Contestation and negotiation of urban health in India: A situated political approach

Abstract

This article examines health as a political struggle, where individuals contest and negotiate to secure health in a situated context. In this context, individuals who are socially embedded and exposed to the existing biosocial arena integrate macro-institutional determinants with everyday micro-institutional settings during the life course. Drawing together institutional analysis and a life course approach, the article examines the interplay of institutions in the exposure, action and outcomes behind individuals health in two case study wards in urban India-one planned settlement, and the other a ‘slum-like’ settlement. It applies longitudinal methods of household survey and life course analyses of individuals reporting diseases to understand the interplay of institutions. The analysis reveals statutory rules creating boundary conditions for exposure to infection. The individuals exploit these using the socially embedded norms to contest and negotiate through coalitions and networks. The statutory rules defines the scope and outcomes of the health-seeking decisions. The study in two case study reveals that seemingly ‘planned settlement’ is conducive over the spread of infections than in slum-like settlement. It calls for strategic focus on improving the boundary conditions – the environmental hygiene and public health infrastructure – which might be more effective than contemporary neo-liberal techno-centric and individualized interventions. Failure to promote these actions will provide an environment conducive to the future spread of infectious and non-infectious diseases. Theoretically, it pushes for greater understanding of the socio-political struggle of individuals, rather than focusing on risk factors and dualistic nature of macro- and micro-institutions. The approach leaves room for applying situated political approach in understanding mobility and seasonality of exposure to diseases in urban regions.