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Policy and Advocacy
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Session on
The Impact of Urbanization on Public Health in India
13th World Congress on Public Health, Addis Ababa, Ethiopia
27 April, 2012, B: Aklilu Lema Hall (Millennium Hall), 1400-1530 hours

India is home to 1.21 billion people and houses the world’s second largest urban population (after China). One-third of India’s population (377.1 million) resides in urban areas. This figure is expected to reach 535 million by 2026. India’s neighbours, Bangladesh and Nepal are also urbanizing rapidly and are home to 17 million and 5.4 million urban dwellers, respectively.

The Planning Commission of India acknowledges that one-quarter of urban India is ‘poor’ i.e., lives below the official poverty line of monthly per capita consumption expenditure of 578.8 Indian rupees (equivalent to 12 USD). However, the tumult of urban prosperity mutes the co-existence of undernutrition, food insecurity and deprivation among urban poor populations residing in slums and informal settlements. Further, use of “urban aggregate” data masks the intra-urban disparities. In India for example, re-analysis of the urban sample of the Demographic Health Survey (DHS), 2005-06 shows that children less than five years who are chronically undernourished among the poorest urban quartile are 1.3 times higher as compared to urban aggregate data and 2.5 times as compared to the richest urban quartile. Similar intra-urban disparities have been found in Nepal and Bangladesh. Overall urban health and wellbeing metrics is weak in terms of its ability to highlight inequities within urban areas. Practice of using simple tools to understand deprivations and of spatially mapping inequities and vulnerable pockets is yet to be adequately developed. Despite physical proximity of service delivery points, cities are the locus of inequitable access and reach of healthcare services. There is poor social cohesion and collective self-efficacy to seek essential services among the urban underserved. Coordinated efforts of multiple stakeholders in responding to urban inequities have been limited.

While there is growing recognition of the magnitude, growth and significance of urban poverty in India, the response of governments, donors and other agencies in addressing urban health inequities has been lukewarm. At the same time, programs in select cities in India demonstrate the how-to of approaches that can reduce these inequities and deprivations in this rapidly growing large segment.

In this backdrop, the session entitled “The Impact of Urbanization on Public Health in India” was held on 27 April, 2012 at B: Aklilu Lema Hall (Millennium Hall) between 14:00-15:30 as a solicited session on 13th World Congress on Public Health Addis Ababa, Ethiopia. This session was moderated by Mr. Amit Prasad, Technical Officer, World Health Organization Centre for Health Development, Kobe, Japan and Mirgissa Kaba, Ethiopian Public Health Association, Ethiopia.

This session stimulated discussion around five broad themes–

  1. Methods of using existing data to identify extent of intra-urban nutrition disparities in India, Nepal and Bangladesh, which can be adapted to other countries.
  2. An Indian adaptation of the USDA 6-item household food-insecurity scale for measuring experiential urban food insecurity will initiate discussion on minimal items for inclusion in surveys.
  3. Qualitative adaptation of WHO’s Urban HEART (Health Equity Assessment and Response Tool) at city and sub-city levels in India will generate discussion on how this tool can be flexibly localized where quantitative indicators are not available.
  4. Lessons from research and advocacy approaches which have started to draw policy attention to disadvantaged urban populations in India will stimulate discussion on adaptability potential of these approaches to other developing countries.
  5. Sharing program experiences of how underserved urban poor communities can be organized, trained and mentored towards self-reliance, learn negotiation skills, use them gently and perseveringly to improve to service access.

The presentations made at this session can be assessed below:

1. Development and Validation of an Experience-Based Measure of Household Food Insecurity in Urban North India.  Vani Sethi, Siddharth Agarwal  (UHRC) and Mark Nord (US Department of Agriculture)

2. Intra-Urban Disparities In Childhood Stunting In three Urbanizing Southeast Asian Countries Vani Sethi, Siddharth Agarwal and Prakash C Sahoo (UHRC)

3. Community Driven & Managed Slum Well-being Programme in Agra city, India.Naushad Ali, Siddharth Agarwal and Vani Sethi (UHRC)

4. Bringing Policy Focus to Urban Health in India: Lessons for Developing Countries. Siddharth Agarwal (UHRC)

5.  Assessing & Addressing Urban Health Inequities: The Indian Adaptation of WHO Urban HEART

5A. Mapping Urban Health Inequities across wards when quantitative indicators are not available and preparing a response plan: Experience from Bally City of East India
Siddharth Agarwal and Vani Sethi (UHRC)

5B. Assessing & Addressing Health Inequities Across Slum-neighbourhoods: Experience from Indore City, Central India
Vani Sethi, Siddharth Agarwal, Neeraj Verma, Shabnam Verma and Rajkumar (UHRC)


To view the complete video of the session click here [Impact of urbanization on Public Health in India Video]

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