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This chapter studies the link between urban planning and health. Access to safe drinking water is already a very serious issue for large urban populations in fast-growing economies such as India. Water availability is further being impacted by climate change, leading to the drastically increased spread of water-related diseases.

Leh Town, which is located in an ecologically vulnerable semi-arid region of the Himalayas in Ladakh, has been considered for this study because it is undergoing large-scale transformation due to rapid growth in its tourism industry. In 2012–2013 our interdisciplinary group comprising researchers from Germany and India conducted field surveys, including geographic information system-based (GIS) mapping of point sources of water pollution, questionnaire surveys of 200 households and 70 hotels and guesthouses and semi-structured interviews. We also reviewed secondary medical data.

We found that diarrhoeal incidence has increased in the local population in Leh in the past decade, which may be linked to water pollution: Further, we found that rapidly increasing water consumption coupled with a lack of adequate water and sanitation infrastructure is causing serious water pollution.

Further, data is needed for causal connections between water pollution and health impacts to be conclusively drawn.

This study discusses the use of GIS to support a call for the need for more integrated urban planning and decision-making that holistically addresses water and health challenges in Leh and advocates the development of a decentralized or hybrid sanitation system to support water resources conservation as a central dimension of an integrated health management approach.

GIS is also a very useful platform for supporting participatory urban planning in Leh.

With such an integrated urban planning approach, Leh would be a lighthouse example for other towns in the region.

The purpose of this paper is to examine the prevalence of tobacco use and associated factors influencing the use of tobacco among adolescents in a school setting.

A cross-sectional descriptive study was conducted amongst Bhutanese adolescents studying at high schools in the district of Wangdue Phodrang in May 2016. A total of 378 eighth-grade students from four schools participated in the study. A self-administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were carried out to describe the predictors of tobacco use.

Of the 378 student participants, 52.90 percent were girls and 47.10 percent boys. The age ranged from 11 to 19 years, and the majority lived in school hostels (82 percent). The prevalence of smoking was 10.80 percent while smokeless tobacco users constituted 11.10 percent in the month preceding the study. Gender, tobacco use by siblings and friends, ever having tried alcohol, consumption of alcohol in the last 30 days, previous experimentation with cigarettes/bidi and smokeless tobacco/baba (p-value <0.05) were significantly related to the use of tobacco among students. In multivariate analysis, tobacco use by friends (AdjOR=1.09; 95%CI=0.01–2.48), ever having tried alcohol (AdjOR=2.24; 95%CI=1.75–3.72), current alcohol use (AdjOR=2.63; 95%CI=1.52–4.31), experimentation with cigarettes/bidi (AdjOR =39.46; 95%CI=11.91–90.63) or with smokeless tobacco/baba (AdjOR=32.61; 95%CI=11.78–90.30) were observed as the strong predictors of current tobacco use among adolescents.

These study results re-emphasized the rising public health concern of tobacco use among younger boys and girls. The findings may help the Bhutanese policy makers and managers to better understand the present situation of adolescent tobacco use and its associated determinants, and formulate appropriate tobacco control strategies for adolescents.

The case is structured to achieve the following learning objectives: ■ to assess how an intuitive response to social need can be complemented with a methodical approach to social entrepreneurship; ■ to analyse the importance of business model canvas from the social sector lens; ■ to evaluate the value created by a small NPO 17000 ft Foundation; ■ to analyse the core elements of a business model for success in the social sector; and ■ to assess and evaluate the options for an early-stage NPO to engage in scaling for a systemic impact.

17000 ft Foundation (hereafter referred to as 17000 ft) is a not-for-profit (NPO) organisation incepted in 2012 by Sujata Sahu, with the objective of supporting education of children living at high altitudes in remote villages of Ladakh, India. It is an effort that contributes toward objectives of clause 6.1 on educational inclusivity in the new National Education Policy 2020 of India. The case study is set in the context of Indian education, with all its challenges. It describes how Sujata Sahu was motivated to start the Foundation and how it developed to become a complex organisation working on different education-related projects simultaneously. The Foundation’s business model is interesting and unique. It leverages digital technologies to develop a network of interconnected activities, involves local communities and uses an extensive network of different kinds of stakeholders to impact a change in the quality of education in government schools in these remote villages. The case provides a solid basis for the discussion of the vital role of NPOs such as 17000 ft (in emerging economy) which is creating social and economic value for the remote villages of Ladakh, India. The new NEP 2020 argues for equity and inclusivity in education for all, but it failed to provide a blueprint for the implementation process. On the other hand, 17000 ft with its small team was invested and experimental in its approach. It had been working on the same cause of educational inclusivity. They had piloted a quality education business model for the harshest and remote Indian terrains and proven its positive impact. What were some of the core elements that had led them to success so far? The announcement of NEP 2020 provided a new ray of hope. How could they contribute and work together with the government to impact inclusive education and development in India? What collaborative mechanisms could possibly help them replicate their proven business model across the 1,000 schools of Ladakh and beyond? How could they scale for a systemic impact? After all, a nation as big as India required multiple strategies and multiple stakeholders from NPOs, private companies, government agencies, educational institutions, etc. to work collaboratively to bridge the inclusion and equity gaps in education.

The case can be used in graduate and executive education courses in entrepreneurship and strategic management. It can also be used for executive sessions at incubation centres for NPO start-ups and is aimed at early-phase social entrepreneurs.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.