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Basic Amenities, Deficiency-induced Ailments, and Catastrophic Health Spending in the Slums of Lucknow, Uttar Pradesh
The pattern of disease that comes about due to inadequate availability and poor quality of drinking water as well as substandard sanitation and micro-environmental (drainage, sewerage, and solid waste disposal) facilities in the slums of Lucknow are investigated in this paper. It estimates the relevant health costs and catastrophic health spending in these slum households. The results suggest that limitations in these public utilities cause numerous water-borne and faecal-transmitted infections as well as other infectious diseases. Consequently, the poorest sections of the urban population of Lucknow, who live in slums, spend almost a third of their consumption expenditure on out-of-pocket expenditure, and over half of these disease-affected households have encountered CHS. It suggests a comprehensive and integrated approach for reviving a large number of short- and long-term policies, which involve specifically developing a policy for providing free medical facilities to all acute and chronic cases in poor households, which would lead to a reduction of OOPE and CHS in slum areas.
The authors are extremely grateful to the anonymous referee, Sanjay Mohanty and V Saravaran for their insightful and constructive comments and suggestions that contributed to the improvement of the paper. Further, the authors acknowledge ICSSR, New Delhi for its financial support towards a larger study conducted earlier.
[Figure 1 accompanying this paper is available on the EPW website.]
The World Urbanization Prospects estimated that nearly 55% of the world’s population lived in urban areas in 2018. Asia alone accommodates 54% of the world’s urban population, and almost half of its total population lives in urban areas (United Nations 2019). Along with this rise in urban population, the number of slums and their population are also swelling steadily, especially in developing countries. Almost one-eighth and one-sixth of the populations of the world and developing countries, respectively, live in urban slums (UN Habitat 2015–16). In India, households belonging to a total of 33,510 slums in urban areas in 2012–13 (41% notified, 59% non-notified) account for 17.5% of urban households in the country (MoSPI 2013).1 The rapid proliferation of slums in developing countries is due to a combination of numerous factors, such as high urban population growth,2 alongside a disjointed modernisation process,3 and low investment in urban infrastructure (Fox 2014; Davis 2017; Marx et al 2013). As a result, slum populations have to contend with limited accessibility to drinking water, sanitation facilities,4 and micro-environmental5 and other public utilities (Katukiza et al 2012; Kulabako et al 2010). Further, the lack of basic amenities in slums is due to the irregular upgrading of the legal status of the individuals who live there, a low rate of private investment in households owing to a fear of eviction, poor financial conditions, and inadequate accessibility (Nolan et al 2018; Chaplin 2011; Katukiza et al 2010; Katukiza et al 2012).
Poor sanitation in urban slums results in a heavy pollution load, largely due to the poor management of human excreta, solid waste, storm water, and grey water6 (Katukiza et al 2012; Katukiza et al 2010; Kulabako et al 2010; Karn and Harada 2002). Human excreta is predominantly disposed using unlined pit latrines, flying toilets, and pour-flush latrines (the latter is not as common), and largely through open defecation. Solid wastes are dumped illegally in open spaces or open drains, and grey water is discharged into open storm water drains in slums (Alam et al 2013; Katukiza et al 2010; Kulabako et al 2010). These ill-managed sanitary conditions have adverse impacts on public health. Pathogens in faeces, nutrients and micro-pollutants in urine, and suspended solids and organic micro-pollutants in grey water, cause heavy pollution in soil, ground, and surface water. These factors can eventually result in high morbidity (Mara et al 2010; Katukiza et al 2010). The sustained prevalence of vector-borne and bacteria-infected contaminated drinking water, and waste-induced diseases (such as diarrhoea, malaria, cholera, dysentery, and typhoid) are widely noticed in slums in many developing countries (Alam et al 2013; Mara et al 2010; Genser et al 2008; Karn and Harada 2002). As a consequence, health expenses in urban poor households have been increasing continuously.
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