Making the Invisible Visible

Infochange Agenda, Pune, India, October 2014

9 Pages Posted: 24 Apr 2016 Last revised: 8 May 2016

See all articles by Siddharth Agarwal

Siddharth Agarwal

Urban Health Resource Centre; Dept. of International Health, JHBSPH

Date Written: October 31, 2014


Health, nutrition and wellbeing disparities in urban India are stark. Stunting among children U 5 years in the poorest urban quartile was 2.5 times higher than among those in the richest urban quartile and was significantly higher than the urban aggregate. The urban poor are in fact far less likely to avail of ICDS and other schemes than the rural poor. Among the poorest quartile of India’s urban population in 2005-06, 52.8% did not use a sanitary flush or pit toilet; among the rest of the urban population, 96% used a sanitary toilet.

These disparities assume prime importance in the wake of rapid urbanisation taking place in the country. India’s urban population increased rapidly from 217 million in 1991 to 285 million in 2001 to 377 million (31%) in 2011. It is expected to increase to 535 million (38%) by 2026. Projections are that by 2031, about 600 million Indians will reside in urban areas.

While Indian cities, one the one hand, are booming with commercial growth, behind the glitter of urban life is a large segment that is hidden, voiceless, deprived, hungry, with poor access to healthcare and basic services like sanitation, drinking water, housing, education.

A significant number of the urban vulnerable remain unnoticed for various reasons. According to the 65th Round (2008-09) of the NSSO, 49% of slums are non-notified in India. In 2011-12, when the UHRC updated Indore’s slum list and estimated population for the District Health Department of Indore, it revealed a total of 633 slums in the city with an estimated population of 918,575, nearly 50% of Indore’s population. According to 2011 Census data, Indore’s population in 2011 was 1,960,631, of which 590,257 people lived in slums, accounting for around 30% of the population.

To improve the urban health-care system such that access to preventive, promotive and curative care in equitable, a) listed, unlisted, hidden, informal habitations should be mapped on the city map, b) community demand for healthcare services should be enhanced as proposed in NUHM through slum-level Mahila Arogya Samitis, c) building capacity of slum communities to adopt healthy home-based practices e.g. hand-washing at critical junctures and pro-actively seek preventive and curative care, d) Address social determinants of health through coordinated interventions - i) physical, environment and infrastructure services, ii) health, nutrition and food subsidy services. iii) poverty alleviation and livelihood improvement, iii) overcome gender inequity, alcoholism, domestic violence and other social ills, iv) building social capital among slum communities and associated governance improvement efforts with greater responsiveness and accountability towards demand, e) foster partnership between public and socially sensitive private sector such as charitable hospitals, NGOs engaged in health program.

Keywords: slums, under-nutrition, sanitation, urbanisation, India, unlisted informal settlements, community demand for services

JEL Classification: A13, D00, D10, D30, D31, D63, D69, D70, D79, E21, E24, E29

Suggested Citation

Agarwal, Siddharth, Making the Invisible Visible (October 31, 2014). Infochange Agenda, Pune, India, October 2014, Available at SSRN:

Siddharth Agarwal (Contact Author)

Urban Health Resource Centre ( email )

136, Humayunpur, First Floor
Safdarjung Enclave
New Delhi, Delhi 110029
911126199771 (Phone)


Dept. of International Health, JHBSPH ( email )

Wolfe Street
Baltimore, MD 21205
United States

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