This unit explores the availability, quality and access to health services in urban areas. This exploration is premised on the idea that health care is a ‘public good’. The India Exclusion Report 2015 defines public good as ‘a good, service, attainment, capability, or freedom — individual or collective — that is essential for every human being to be able to live a life of dignity’. Thus, public goods are those which must be enjoyed by all persons, especially the most vulnerable and marginalized. Such an understanding also places moral, legal and constitutional obligation on the state to ensure universal and equitable provision and access to public goods such as health care.
Research finds that the urban poor populations are excluded either from any kind of health care services whatsoever, or from services that are affordable, accessible, respectful and appropriate. For the urban poor, the relative abundance of services in urban areas does not translate into better health care. People who are excluded from some critical public goods, like housing or just conditions of work, are more likely to be excluded from other public goods as well, such as health care, clean drinking water and sanitation. Their exclusion is further exacerbated by the inadequate dispensation of schemes, services and programmes, the various barriers to access enacted at the point of delivery (the Primary Health Centre), as well as through institutional bias. Higher ill-health burdens among the urban poor, their concentration within unsafe occupations, combined with multiple exclusions from health care create grim health and economic outcomes for urban poor households. Many simply don’t seek health care at all, and choose to wait out their ailments, sometimes resulting in death or permanent disability.
This Unit, based on a chapter of the India Exclusion Report 2015-2016, includes a teacher’s guide for facilitating exploration and discussion of the issue, along with a playlist of resources on the topic for deepening student understanding. The factsheet provides a detailed account of health as a public good in Indian cities. The student guide provides supplementary resources such as films, videos and articles that students can use for independent exploration and discussion. The teacher’s guide provides pointers to teachers as they engage with this issue in the classroom. The urban health care unit will be of interest to practitioners, teachers and students of geography including human geography, urban studies, public health, political science, sociology, law and governance.