Priorities in Health and Nutrition of the Urban Poor: The Case of the Calcutta Slums
Debarati GUHA SAPIR
«The slum: 400 baht a month for a family consisting of one father, one mother, eight children, four dogs, ten cats, six ducks and ten million mosquitoes.»
(Morell and Morell, Bangkok, 1972)
In the last decade before the end of this century, urban populations are projected to increase by 66% throughout the world, and by 100% in tropical and sub-tropical countries. The three major Indian cities of New Delhi, Bombay and Calcutta are all included in the list of the world’s 16 fastest growing cities, with growth rates over the last two decades of 125%, 88% and 75%, respectively (Harpham, 1988). Between 1971 and 1980, India’s urban population increased by 46,4%, resulting in a total urban population of approximately 160 million in 1981. Today, about a quarter of India’s population is urban and by the end of the century urban populations will account for 33% of the total or 230 million (Hardoy and Sattherwaite, 1989). The growth in these cities has been largely in the lower socioeconomic classes. Scattered evidence suggests that birth rates among the urban poor in all three of these cities are high and that this may even be a greater net contributor to their increase today than rural urban migration.
Aggregated statistics of urban populations are almost consistently better than the rural statistics. Although commonly used, aggregated statistics are extremely misleading and provide a false sense of security. Available evidence suggests that developmental indicator rates of the urban poor are vastly different from the aggregated figures of urban populations overall (Linn, 1983). Basta (1977) presents a series of illuminating examples of the differences in rates of development indicators between the urban poor and the urban rich. In many cases, the rates were worse than national averages and in some cases, worse than the rural levels. The range of differences of disease specific prevalence rates for the urban poor were often two or three times worse in comparison to the rural poor. For example, Basta observed in Manila rates of gastroenteritis among squatters to be 1,352/100,000 compared to rates of 780/100,000 among the non-squatter population. Similarly, in Bombay, leprosy in squatter settlements was 22 per 1,000 compared to 6.9 per 1,000 for the city as a whole (Ganapati, 1983). The overall urban literacy rate in India was 57.4%, according to the 1980 Census, but was only 26% among the urban poor, according to a Task Force Report on Housing and Urban Development (Government of India, 1988). Unfortunately, systematic statistics on the urban poor are difficult to obtain for at least two reasons: the data are almost always consolidated over the entire urban population; and evidence of the differences between urban poor and rich is scattered and fragmented (Boyden, 1991).
National Plans for Urban Health
Urbanisation measures in India to manage massive influxes and high birth rates have been seriously inadequate. The consequence has been a proliferation of some of the worst slums in the world in Calcutta and Bombay. Decennial growth rates in these cities have been 37.8 and 30.4 respectively (Government of India Census, 1981). Although large scale evictions have been reported in these Indian cities since 1980 (Srivastav, 1982), nevertheless, the urban growth rates of these cities show no significant signs of abating. As urban growth rates continue to increase, the problems as a result of high growth rates can only be expected to exacerbate conditions in the decade to come.
The national planning process, directed by the consecutive Five-Year Plans, significantly affects urban conditions and health programmes. However, neither the Fifth nor the Sixth Five-Year Plan (covering the periods 1975 to 1980 and 1980 to 1985, respectively) directly addressed urban poverty issues, although the Sixth Plan did allocate resources for «61,000» urban poor for «additional consumption benefits» (Government of India, 1988). The Seventh Five-Year Plan (1985 to 1990) represents the first attempt to address urban poverty issues directly. It places considerable emphasis on the improvement of slum dwellers’ living conditions and acknowledges the «growing incidence of poverty in urban areas» and the rapid growth of slums. Among other components of its strategy, the Plan proposes to improve the access of urban poor to basic amenities such as education, health care, sanitation, and safe drinking water.
Context of Life in Indian Slums
The physical, economic, and environmental conditions of slum populations in India can be quite different from those in rural villages. The most visible characteristic in Indian slums is the extreme penury of space. A survey conducted by the Delhi Development Authority in 1986 estimated that a typical family of four in the slums of Delhi, lived in a space of approximately 7.5 square meters. A report of the Government of India in 1988 reported that more than 67% of Calcutta’s total urban population lived in one-roomed housing. In addition to lack of space, life is characterised by hard labour for all family members, including children, in difficult and life-threatening conditions such as construction sites or industrial sites where exposure to motorised traffic and open machinery is common. Reported child labour accounted for about 4,3% of employed males and 7% of working females among the urban population of India (Government of India, 1988; UNICEF, 1991). Industrial, automobile and human pollution of all types also aggravate the situation. Finally, social disruption due to increased consumption of hallucinatory drugs and alcohol, the power struggles among rival gangs, and the breakdown of the family structure, significantly reduce the quality of life of the poor.
This paper is based on data from a household survey of 2,603 families with at least one child under five years of age living in 37 randomly selected slums recognised by the Calcutta Metropolitan Development Authorities. In addition to standard demographic and socio-economic histories of the family, the survey obtained detailed information on health care use, maternal histories, dietary intakes of mother and youngest child, reported mortality and morbidity histories, and nutritional anthropometry. This paper discusses only a few of the issues addressed by the whole survey. Following this first introductory section, section two describes the history and context of the Calcutta slums, and the public services and administrative infrastructures that exist to support it. Section three presents the results of the survey, followed by a discussion of the results in section four. Section five presents the conclusions of the paper and the recommendations for priority areas for strategy development.
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