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 (Under-
nutrition 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.