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- Convenors:
-
Linda Waldman
(Institute of Development Studies)
Ramila Bisht (Jawaharlal Nehru University)
- Location:
- JUB-144
- Start time:
- 11 September, 2015 at
Time zone: Europe/London
- Session slots:
- 2
Short Abstract:
Africa's and Asia's unprecedented urban growth leads to unplanned peri-urban and informal settlements with no service delivery. This session explores equity, emic, and emotive aspects of urbanization and health, asking about health system exclusions and peri-urban experiences of health-seeking.
Long Abstract:
Unprecedented urban growth in Africa's and Asia's urban areas is occuring(UN, 2014)and making evident the limits of city planning and public service delivery. The resulting peri-urban sprawl and informal settlements are liminal spaces between the city and the hinterland; heterogenous and unplanned spaces where urban growth continues unabated yet rural dimensions remain; and unregulated spaces where neither urban nor rural policies prevail (Marshall et.al., 2009). People living here experience physical ill-being, abysmal water and sanitation facilities, overcrowding, toxic exposures, unregulated employment conditions, a lack of access to, and an inability to utilize, urban health services (Hawkins, MacGregor and Oronje, 2014).
There is increasing recognition of the health, environment and urbanisation intersections and growing academic and policy recognition of the peri-urban as critical for development (Dupont, 2007; Narain et.al, 2013), yet little anthropological research detailing health inequity in rapidly-urbanising cities. This session explores the equity, emic, and emotive aspects of urbanization and health, asking about health system exclusions. How do peri-urban residents engage in health seeking? What are the coping mechanisms for ill-health in informal settlements? What shapes women's experiences of health and how are socio-cultural norms, such as restrictions on women's movements, negotiated in relation to urban health seeking? What are residents health concerns? Does peri-urban residence reinforce health inequity? What policies and interventions enable poor urban communities to address sexual and reproductive health needs or to tackle health conditions, and with what effect?
Accepted papers:
Session 1Paper short abstract:
India urban growth is phenomenal. In such a scenario urban health not only becomes crucial for health accessibility but also has huge importance to sketch how the urban health system works in Indian cities.
Paper long abstract:
To begin with the urban health systems in India are mainly issue based. Studies indicate that negligible attention has been given to the range (types) of health related deprivation in urban India. The non communicable diseases were primarily considered outcome of the urbanisation processes, but of late urban health statistics show that the communicable disease are also accounting for high morbidity in urban India. More so, the worrisome aspects are the ever increasing incidents of road rage, trauma injuries, and rising number of deaths in urban areas.
Objective: The paper explores thematically the disease profile of urban India, urban areas and health delivery system. On the basic premise of the urbanisation (types and classification of urban areas in India) and structure of urban health system where the urban health system transits to rural health system, the paper explores the gaps in the health delivery in urban system. The paper hypothesises that the gap which is due to lack of information and lack of understanding may have been a major cause of rise in the morbidity and mortality in urban areas.
Method: The Cochrane Database of Systematic Reviews was explored for Indian reference and also to build up the understanding of the international studies on the urban health system.
Conclusion: The paper provides some policy oriented suggestions to bring out the clarity in health service delivery in India and also presents a snapshot of policy interventions brought for better urban health care delivery in other parts of the world.
Paper short abstract:
This essay focuses on HIV management at the world’s 3rd biggest mining company. Through ethnographic research at South Africa’s mines, I examine how the disjuncture between corporate and state healthcare creates an awkward urban topography of authority, and uneven service provision.
Paper long abstract:
It is over a decade since South Africa's leading mining companies first rolled out an HIV treatment and well-being programme for its employees. With sero-prevalence at South Africa's mines estimated at over 20%, HIV management has become the focus of the most intensive exercise of corporate responsibility. This essay focuses on HIV management at Anglo American—the world's third biggest mining company, largest private-sector employer in Africa, and the first company to provide antiretroviral therapy "free of charge" to their workforce in a context of little or no access to state healthcare. Through ethnographic research on South Africa's platinum belt, I examine how the new technologies of HIV management reinscribe old boundaries demarcating the company's zone of responsibility, erecting a metaphysical 'cordon-sanitaire' between the workplace and, what is described in corporate jargon as, the 'world beyond our perimeter fence' (Anglo American 2005: 16). While, the beneficiaries of this mission constitute a vanguard of ART recipients, the disjuncture between corporate responsibility and state healthcare translates into an awkward urban topography of authority, and uneven service provision, at the local level in Rustenburg. Increasing numbers of mineworkers opt to live outside the hostels - mostly in the informal settlements which sit cheek-by-jowl to the mining compounds, rubbing up against the eight foot fences. The spatialization of corporate responsibility creates liminal spaces between the company and the world beyond its domain, as responsibility for healthcare provision in the informal settlements is displaced between the state and the mining companies.
