by Amith Galivanche
Mentor: Ramnath Subbarman, Public Health and Community Medicine, TUMS; funding source: Nathan Gantcher Student Summer Scholars FundAmith-Galivanche-Poster
About one in eight people globally reside in urban slums. Slum health is important in the realm of global public health and the United Nations has developed a definition for “slum” that is fairly comprehensive. It incorporates aspects of slum life that include poor access to safe water, cramped living conditions, insecure housing tenure, and difficulty accessing basic services. However, where this definition falls short is also where most research on slum health falls short—it fails to address the vast disparities that exist between urban slums in terms of legal status.
In India, about 60 percent of people living in slums live in “non-notified” slums, which, in contrast to “notified” slums, are not recognized by local governments as legitimate settlements. For non-notified slums, there exists no pathway to accessing certain basic services through the city such as safe piped water, adequate sanitation, or waste-disposal, and these communities are often additionally plagued by social stigma that feeds into this legal exclusion. Additionally, housing tenure is typically unstable in non-notified slums, which goes hand-in-hand with poorer living structure quality.
It is well-understood and established that water, sanitation, and hygiene (WASH) infrastructure, housing tenure, and housing quality are all directly correlated with health outcomes. Therefore, it is important and relevant to study the effects of legal exclusion, which further complicate the obstacles that all slum residents face in protecting the health of themselves and their communities.
This project aims to understand the disparities between notified and non-notified slums, establish that they exist, and assess whether or not notification can improve these outcomes for slums that are not currently notified. This was done largely through a literature review on the limited amount of literature that currently exists on the impact of legal exclusion and notification on basic services, housing tenure, and health outcomes.
Additionally, an integral part of this project is the gathering of life narratives from individuals residing in a non-notified slum in Mumbai called Kaula Bandar. Currently, interviews are in progress. In order to inform this project so far, interviews with residents of Kaula Bandar from a few years ago were qualitatively coded and their life experiences, especially pertaining to the toll that it takes on their mental health, were analyzed and quotes were pulled to provide an individual perspective.
The literature showed that access to basic services is markedly poorer in non-notified slums in Mumbai compared to notified slums. In another paper, it was shown that, in Aligarh, women in non-notified slums had poorer maternal health outcomes than those living in notified slums. These two studies are just the tip of the iceberg in terms of the disparities that exist.
Next, literature was reviewed to determine whether or not notification could be an effective method of improving poor outcomes. While there is very little literature on legal exclusion and notification as they relate to health, some literature did show a positive correlation between notification and improved access to basic services over a long period of time. For example, it is shown that, when comparing progress in notified slums versus non-notified slums over a period of several years, non-notified slums stayed stagnant while notified slums improved drastically. Additionally, some literature showed that improving land-tenure rights led to improved housing structure quality.
In summary, it is important to consider that global public health solutions may revolve around these policy implications. It is important for duty-bearers to consider that improving health outcomes for marginalized populations may go hand-in-hand with enacting policy reforms to address current systems of legal exclusion.