Urbanization, Urban Poverty and Health of the Urban Poor: Status, Challenges and the Way Forward

Abstract

Background: One of the dominant concerns of the present age is the improving the living conditions of the rapidly increasing population living in cities. For the first time in human history beginning 2007, more than half of the world’s population will live in cities. Estimates by the United Nations suggest that the world’s urban population has been increasing at a rate of 1.8 per cent annually and will soon outpace the overall world population growth rate of 1 per cent. Nearly 48 per cent of the world’s population lives in urban areas and the prime locus of this spurt in city dwellers are the developing countries such as India. India, as the rest of the developing world, is urbanizing rapidly. 27.8 per cent of the country’s population comprising 285.4 million people, live in urban areas. India’s urban population grew by 31.2 per cent during the decade 1991-2001 which is significantly higher than the rural rate of 17.9 per cent. During this preceding decade, the urban population increased by 68 million persons. The poor comprise a large and sizeable proportion of our cities and towns. Over a fourth (25.7 per cent) of India’s population resides in urban areas. Poverty is therefore no longer a rural phenomenon. Health vulnerability of slum populations: Slum residents are especially vulnerable to health risks. ‘Vulnerability’ can be defined as a situation where the people are more prone to face negative situations and when there is a higher likelihood of succumbing to the adverse situations. With reference to health, it implies a situation leading to increased morbidity and mortality. Agarwal and Taneja have studied mutli-factorial aspects that adversely affect health vulnerability of slum and informal settlement population. Disaggregation of data by asset based wealth quartiles reveals the sharp disparities which exist between the urban poor and better-off sections in urban areas. In fact, slum dwellers in cities suffer from adverse health conditions which are sometimes worse than those living in rural areas. Utilization and reach of primary health services is poor among urban slum communities in India even though there is physical proximity to advanced health care facilities. Under-nutrition is an important factor contributing to poor health in urban slum communities. Over half of India’s urban poor children are underweight and/or stunted. In most states, under-nutrition among the urban poor is worse than among rural areas. Poor sanitation and hygiene, less than optimal care during illnesses, quality and affordable healthcare facilities not being in physical proximity to slums, low awareness and practice of recommended health practices contribute to poor access to services, poor health behaviours and nutritional status among the urban poor result in high infant and child mortality which are considerably higher among the urban poor as compared to national and state averages. The notion of “illegality” of slums leads to their exclusion from programmes and services. Inadequate and ineffective government health services, unclear accountability and weak coordination among different stakeholders, weak linkages between slum communities and service providers, low demand for services and poor environmental conditions adversely affect health and nutrition of slum dwellers. Opportunities in urban areas: The National Rural Heath Mission (NRHM) having an allocation and strategy for urban health, constitution of a national task force to frame appropriate strategies for urban health care, presence of Health Department, NGOs, private and charitable hospitals and Corporate sector social responsibility units are potential partners in urban areas. Private Public Partnership (PPP) with a pro-poor focus, slum and vulnerable groups directed innovative urban health programming, advocacy and focus on energetic policy implementation are approaches that have shown merit in addressing health and nutrition challenges of the urban poor. Conclusion: In order to make health services accessible to the urban poor, it is necessary to augment urban primary health infrastructure. Partnership with the private sector is an effective way to improve access to health services in urban slums. It is also necessary that different agencies which influence the health of the urban poor work in close coordination so that there is better impact of urban improvement programmes. The capacity of health department officers needs to be enhanced so that they are able to tackle the challenging problem of improving access of services to the urban poor and manage new initiatives like public-private partnerships. Migratory trends need to be considered while planning for services in slums as a large section of the urban poor are rapidly mobile. There exists vast talent and resources within slum communities. Strengthening community capacity in the form of self-help groups will help in improving awareness, demand and utilization of health services.

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