Improving the Health and Lives of People Living in Slums

Abstract

Urban poverty, ill health, and living in slums are intrinsically interwoven. Poverty is multidimensional and there is no agreement on a universal definition. UN-HABITAT has introduced an operational definition of slums that is restricted to legal aspects and excludes the more difficult social dimensions. The World Health Organization definition is more comprehensive and uses a health and social determinants approach that is strongly based on the social conditions in which people live and work. Health and improving the lives of people living in slums is at the top of international development agenda. Proactive strategies to contain new urban populations and slum upgrading are the two key approaches. Regarding the latter, participatory upgrading that most often involves the provision of basic infrastructure is currently the most acceptable intervention in developing countries. In urbanization of poverty, participatory slum upgrading is a necessary but not sufficient condition to reduce poverty and improve the lives of slum dwellers. Empowering interventions that target capacity development and skill transfer of both individuals and community groups-as well as meaningful negotiations with institutions, such as municipal governments, which can affect slum dwellers' lives-appear to be the most promising strategies to improve the slum dwellers' asset bases and health. Non-governmental organizations, training institutions, and international development partners are best placed to facilitate horizontal relationships between individuals, community groups, and vertical relationships with more powerful institutions that affect the slum dwellers' lives. The main challenge appears to be lack of commitment from the key stakeholders to upgrade interventions citywide.

Slum Upgrading and Health Equity

“…Based on this review, we found 182 possible evaluations but narrowed them down to thirty-two by selecting those that had at least one additional published report on the project. We also narrowed our search by focusing upon “integrated” or multi-sectoral interventions, which aimed to address physical, social and urban governance concerns in informal settlements [26,27]. We focused our search on multi-sectoral interventions because we hypothesized that these might offer reviews and/or evaluations of several environmental and social impacts.…”

Formalizing the Informal: Understanding the Position of Informal Settlements and Slums in Sustainable Urbanization Policies and Strategies in Bandung, Indonesia

“…While this typology helps us to understand the morphology of informal settlements in the city, it also reinforces that informal settlements and slums emerge and flourish in locations that are at higher risk to climate change and environmental hazards, such as land slips, steep slopes, flood-prone areas and poor drainage [40][41][42] (see Figure 2). In developing countries, it is estimated four out of every ten non-permanent houses are located in areas subject to landslides, flooding and other natural disasters [43], with informal settlements in such areas with non-compliant technical codes and construction increasingly vulnerable to extreme natural events [44]. reinforces that informal settlements and slums emerge and flourish in locations that are at higher risk to climate change and environmental hazards, such as land slips, steep slopes, flood-prone areas and poor drainage [40][41][42] (see Figure 2).…”

“…reinforces that informal settlements and slums emerge and flourish in locations that are at higher risk to climate change and environmental hazards, such as land slips, steep slopes, flood-prone areas and poor drainage [40][41][42] (see Figure 2). In developing countries, it is estimated four out of every ten non-permanent houses are located in areas subject to landslides, flooding and other natural disasters [43], with informal settlements in such areas with non-compliant technical codes and construction increasingly vulnerable to extreme natural events [44]. Demand for affordable housing and proximity to jobs in inner city locations exerts pressure on existing landowners, settlers and their housing stock, and as such intensification of informal settlements and the emergence of slums are inevitable.…”

The social determinants of health and health service access: an in depth study in four poor communities in Phnom Penh Cambodia

“…These include poor outcomes for maternal health, higher rates of teenage pregnancy [3] and financial barriers to child health care in Nairobi [4]; high rates of respiratory conditions in children under the age of five years due to poor environmental conditions in Karachi slums [5]; and lower body mass index amongst the poorest child slum dwellers in Dhaka [6]. Studies and reviews highlight the multi dimensional nature of poverty and ill health in urban slums including the diversity and heterogeneity of social structure and health access [7], and recommend a range of responses ranging from targeted medical interventions, to capacity building and skills transfer, to infrastructure development and improved networking of NGOs, municipal governments and private practitioners [8]. …”