May 9, 2009 10:59:51 pm
No other population is so much a part of our lives,whose absence can so affect our lifestyle,and yet is so shockingly invisible to policy as the urban poor. In just the latest reminder of this invisibility,in this election campaign the urban poor our domestic helps,labourers,street vendors have received no specific attention,for example, in party manifestos. Even as two leading parties accuse each other of copying manifestos,it is clear that no memorable catchphrase fits the urban poor,neither aam aadmi nor India Shining.
When nearly 100 million urban dwellers in India are estimated to be poor,(which is about one-tenth of the countrys population and more than the population of many countries),one would expect them to be paid due attention. The urban poor are part of the colossal growth in urbanisation that India is experiencing; numbers are projected to swell to 200 million by 2020. They remain largely unserved by basic healthcare services. Yet,if we look through the major parties election manifestos,while the rural poor are mentioned as a classified group and agriculture,housing and health concerns have been addressed the urban poor do not merit dedicated focus. This is disappointing. (One party mentions urban programmes it kick-started while another just touches upon poverty among slum dwellers.)
There seems to be insufficient understanding of the vulnerability of the urban poor and of their health and nutrition needs. Most of the urban poor are residents of slums,many of them unlisted. This puts them beyond the pale of government healthcare services,as residents of unlisted slums face the threat of eviction and prefer to remain unnoticed. Migration and mobility are also factors; cost,timings,and factors like lack of confidence in accessing healthcare services put secondary care and private-sector facilities out of their reach.
A re-analysis of data from the third National Family Health Survey shows that one in 10 children born in slums does not live to see her fifth birthday; that only 40 per cent of slum children receive all the recommended vaccinations; that of the 2.25 million births each year among the urban poor,more than half are at home; and that 54 per cent of children under five years are stunted,and 47 per cent underweight.
Thinking of urban issues mainly as infrastructure,employment and livelihood as party strategies seem to with very little attention paid specifically to the dismal health status of the urban poor,will make this worse. Water and sanitation get a mention but there seems to be very little focus on the link between safe drinking water,toilet usage,environmental sanitation,and good health. The need to strengthen the public health delivery system in urban areas,and the importance of preventive care,is also not adequately addressed.
The urban poor continue to be underserved by the inadequate and sub-optimally working public health infrastructure and have to access private medical facilities which impose a significant cost on them,often leading to severe debt.
There are problems in healthcare service delivery in rural areas too and the needs of the rural population are important. Nevertheless,the complete lack of attention to the needs,including health needs,of the fastest growing segment of Indias population appears to be a glaring oversight. It goes against the grain of the inclusive growth that India needs. A liberal democracy cant discriminate between rural and urban while providing healthcare.
Issues as fundamental as the health of disadvantaged communities,therefore,should not die in the post-election tumult of coalition maneuvering.
It is important to realise that urban crises are not only about traffic jams and infrastructure. Urban health has a poverty-related (a human) component,that simply cannot be ignored.
The writer is executive director of the Urban Health Resource Centre,Delhi
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