts as the spark that brings it on.
Air and water pollution, and an increasing number of processed foods, are key differentiators of urban life from a rural one. All of them introduce harmful substances directly into our bodies, causing inflammation. Furthermore, urban life often entails a sedentary lifestyle with more stress, which hampers the body`s own mechanisms of keeping inflammation in check. A 2016 study conducted in Karnataka on adolescent girls found that urban poor often rely on processed food because it is convenient and cheaper than acquiring cooking fuel, ingredients, and space. Equally poor rural households, however, always prepared and ate simple, homemade meals. A 2025 study from Delhi found autoimmune dysregulation to be far higher in children living in areas of heavy traffic. Urban environments are also linked to reduced microbial diversity, vitamin D deficiency from limited sunlight exposure, sleep and circadian rhythm disturbance due to disruptive schedules, and measurable shifts in the gut microbiome compared to rural settings, all of which contribute to an increased autoimmune risk.
Urban adults of means often engage in leisurely physical activities and can even opt to buy organic produce of more nutritional value. A 2018 Chandigarh study found that the socioeconomic differences are reflected even in student life, where affluent urban children were found to engage significantly more in sports or leisurely physical activities. Choices that are healthy and can reduce inflammation are accessible to them.
Urban residents from low-income groups, homeless persons and those in makeshift roadside shelters appear more vulnerable to autoimmune responses due to pollutant exposure and processed diets. They also face major barriers to care, including limited financial capacity and awareness, restricted access to rheumatology and endocrinology specialists, high imaging and laboratory costs, poor affordability of biologics, and frequent diagnostic delays. Low-income groups often rely on government schemes and subsidies to aid in medical expenditure. Autoimmune conditions require continuous medication, often throughout life. Making provisions in the current state and national schemes, such as Pradhan Mantri Jan Aarogya Yojana and Mahatma Jyotiba Phule Jan Arogya Yojana, for the periodic disbursement of free medication, along with palliative care if required, can go a long way to provide for these vulnerable sections.
Urban residents from low-income groups, homeless persons and those in makeshift roadside shelters appear more vulnerable to autoimmune responses due to pollutant exposure and processed diets.
Developed nations such as the United States (US) and the United Kingdom (UK) report higher proportions of autoimmune diseases but have responded with stronger systems of care. The US has invested heavily through the National Institutes of Health research funding, while the UK’s National Health Service ensures broad access to costly biologics. With greater resources and more time to prepare, these countries have built infrastructure and clinical systems that many developing nations still lack. Some of the developing nations are now paving the way for autoimmune care, like Brazil`s Sistema Único de Saúde organisation, providing free medications for autoimmune hepatitis and lupus. Among South Asian countries, Thailand has a Universal Coverage Scheme including biologic treatment options for autoimmune diseases on the rise. South Africa has a robust HIV management infrastructure, much like India. They have leveraged it to co-manage autoimmune and immunodeficiency conditions. India could draw on these examples to leverage existing healthcare systems and expand autoimmune care through improved specialist access, affordable diagnostics, and treatment support.
India can strengthen autoimmune disease care by creating a dedicated research fund that supports large-scale gene–environment cohorts, microbiome studies, and real-world evaluation of biosimilars. Policy priorities should also include mandatory latent tuberculosis and hepatitis screening protocols before biologic initiation and strengthening the Pharmacovigilance Programme of India (PvPI). Together, these steps would accelerate evidence generation, reduce diagnostic delays, and lead to the relevant development of advanced treatments.
Mandating front-of-package food labelling would empower consumers to make healthier choices. While roadside and median greenery can help reduce air and noise pollution, it must be complemented by systematic urban design measures to address these challenges effectively. Enforceable green buffers between high-traffic corridors and residential or commercial areas, alongside low-emission zones near schools and hospitals, can significantly reduce pollutant exposure and reduce autoimmune risks. Expanding clean bus fleets, creating shaded green corridors with continuous sidewalks, and introducing traffic-calming measures can make cities more walkable and healthier.
Enforceable green buffers between high-traffic corridors and residential or commercial areas, alongside low-emission zones near schools and hospitals, can significantly reduce pollutant exposure and reduce autoimmune risks.
As type I Diabetes is on the rise in Children, children in high-risk families could be screened as part of their general check-ups. Access to experts through telemedicine could be improved. This can prove especially helpful in rural areas where awareness and facilities for a relevant diagnosis are scarce. Currently, the medical protocol for autoimmune treatment focuses mainly on immunosuppression. This does not often lead to remission or a long-lasting cure. Recent developments suggest the inclusion of CAR-T Cell Therapy for reprogramming the immune response.
As India urbanises and autoimmune diseases rise, policy must move beyond treatment to prevention, early detection, and evidence-driven care. Dedicated funding for gene–environment cohorts, microbiome research, and biosimilar evaluation, coupled with mandatory screening protocols and stronger pharmacovigilance, will accelerate progress. Urban health can be safeguarded through front-of-package food labelling, green buffers, clean transit, and a walkable design. Early screening of high-risk children, expanded telemedicine access, and biomarker-based treatment protocols can further reduce delays and improve outcomes. Together, these measures offer a comprehensive path to equitable, sustainable autoimmune care in India.
Nihar Kulkarni is an Intern with the Health Initiative at the Observer Research Foundation.
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Nihar Kulkarni is an Intern with the Health Initiative at the Observer Research Foundation. ...
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