Improved health outcomes in urban slums through infrastructure upgrading

The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortal...

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Bibliographic Details
Published in:	Social science & medicine (1982) Vol. 71; no. 5; pp. 935 - 940
Main Authors:	Butala, Neel M., VanRooyen, Michael J., Patel, Ronak Bhailal
Format:	Journal Article
Language:	English
Published:	Kidlington Elsevier Ltd 01-09-2010 Elsevier Pergamon Press Inc
Series:	Social Science & Medicine
Subjects:	Biological and medical sciences Clinical outcomes Communicable Disease Control - methods Communicable Diseases - epidemiology Environment. Living conditions Epidemiology General aspects Health hazards Health Policy Health Problems Humans Illness Impact analysis Incidence India India - epidemiology Intervention Living conditions Medical sciences Microfinance Millennium development goals Miscellaneous Morbidity Mortality Rates Policy Making Population growth Poverty Areas Public health Public health. Hygiene Public health. Hygiene-occupational medicine Regression Analysis Sanitation Sanitation - standards Slums Urban areas Urban Health Urban poverty Urban Renewal Urban slums Urban slums Urban health Morbidity Waterborne illness India Sanitation Intervention Millennium development goals Microfinance Water Supply Water Supply - standards Waterborne illness Asia India Ahmedabad India Intervention Millennium development goals Microfinance Urban health Sanitation Urban slums Waterborne illness Morbidity India Water Prognosis Epidemiology Sanitary equipment Health and environment Shantytown Upgrading Evolution Public health Human Urban Slums Urban environment Poverty Exposure Contamination Infection Social medicine Water pollution
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Summary:	The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortality. This growing problem creates a unique challenge for policymakers and public health practitioners. While the Millennium Development Goals (MDGs) aim to address these conditions and standards for water and sanitation as well as pertinent health outcomes, little evidence on interventions exists to guide policymakers. Upgrades in slum household water and sanitation systems have not yet been rigorously evaluated to demonstrate whether there is a direct link to improved health outcomes. This study aims to show that slum upgrading as carried out in Ahmedabad, India, led to a significant decline in waterborne illness incidence. We employ a quasi-experimental regression model using health insurance claims (for 2001–2008) as a proxy for passive surveillance of disease incidence. We found that slum upgrading reduced a claimant’s likelihood of claiming for waterborne illness from 32% to 14% and from 25% to 10% excluding mosquito-related illnesses. This study shows that upgrades in slum household infrastructure can lead to improved health outcomes and help achieve the MDGs. It also provides guidance on how upgrading in this context using microfinance and a public–private partnership can provide an avenue to affect positive change.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0277-9536 1873-5347
DOI:	10.1016/j.socscimed.2010.05.037