Health Of The Urban Poor In India

HEALTH OF THE URBAN POOR IN INDIA: AN OVERVIEW

Dr Nihar Ranjan Ray Dr Nayan Makwana Indian Institute of Public Health, Gandhinagar

Introduction: As the world moves into the year 2008, there will be more number of people living in urban areas than rural areas. In fact, the 20th century witnessed a rapid growth in urban population. The next few decades will see unprecedented scale of urban growth in the developing world including those in Asia and Africa continents. The urban population in these two continents will double in a period of 30 years. Asia has been witnessing the triple dynamics of growth, rapid urbanisation and growing poverty. While many Asian countries witnessed higher economic growth, the growth pattern brought about enormous disparities across and within nations. India has shared the growth pattern and rapid urbanisation with some of the fastest growing regions in Asia. The Country has witnessed around 8% growth in GDP in the last couple of years and has planned to achieve a target of over 9% growth by the end of 11 th plan period. India’s urban population is also increasing at a faster rate than its total population. With over 575 million people, India will have 41% percent of its population living in cities and towns by 2030 AD from the present level of 286 million and 28%. Economic development and urbanisation are closely linked. In India, cities contribute over 55 % to country’s GDP and urbanisation has been recognised as an important component of economic growth. With India becoming increasingly globalized and urban, there is also an increase in the number of poor people living here. As per the latest NSSO survey reports there are over 80 million poor people living in the cities and towns of India. The Slum population is also increasing and as per TCPO estimates 2001, over 61.80 million people were living in slums. It is interesting to note that the ratio of urban poverty in some of the larger states is higher than that of rural poverty leading to the phenomenon of ‘Urbanisation of Poverty’. Urban poverty poses the problems of housing and shelter, water, sanitation, health, education, social security and livelihoods along with special needs of vulnerable groups like women, children and aged people. Poor people live in slums which are overcrowded, often polluted and lack basic civic amenities like clean drinking water, sanitation and health facilities. Most of them are involved in informal sector activities where there is constant threat of eviction, removal, confiscation of goods and almost non-existent social security cover. With growing poverty and slums, Indian cities have been grappling with the challenges of making the cities sustainable i.e. inclusive, productive, efficient and manageable. The sustainability of urban development in India is seen in the context of shelter and slums, Basic urban services, Financing urban development and Governance and Planning. India has entered the Eleventh Plan period with an impressive record of economic growth. However, the incidence of decline of urban poverty has not accelerated with GDP growth. Infact, urban poverty will become a major challenge for policymakers in our country as the urban population in the country is growing, so is urban poverty. Therefore, a need has arisen to develop new poverty reduction tools and approaches to attack the multi-dimensional issues of urban poverty. For this, policymakers at the national and local levels should have a good understanding of the nature of urban poverty as well as accurate data on various issues relating to it, in order to develop programme/policies to manage urban poverty in a systematic manner. India Urban Poverty Report using human development framework provides a good insight on various issues of urban poverty such as basic services to urban poor, migration, urban economy and livelihoods, micro finance for urban poor, education and health, unorganized sector and livelihoods.

Urban India : Statistical Profile 2001 Urban Population

286 milion

Urban Population%

28%

No. Of Urban Town

5,161

No. Of Metros.

35

Metro Population

38%

Urban India : Slums & Poverty Scenario Slum Population

1991: 42 Milion 2001: 62 Milion

Growth in Urban Population :

1991 – 2001, 58 Milion

Growth in Slum Population :

1991 – 2001 , 20 Milion

Poverty Scenario : Urban BPL Population 1973 – 74 : 60 Milion 1999 – 2000 : 67 Milion Share of Slum Population in City Population (Percentage) Mumbai

54

Faridabad

46

Aligarh

45

Meerut

44

Warangal

43

Amravati

43

Raipur

37

Nagpur

36

Kolkata

32

Urban India : Growth in Population % Slum Population Decadal total Population Growth

25 %

Decadal Urban Population Growth

40 %

Decadal Metro- Population Growth 79 % Decadal Slum Population Growth

70 %

URBAN POPOULATION DISTRIBUTION 42.6 million people in slums (2001) - 15 % of total urban population of the country and 22.6 % of urban population of the states/union territories reporting slums. 640 cities/towns in 26 States/Union territories in 2001 have reported slum population. Andhra Pradesh has the largest number of towns (77) reporting slums followed by Uttar Pradesh (69), Tamil Nadu (63) and Maharashtra (61). 11.2 million in Maharashtra followed by Andhra Pradesh 5.2, Uttar Pradesh 4.4 and West Bengal 4.1 million

6 millions children (0-6) in slums (Maharashtra alone accounts for 1.6 million children in slums) 7.4 million (17.4%) of the total slum population belong to the SC (Scheduled Castes) and one million (2.4%) to the ST (Scheduled Tribes). Source: Census of India 2001 Metadata and Brief Highlights on Slum Population Definition of Slum ~ About Slum Data ~ Data Highlights

Social indicators Sex ratio of the total slum population is 876 (the corresponding non slum urban population 905) -Child Sex Ratio in the age group 0-6 is 919 in the slum population (corresponding non slum urban population 904)

-Literacy rate in slum areas stands at 73.1% (80.7% male and 64.4% female) against overall non-slum urban literacy rates of 81.0% (87.2% males and 74.2% females) Sourse:Census of India 2001 Metadata and Brief Highlights on Slum Population Definition of Slum ~ About Slum Data ~ Data Highlights Health Indicators

Neonatal, infant and under-5 mortality rates are considerably higher (One out of 10 children born in urban poor families during the year is not destined to see his/her fifth birthday) More than half of India’s urban poor children are underweight and/or stunted (Undernutrition among urban poor children is worse than in rural areas) About one third of the urban poor children suffer from chronic under nutrition (Stunted -3 Standard Deviation) Source: Health of the Urban Poor in India: Current Scenario and Challenges –USAID, Urban health resource center Access to health -Of the 2 million births each year among the urban poor more than 50% of the deliveries occur at home. 1.1 million mothers would not have received adequate ante natal care 1 million newborns are likely to be Low Birth Weight Breastfeeding is likely to be delayed for about 1.6 million newborns -Only 2 out of every 5 urban poor children aged less than 24 months, receive complete immunization. -About half of urban poor households do not receive water supply and about two-thirds do not have a toilet. Source: Urban Poor in India: Current Scenario and Challenges –USAID, Urban health resource center

NRHM task force on Urban health model

Community level activities in urban slums shall primarily be carried out by Link Volunteers and Women’s Groups, with coordination support from Non-Governmental Organizations. Link Volunteers (LV) Women’s Health Committee To expand the base of health promotion efforts at the community level and to build sustainable community processes,each Link Volunteer shall promote one or more women’s group or Women’s Health Committee in her own target area (of approximately 250-350 households).

Health focus of National Slums policy i)

Participatory Health Delivery

ii)

Demand for Health Services:

iii)

Private Sector Partnerships:

iv)

Health Insurance to Widen the

v)

Access to Curative Health Care

Conclusion: This is clearly evidenced from discussion that the overall health status of urban poor residing in the slums of the suburb region is fact to ponder over . Their health status is even poorer then that of the rural population. The vulnerability of urban poor for the poor health status and communicable and non communicable diseases is enhanced as their non focused group and ignored continuously by the health department and municipality and corporation. So a specially designed policy should be there to address their promotion of health.