/ 8 November 2019

Delhi health crisis linked to urbanisation

Health hazard: Traffic during heavy fog in Delhi. Air pollution has damaged the lungs of half the city’s children. Photo: Cathal McNaughton/Reuters
Health hazard: Traffic during heavy fog in Delhi. Air pollution has damaged the lungs of half the city’s children. Photo: Cathal McNaughton/Reuters




India’s capital city, Delhi, often hits the headlines. The United Nations reckons it is expanding by 100 people an hour, or 3% a year, making it the world’s fastest-growing city. Delhi is expected to overtake Tokyo and become the world’s largest metropolis by 2028.

On a recent research visit to the city, I discovered flaws in the government’s handling of this process. Delhi’s experience is a warning to many African countries experiencing rapid urbanisation.

Cities that don’t prepare for the population influx risk falling so far behind the curve that they become overwhelmed. It then becomes impossible to catch up with people’s needs for housing, transport, jobs and basic services.

For too long, Delhi has neglected the requirements of its poor communities for decent and dignified living conditions. A catalogue of chronic public health problems now faces local residents. Too many have been left behind while privileged groups benefit from government largesse.

Citywide health problems

According to the World Health Organisation, Delhi has the worst air quality of any major city in the world. Air pollution wreaks havoc on human respiratory systems, damaging the lungs of half of all children in the city. The main cause is vehicle emissions, followed by dust from building sites, and the burning of household and factory waste (including rubber and plastic) and stubble in surrounding agricultural areas.

Traffic congestion is another serious problem, causing noise pollution (as drivers hooting incessantly) and frequent accidents involving pedestrians. Living in the city is stressful and corrodes mental health. The government appears to lack the resolve and capacity to do much about curbing these basic hazards.

Childhood stunting is widespread, caused by insufficient nutrient intake and frequent infections. This is a symptom of multidimensional poverty, which persists despite India’s strong economic growth in recent years.

According to the United Nations Children’s Fund, more than a third (38%) of children under five suffer from impaired development, with lifelong effects on learning capacity, earnings and the risks of diabetes and hypertension.

Public health problems are acute in Delhi’s informal settlements, in which between 20% to 40% of the city’s population live. The poorest neighbourhoods lack vital public services and are vulnerable to demolition because they are unauthorised and there is pressure on the land from burgeoning real estate development.

Resettlement colony

We began with a walking tour of Madanpur Khadar, a “resettlement colony” of about 20 000 people in eastern Delhi. It was established in the early 2000s following forced evictions from squatter settlements in the core city. The Delhi Development Authority acquired the agricultural land, subdivided it into tiny plots of between 12m2 and 22m2, and leased them to the evicted families for a modest sum.

After being granted security of tenure, people have built their own homes incrementally and vertically, using bricks and mortar funded through meagre savings and renting out rooms to lodgers. The tallest structures now reach up to five or six storeys high, although some families still live crowded together in a single-storey room. The uneven building heights give the settlement an irregular and unfinished appearance.

Laying out a rectangular street grid at the outset has proved important in ensuring a functional built form and good internal connectivity. Many of the ground-floor units on the most accessible streets have been converted into small shops and premises for service providers. Other streets and alleyways are very narrow, restricting the amount of light and ventilation entering people’s homes, and undermining their health and wellness.

One of the biggest problems is the lack of investment in water and sanitation infrastructure. An open drainage channel runs in front of most buildings, but it is unhygienic and overflows when it rains. Hand pumps give residents access to ground water, but this is unsafe to drink so people have to buy potable water from street vendors. Public toilets are in short supply and are poorly maintained, so open defecation in surrounding areas remains common.

Centralised refuse collection is also neglected, so there is considerable fly tipping. Several open spaces were originally set aside by the municipality for future playgrounds or small public parks, but the lack of investment and poor maintenance mean there is still little greenery and they are treated as rubbish dumps or vacant ground on which cows, pigs and dogs roam freely.

