Urban Development and Emerging Issues of Inclusion, Governance and Sustainability- A Note on Vulnerable Populations in Urban India

Access to resources, services and opportunities has differed for people as individuals and as groups over time and space. Governments and international agencies have strived for equitable distribution and have attempted various measures time and again. Universal access to health care has been one such prime concern for a fairly long time. Emanating from the Alma Ata Declaration ‘Health for All’ in 1978, the signatory countries, including India, have formulated policies and programmes in this direction. However, considering the layers of disparity with which the country is laden- social, religious, ethnic, linguistic and regional, for instance, India has continuously experienced barriers in materializing universal access to health care. Social disparities superimposed on regional, further accentuate the differentials in access to health care and utilization of health services. Urban areas are better endowed with infrastructure as compared to rural areas; within urban, non-slum area is better than slum. The health outcomes also follow the similar differentials. Broad social, rural-urban, regional and sub-regional disparities in infrastructure, educational attainment and health outcomes are fairly well evident. However, not much has evolved to examine social discrimination in access to resources and services, particularly, health, in the urban areas. Universalisation of access to health care therefore needs to be understood from that perspective. The trajectory of availability, access and utilization continuum is used to analyse the universal access to health care. Towards Utilization of services and resources Utilization of services can happen when there are adequate resources available and sensitive providers accessible, that is can be reached and communicated with. While availability of resources can be measured by existing data; measuring the sensitivity of providers towards the issues of enabling environment for utilization of services still awaits a meaningful framework for generating the data base. Along the same axes, access, therefore, becomes an outcome of the capability of awareness, information, knowledge and conducive environment to use these; and propensity to overcome inhibitions and obstructions for interactions with providers and providing institutions. Inhibitions largely arise due to no or few opportunities for education and income generating activities leading to poor living conditions comprising of housing, nutrition, lifestyle and health, and social environment. Availability of resources is governed by the procurement chain- from the place of generating the resource, through the market to the providing intuitions/ individual providers to the users. The policy regime, market and marketing, media and advertisement and motivation and buying capacity of the user collectively influence the availability of resources. Perception of self has elements of the image created by others. The positive images enhance confidence by limiting inhibitions, and are cherished, while negative images, particularly when emanating from biases and stereotypes, are resented and continuous efforts are made to deconstruct them. Utilization of resources and services is determined largely by three factors- access, availability and perception of self. Such factors cause disparity in utilisation and are relevant in addressing social inclusion of vulnerable populations. Thus, utilization is affected by exclusion and discrimination as much as it is by the access to and availability of resources, services and personnel (Acharya, 2010). This becomes extremely relevant, therefore, to examine the determinants of social discrimination and its consequences on health care access among vulnerable populations in urban areas. The research in this area needs to delve in the nuances of social ecology of residential spaces of the urban poor in slums to reflect on social discrimination affecting utilization of resources and services.