Urban Health

Abstract

Three fundamental tenets of this article are: ‘whether all the sections of urban poor have been sufficiently considered’, ‘participation of urban poor vis-à-vis urban health’ and ‘communication for mobilizing community participation’. Urban poverty in India has a global significance as about 39.8 per cent of the world’s urban poor live in India (The World Bank, 2008). Their number in India is not only matched by the number of urban poor in a single country but even by the number of urban poor in any other subcontinent. Participation of the urban poor in improving and maintaining urban health becomes very crucial as they are the most health-vulnerable and suffer from highly impoverished quality of life characterized by deprivation from basic services related to health and hygiene. However, the application of participatory principles in urban health has been hitherto neglected unlike the emphasis on participation since long in the arena of rural health. Any schemes and programmes of urban health will hardly succeed unless they incorporate the component of community participation. The article analyzes the extent to which the various sections of the urban poor, and especially women, are considered while considering the issues of urban health. For example, though ‘slum dwellers’ are many times regarded as a homogenous category, the most neglected among them are those residing in non-notified slums and are hitherto highly neglected. Health concerns and deprivations are more severe among non-notified slums than in notified slums as it is not mandatory for urban local bodies in many states to provide basic services to dwellers from non-notified slums. Another neglected entity among urban heath discussions is that of small and medium towns. Data shows that the access parameters to basic services, especially for urban underprivileged worsen as one moves down the urban population size. However, a major attention of the urban health debate carries a large city bias. Though there have been efforts to change this situation, their effectiveness needs to be amplified multifold through ‘effective communication’. Communication becomes an extremely crucial aspect for mobilizing community participation in urban areas. Though the extent and quality of community engagement in rural areas can invite diverse perspectives, there is at least a legacy of efforts on community participation for rural health for a good number of decades. Relatively in the urban context, community participation in general and for urban health in particular are at the infant stages and needs more focus and innovation. The article strongly puts forth the need for developing context-specific customized communication tools for mobilizing participation of the urban poor community in improving urban health. A special consideration should be wide bandwidth in education status among the urban poor. Of special significance will be the tools which enable ‘community self-assessment and planning (SAP)’. The above aspects are explained with illustrations from diverse health domains as the author has been involved as the principal investigator or initiator for slums redevelopment, proper adolescent health and the role of men in improving women’s health (enabling men to be more responsible for women’s health).