Having declared health as a major security concern, the World Health Organisation has urged all member-countries to look at the growing interdependence between health and security and invest generously in the heath sector to build a safer future.
It is true that India is progressing but there is another reality that we can’t deny: malnutrition deaths and destitution even in metropolises like Mumbai and Delhi. Demographers predict that while our urban population would double in the next 10 years, urban poverty will, in fact, double in five years.
Each Indian city has two parts: one half lives in relatively clean and healthy environs while the other lives in congested and overcrowded slums sans basic amenities. This lack of proper infrastructure makes people vulnerable to disease and health risks. In fact, development indices (infant and maternal mortality, immunisation and hospital deliveries) in cities are not different from rural areas. The infant mortality rate among the urban poor is 101.3 per thousand as compared to the urban average of 63.1 and the rural average of 103.7.
Moreover, with limited access to health services, 56.1 per cent of childbirths take place at home in poor urban families without trained attendants. This only pushes up the number of neonatal and maternal deaths.In the current context of increasing threats to people’s health, urban poverty and the quality of life of the urban poor assumes increasing significance. While India’s population is growing at 2 per cent, the annual growth of the urban population is 3 per cent. Meanwhile, metropolises are growing at 4 per cent, while growth rate of urban slums is 5 per cent. This imbalanced growth is forcing stakeholders, including healthcare providers, government and non-government agencies, to re-examine the issue of urban poverty.
Poverty is no longer a rural phenomenon. In 2001, 28 per cent of the population (90 million) was living in urban areas and of them, as much as 32 per cent were extremely poor.
Though people move to cities from rural areas in search of a better life, there is very little that changes. Most migrants can’t access medical care due to financial constraints and lack of awareness. They are hardly aware of immunisation or hospital deliveries. When the Urban Health Resource Centre (UHRC) Team, a non-profit organisation working with the urban poor in Delhi and Indore, conducted a survey in Indore’s slums in 2003, it found midwives were using stone or glass to cut umbilical cords. And, infants were given black tea and honey for three days after birth because breast milk was considered impure.
Given this scenario, there is urgent need for a well thought-out strategy that will take health and other services to the urban poor. This is the fastest-growing segment of the population and their numbers are expected to touch 605-618 million between 2021-25. More important, they cannot be wished away. Cities need them: they remove the garbage, clean the streets, pull the rickshaws and do all kinds of not-so-pleasant jobs that makes life so much better for us. What is also little known is that they contribute 40 per cent of the urban GDP!
In fact, health care providers and urban planners have suggested an agency on the lines of the National Rural Health Mission to deal with the various challenges that they face for providing services to this segment. For starters, there is need for a comprehensive mapping of slum areas in cities because accurate planning is possible only if numbers and locations of slums are known.
We also need to identify who actually needs support. There are scores of hidden and temporary slums and these never find a place on the government lists because they are located on the fringes of cities or on private lands.
Different slums have different vulnerabilities based on their location, employment patterns, literacy levels and gender status. For example, slums located near waste disposal sites and open drains are clearly disadvantaged in terms of health and hygiene
Gender equity is critical as it enables the mother to use information she receives and take decisions regarding her own health and that of the family.
Moreover, it has also been found and established that empowered slum communities can ensure better accessibility and supply of services. Women from slums can trained to support others in pregnancy, assist in providing neonatal care and create a demand for services through individual and group counselling. They can also facilitate the holding of immunisation and antenatal care camps and the community to attend these camps and use the available services properly.
Siddharth Agarwal is Executive Director, Urban Health Resources Centre