Online Program

Poverty and poor health in India: Is there really an "urban health advantage"?

Wednesday, November 6, 2013 : 10:30 a.m. - 10:50 a.m.

Laura Baronoff Nolan, BA MSc, Office of Population Research, Princeton University, Princeton, NJ
Over half the world's population now lives in urban areas; urbanization in low- and middle-income countries (LMICs) has been particularly recent and rapid. The health of urban residents is generally better than that of rural residents, but averages mask wide socioeconomic disparities. In fact, it is well known that the health of the urban poor is often significantly worse than that of the rest of the urban population; UN-HABITAT reports that in Bangladesh, Ethiopia, Haiti and India, child malnutrition in slums is even comparable to if not worse than that in rural areas. Rapid and unplanned urbanization in LMICs has led to dramatic increases in urban poverty and deprivation which are linked to exposure to environmental hazards, crowded living conditions and lack of potable water and sanitation. Using India's most recent National Family and Health Survey (NFHS-3), child height for age (WHO standardized) is compared across urban and rural areas. Urban residents are further divided into slum and non-slum dwelling by an index created from 1) Nondurable housing, 2) Insufficient living area, 3) Unimproved water source, 4) Unimproved sanitation, 5) Insecurity of tenure, to avoid aggregating over urban health differentials. This study should inform policy discussions around India's proposed National Urban Health Mission, which is intended to provide affordable, accessible and acceptable health services to the urban poor. More generally, the finding that the supposed “urban health advantage” may not extend to all urban residents is an important step towards improving both urban and population health.

Learning Areas:

Provision of health care to the public
Public health or related public policy
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss why considering urban health inequality is important. List at least three reasons why urbanization in low- and middle-income countries may be bad for child health. Describe at least three disparities between and within urban and rural child health in India. Evaluate whether there is indeed an "urban health advantage".

Keyword(s): Urban Health, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.