Paper short abstract:
We explore the intersections between agricultural activities, pollution and health in Ghaziabad, on the outskirts of New Delhi, India. We argue that residents’ conceptualize ‘polluting activities’ and health through a pragmatic livelihood lens, rather than through biomedical concepts of sanitation.
Paper long abstract:
Brook and colleagues described, in 2003, peri-urban India as a 'space crying out for attention' (2003: 134). Ten years later, Narain et.al. (2013: 10) argued that peri-urban growth is 'witnessed conspicuously' in India, where a combination of neoliberal policies, a real estate boom, land speculation, the IT boom and government policy (for the relocation of industrial waste and special economic zones) has 'transformed the pace of development'. Characterised by a predominance of poor and disadvantaged residents; a lack of services, infrastructure and facilities; degraded natural resource systems (Dupont, 2007) and industrial hazards (Brook et.al., 2003; Narain and Nischal, 2007; Narain et.al., 2013); the peri-urban is a visible manifestation of urban socio-spatial inequalities.
There is considerable recognition of the intersections between health and poverty in India's peri-urban context (Sharma and Pawar, 2007; Dongre et.al. 2009; Agarwal, 2013; DST, 2008), yet very little understanding of how peri-urban communities understand and conceptualise their experiences and health. Using qualitative research methodologies, this paper explores the intersections between agricultural activities, pollution and health in Ghaziabad, on the outskirts of New Delhi, India. It shows how residents' conceptualization of 'polluting activities', such as the use of sewage for crop irrigation is framed, not by biomedical concepts of health, cleanliness and sanitation, but rather by pragmatic livelihood needs such as getting rid of waste water and rapid crop production for sale at markets. In so doing, the paper focuses on the emic and emotive understandings of urbanization and health of peri-urban residents in rapidly-changing Ghaziabad.
Paper short abstract:
This paper brings together perceptions related to health seeking by migrant laboring low caste urban residents from four studies undertaken by the author in Delhi and its peri-urban area over twenty-five years, and examines them with reference to the health and urban planning approaches over the years.
Paper long abstract:
A cholera outbreak in the Indian capital city of Delhi in 1988 provided the context to elicit and understand health related perceptions and behaviours of the residents of resettlement colonies of the migrant poor. These were planned colonies and therefore what was subsequently explored was how the urban planning model resulted in such a public health crisis for the poor and the approaches adopted to deal with it.
A study of migrant construction workers in Delhi and their health seeking from about the same time, with periodic revisits upto the present, provides another set of detailed perceptions of these workers belonging to the ex-untouchable low caste. Understanding of the changing perceptions about determinants of health and the patterns of treatment seeking will be highlighted. A study in 2013 of the treatment seeking by urban poor as well as middle class residents and another in the peri-urban area of Delhi, Karhera village of Ghaziabad in 2014, again provide insights into the prevailing health perceptions.
These various data sets are analysed together in this paper through the lens of dynamicity of perceptions as well as that of perceptions of empowerment and disempowerment. Extracted from these are lessons for methodological approaches to studying health seeking behaviours and perceptions, as well as messages for health planning for the city and its poor.
Paper short abstract:
Matrilocal indigenous Khasi women in India have poor maternal health indicators, but are excluded from the indigenous political arena. State health policies are influenced by the central state and health data are lacking. Gender and healh equity require reforms of indigenous and state institutions.
Paper long abstract:
Meghalaya is a rapidly urbanizing state in India's 'tribal belt', with a predominantly indigenous population (86%), of which the matrilineal Khasi constitute slightly more than half. The state has some of the worst maternal health indices in the country and the highest unmet contraceptive need in India.
This qualitative research combines political and medical anthropology with public health policy analysis. We examined how the Indian state prioritises health needs, and how and whether poor and indigenous women are able to participate in decisions about their sexual and reproductive health in a context where indigenous and state governance systems co-exist.
The study found that Meghalaya's health policies are strongly influenced by national policies and limited documentation of community felt needs. Health expenditure has steadily declined in the last decade. Public health facilities are available in Shillong, but fear for out-of pocket expenses contributes to urban women's avoidance of seeking health care.
Indigenous governance institutions exist alongside India's state government machinery recognizing indigenous authority, but Khasi women are excluded from holding office in indigenous governance systems. Within the state governance system, the opportunities for Khasi women are relatively better, as women can vote and hold office at every level yet only a handful of women were elected. As a result, women's views and perspectives -including those on sexual and reproductive health- remain submerged.