Not surprisingly, diseases such as diarrhoea, typhoid and tuberculosis are widespread. A power station nearby exposes residents to fly ash and dust particles, which compound their health hazards. There have even been a few cases of dengue fever. Despite this inventory of problems, the government has not provided any primary health centres in the area.

Overall, the settlement is a step up from the makeshift places that many residents occupied before. The most positive features are the street grid, the solid dwellings and security of tenure for residents, although space standards are low, investment in the physical and social infrastructure is lacking and the location is inferior, given the absence of public transport and poor road connections.

Privileged redevelopment

Our next excursion was a revelation in quite different ways. Kidwai Nagar is a desirable housing precinct covering an extensive area of almost 35 000 hectares. It is designed to accommodate government officials in a completely safe and stress-free living environment. The stark contrast with Madanpur Khadar shows what’s possible with sufficient commitment.

A run-down area comprising 2 330 housing units in crumbling two- to three-storey blocks was demolished a few years ago and is in the process of being redeveloped into an upmarket, walled complex. Altogether 4 750 flats are being built in 75 towers of up to 15 storeys, together with 100 000m2 of office space.

A government entity, the National Buildings Construction Corporation, is managing the project. Although the overall population density of the precinct is quite high, internal and external space standards are generous and the complex also includes a string of sophisticated environmental features, a health centre and several schools.

The scheme is very fortunate to have internal parks, play areas, lots of trees, wide paved streets and underground car parks. It even has its own sewage treatment works, waste disposal system and energy supply (solar panels). It is fairly self-contained and does not depend on inadequate, unreliable citywide systems.

The smallest flat is more than three times larger than the biggest home in Madanpur Khadar. And the largest apartment is 20 times bigger. These extravagant apartments each have three underground car parking spaces. In line with established norms and customs, the rents are heavily subsidised to benefit the fortunate civil servants.

Furthermore, the complex is more centrally located than the resettlement colony and much better connected to the rest of the city through the road network. Two adjacent underground metro stations are particularly valuable neighbourhood assets in light of the worsening gridlock on Delhi’s roads.

Overall, it seems unfair that a government initiative ultimately funded by the taxpayer is reinforcing social privilege. With these kinds of fringe benefits available, it is hardly surprising that jobs in the public sector are so strongly sought after.

Hope for the future

Our last visit was to an independent organisation that promotes popular involvement in knowledge creation. Participatory Research in Asia (Pria) believes that India is an overly hierarchical society with an excessively centralised government. Democratic engagement can make public policy more responsive and decision-makers more accountable.

Pria gives particular emphasis to young people (those under 25 comprise 50% of India’s population) and women (who tend to be excluded from decision-making, given the patriarchal nature of the society). There is a focus on essential public services, such as sanitation and healthcare, given their widespread neglect.

Pria’s work begins by collecting information and creating awareness of conditions on the ground. Engaging communities in building a sound evidence base creates legitimate and compelling demands for service improvement. Citizens learn about their rights and what they can reasonably expect the government to deliver. They are empowered by understanding that the problems they face are collective rather than individual.

Close involvement in monitoring local conditions also gives rise to constructive proposals for how things might be done differently. Informed citizens are better equipped to hold decision-makers to account. They are taken more seriously and are more likely to elicit a positive response from the authorities. In short, neighbourhoods can be turned from zones of poverty and exclusion into domains of mobilisation.

Given the extraordinary costs and complexity of organising centralised systems of waste disposal and sewage treatment in a city the size of Delhi, there are many opportunities to introduce devolved solutions at district or neighbourhood level.

By advocating local solutions to local problems, Pria promotes the creation of local jobs and incomes, while improving service provision in deprived communities. Decentralised, off-grid systems are also likely to be less expensive, more resilient and more environmentally sustainable than highly capital-intensive projects.

Summing up, visiting Delhi sparked mixed reactions — surprise at the stark poverty and institutionalised inequality, but also optimism stemming from insights into ways of disrupting the inertia and stimulating social change. Better resourced municipalities working hand-in-hand with local communities could do much to improve the basic conditions of life.

Ivan Turok is an executive director at the Human Sciences Research Council and a member of the Global Challenges Research Fund Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods