The Urban Poor: reality, risks, and solutions to healthcare problems

India is a country experiencing extreme demographic change.  While seventy percent of its people live in rural areas this figure is rapidly changing as people move to cities I search of better economic opportunities, making the urban sector the fastest growing population in India. Of the 300 million people living in cities, a third are in slums (3).  The plight of this urban poor is drastically different to the middle classes, or even the rural poor.  Extreme population density and a lack of sewage system makes these slums a center for disease and other health risks associated with a lack of clean water and sanitation.

The effects of the slum are evident in children mortality statistics; compared to urban or rural children, the urban poor are at extreme risk.  While the Infant Mortality Rate (IMF) for urban areas was about 48 (per 1000 live births), this number is almost 50% higher in slums at 73 deaths per 1000 live births.  This is an indicator of both infant and maternal health.  The conditions that the women are living in are directly affecting the health and growth of their children.  The controversy with slums and government intervention is that the government does not want to encourage these settlements by providing services, but the severity of the health impacts can reach beyond the slums such as spreading disease.  Currently, 30% of urban areas in Delhi have no access to sanitation whatsoever.  With open sewage in streets and not even a field to dump it in, residents are existing in their own filth.  Runoff takes this contamination into the water supply, which creates further health impacts for those living in the slums and also those living downstream (3). 

Another impact of slum development is the necessary land-cover change that takes place and the range of infectious diseases that follow.  When outlying land is deforested for shelter, fuel, and space, there are a number of environmental consequences which precipitate human morbidity and mortality.  By changing the size, shape, and distribution or these “wild” land areas, humans come into greater contact with wild animals and pathogens (1).  It has been determined that HIV was spread through an interaction between primates and humans; it is possible that proper land management and development would decrease the chance of a new worldwide pandemic disease crossing over from animals to humans.  Other less dramatic diseases do occur at greater rates in recently developed land areas; malaria is carried by mosquitos which breed in standing water.  Wetland modification projects would expose a greater number of people to a high risk of diseases carried by mosquitos including Malaria, Dengue fever, Japanese Encephalitis, West Nile virus, Rift Valley fever, and Yellow Fever (2).  These are just a few diseases which occur do to land development and are particularly pandemic in slums, where exposure is high and health care opportunities are scarce, inadequate, or sometimes dangerously ignorant.  The best solution is for the government or an NGO to somehow provide basic health care and sanitation to the urban poor.  This will benefit both the slums, but the health effects which emanate into the cities.

Currently, the greatest challenge to slum healthcare is an availability of doctors, a system of distribution of medical services, and the means of the people to pay for these treatments.  One popular proposed solution is to use medical students as the primary care givers, equip them with vans, and have the government pay for certain healthcare needs (3).  There is a mutual benefit for the medical student who would work in these areas; the students would gain useful and “real-world” knowledge while still providing informed care to the patients.  Additionally, as part of their medical training this work would go unpaid and not cost the government or the patients anything.  The vans are a relatively cheap and upfront investment.  They give the project momentum and encourage the active participation of medical staff in areas they would otherwise avoid. Lastly, the medical supplies paid for by the state would be basic but could mean the difference between life and death for millions of urban slum dwellers.  Vaccinations for infants and children alone would make a marked difference in IMR and under 5 mortality rates, and this cost may even be covered by United Nations grant money.

So, while the issues of the urban poor are complex and many, there are a few fundamental changes which could quickly and cheaply be made to increase the quality of life in India’s cities.

References

1) Earth materials and health: research priorities for earth science and public health (pp. 99-111). (2007). Earth Perturbations and Health Impacts. Washington, D.C.: National Academies Press.

2) Mosquito-borne diseases, infectious disease information, NCID, CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved September 23, 2011, from http://www.cdc.gov/ncidod/diseases/list_mosquitoborne.htm

3) Yadav, K., Nikhil, S., & Pandav, C. (2011). Urbanization and Health Challenges: Need to Fast Track Launch of the National Urban Health Mission. Indian Journal of Community Medicine , _. Retrieved September 23, 2011, from http://courses.furman.edu/mod/resource/view.php?id=106513