Off The Mean Streets

Attempts to address homelessness must begin by understanding its complexities

01 September 2014
Homeless people often suffer from multiple serious ailments, such as post-traumatic stress disorder, chronic respiratory disorders, mental illnesses and tuberculosis. The complexity of their health issues is a major obstacle to accessing appropriate care.
Atish Patel
Homeless people often suffer from multiple serious ailments, such as post-traumatic stress disorder, chronic respiratory disorders, mental illnesses and tuberculosis. The complexity of their health issues is a major obstacle to accessing appropriate care.
Atish Patel

WHEN THE RANGARAJAN COMMITTEE submitted its report on the national poverty rate to the new minister of state for planning at the end of June, it suggested raising the urban poverty line to a daily consumption rate of Rs 47 per person. If accepted by the new government, this revision will nearly double the official number of poor people living in India’s cities to a staggering 103 million—roughly equivalent to the entire population of Bihar. In the next decade and a half, the country’s urban population is expected to increase by more than half to 577 million. As overall population growth and rural-to-urban migration add more and more people to existing cities, and create new cities as well, the number of urban poor is only likely to grow. So, too, are the pressures on municipal governments and the state to reduce socioeconomic inequality and provide for the needs of our cities’ most deprived people.

To be successful, any attempts to alleviate urban poverty will need to look more closely than before not only at specific challenges facing India’s urban poor, but also at the variety of experiences within this growing demographic. In 2012, the government-appointed Hashim Committee acknowledged the difficulties in identifying the urban poor and implementing social policies for them. The committee found that in order to design and deliver successful interventions it is “not enough only to know who the poor are and where they live. It is also important to know the precise nature of the vulnerability and deprivation that they face, as also the extent of such deprivation, both absolute and relative.” In a recent unpublished paper, the former Planning Commission member NC Saxena argues that urban poverty should be measured and addressed on the basis of a number of factors, including lack of access to basic services such as health and sanitation, and abysmal shelter conditions. This fits with research by Siddharth Agarwal, a past president of the International Society of Urban Health, on health inequalities within urban India. Agarwal found that large disparities exist in basic health indicators between the poorest 20 percent of people living in cities and the rest of India’s urban population. (For example, of every one thousand children born to the country’s poorest urban families between 2005 and 2006, 73 died before their fifth birthdays—almost twice the rate of other urban children.) But although these disparities have been acknowledged in the context of discussing social inequality, little extensive research has been done, and urban-policy makers have not addressed the conditions of the very poorest of the urban poor—the homeless.

Last September, 38-year-old Vikas arrived at a health-recovery shelter for homeless men on the banks of the Yamuna river in north Delhi run by the Centre for Equity Studies. (Until recently, the centre also oversaw the National Resource Team for the Urban Homeless, which I head; the team is now a part of the Association for the Rural and Urban Needy.) Two years earlier, while working in a factory in Chandigarh painting and welding spare parts for cars, Vikas had fallen seriously ill, suffering long bouts of diarrhoea and coughing up blood for weeks at a time. He sought treatment at a local government hospital, but was turned away because he lacked proper identification. He then travelled to his in-laws’ home in Bihar, and spent his savings—about Rs 18,000—on treatment at a private hospital, where he was diagnosed with tuberculosis. A year later, however, his health still hadn’t improved, so he left his wife and infant daughter and headed for Delhi in search of better services. He arrived in the capital with no money, and was turned away from a local hospital because he couldn’t pay. He spent the night on the street, and found the shelter the following day.

Ashwin Parulkar Ashwin Parulkar is the project head of the National Resource Team for the Urban Homeless at the Association for the Rural and Urban Needy, previously a unit of the Centre for Equity Studies.

Keywords: urban poverty public health Homelessness disease social policy Hashim Committee
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