Health for the unreached ones

Dr Mohammad Rajja :
Dhaka in many ways is the centre of gravity of development. All the issues that development seeks to address as well as the solutions it has championed animate the landscapes of the country. From physical facilities to service infrastructures, Bangladesh is ripe for both disaster and innovation of a magnitude.
With increase in Bangladesh slum populations and rural to urban migration expected to continue for another decade, slum rehabilitation will drive a build out of low-income housing, but success will depend on participatory planning. Meanwhile, water and sanitation problems demand solutions.
It is nothing surprising to see long traffic jams in Dhaka for hours and flood in the city after rainfalls. The impact and consequences are not different from expected but, yes, at times go to become more hysterical expressions which are nurtured by our callous indifferent attitudes and intolerance.
In recent years, environmental health science has broadened the scope beyond the effects of single pollutants on individuals to entire panorama of external factors that may affect public health and collectively the health of the society. There is a direct impact of environment on health and of the built environment and on the people behaviour. Various aspects of the built environment can have profound, directly measurable effects on both physical and mental health, particularly adding to the burden of illness among ethnic slum minority people and poor communities.
Lack of sidewalks, bike paths, and recreational areas in congested, overcrowded communities discourages physical activity and contributes to obesity and cardiovascular diseases; in other areas which have such amenities, the threat of crime keeps many people inside. Dhaka’s housing, which is associated with exposures to lead, moisture, dust mites, and rodents triggers respiratory tract disease, and mental health stressors such as violence and social isolation. Ethnic minority communities, already burdened with greater rates of disease, limited access to health care, and other health disparities, are also the populations living with the worst built environment conditions. Negative aspects of the built environment tend to interact with and magnify health disparities, compounding already distressing conditions.
Environmental health science is an important overlap of sociology, psychology, demography, urban planning, and architecture. Urban life poses routine risks of overcrowding, inadequate waste disposal, hazardous working conditions, polluted air, and street violence.
The dream of a better quality of life is being undermined by an increasing menace of urban violence.
There is hardly anyone who somehow or the other have not been affected by violent acts. Violence ranges from street crime, such as muggings, mobile snatching, robberies, and carjacking; to kidnappings, murder, drug-related violence, and organised crime conducted by gangs; to assaults, sexual violence, and personal abuse. Exposure to violence is psychologically traumatic and damaging. It inhibits productivity and creativity of the individuals by inducing the state of learned helplessness and hopelessness, which is ultimately affecting the collective growth of the society.
A healthy area is one that continually creates and improves the physical and social environment and expands community resources for enabling the mutual support among population groups for living, but here in Dhaka urbanisation is advancing rapidly.
Dhaka has poverty, inadequate food and shelter, insecure tenure, physical crowding, poor waste disposal, unsafe working conditions, inadequate services, overuse of harmful substances, and environmental pollution. Unsustainable use of natural resources and environmental destruction pose threats to urban productivity and restrict future development options.
Dhaka lacks the capacity to collect and process more than a small proportion of their sewage and garbage. The village newcomers by and large lack habits of cleanliness. The migrants will eventually adapt to the requirements of life in the city, but it is not so certain that the cities will be able to adapt to the influx of rural migrants and to the lack of financial resources needed to confront severe existing and future problems.
Environmental hazards in Dhaka mainly affect poor people especially women, children, and migrants-the people who are least able to avoid the hazards and least able to deal with the illness or injury they cause. Poor people are priced out of safe, well located, well-serviced housing and land sites. Hazards include biological pathogens; chemical pollutants; scarce, poor quality natural resources; physical hazards; natural resource degradation; and global environmental degradation. These preventable health burdens cause disease, accidents, and premature death. Biological pathogens have the most serious impact on human health. Crowded conditions, poor sanitation, and inadequate water supplies, poor facilities for preparing and storing food, and inadequate hygiene contribute to biological etiology of pathogen-induced ill health.
Common chemical pollutants in urban areas are lead, indoor air pollutants from fuel combustion, toxic hazardous wastes, and ambient air pollution. A shortage of fresh water is often why some urban households do not have a safe and adequate water supply.
Common physical hazards in cities are traffic accidents; burns, scalds, and accidental fires and poisonings; falls; and floods. Overcrowding, poor building materials and settlements on dangerous sites are examples of physical hazards.
Noise, overcrowding, inappropriate design, and stresses contribute to the growing psychosocial health problems of many urban dwellers in developing countries, especially adolescents and young adults. Urbanisation has led to increased productivity and economic diversification, but also deprivation, poverty, and marginalisation.
Environmental problems include those caused by widespread poverty and those caused by industrialisation and a change in consumption patterns. The cumulative impact of these causes has serious effects on urban dwellers, especially poor children. Low incomes, illiteracy, and inaccessibility to development opportunities further complicate problems. Slum dwellings have no ventilation, natural light and are most vulnerable. Dhaka’s slums suffer from dust, smoke, and noise pollution. Piles of garbage, potholes, stray animals, flies, and mosquitoes are common. Urbanisation has increased disease-producing agents, toxic chemicals and car exhaust fumes.
Lead emitted from car exhausts or industry causes reduced fine motor coordination, hyperactivity, lower IQs, and perceptual problems in slum children. Few slums have access to potable water and sanitation services. Children in slums are more vulnerable to diseases and deficiencies than their rural and other urban counterparts. Urban pressures weaken traditional family values and social control over children. Schools are not always available which further breeds to the vicious cycle of disparity. Interaction between children and parents, recreation, and cultural stimulation are all lacking.
Urban upgrading, poverty reduction, and pro-poor governance by increasing awareness of the link between urban violence, poverty suitable options to mitigate urban violence and enhance public safety and security in Dhaka is an immense need of today. Due to the lack of understanding of the complex nature of the problem and the link amid poverty and violence needs policies that focus on repression and conventional policing measures. Programmes to improve the lives of urban slums will have limited impact. Sporadic initiatives have to take a form to integrate urban social and physical strategies that mobilise effective partnerships led by government and certain NGOs.
Innovative approaches are needed to address the multifaceted nature of violence and specific security needs of the urban slum poor. Without this, the vision of a better quality of life for city slum poor will remain just a dream.
Slums live under the threat of demolition and eviction. Open space is used by the urban poor to tie up cattle owned by them. Sanitation is the most pressing issue in a majority of slums with situations varying from existence of individual toilets which lead into open drains to public toilet. Public toilets provided in slums suffer from lack of regular cleaning, rendering them unusable. Children defecate in drains in most slums. Drains are open and narrow, which remain blocked due to disposal of solid waste and absence of regular cleaning. In some areas of Bangladesh open spaces are used for sewage and garbage disposal, creating an extremely unhealthy environment.
Public taps and hand pumps provided in slums often dry up in summer, leaving residents dependent on groundwater for meeting their basic needs. Water quality is poor. At times residents access the drinking water by inserting pipes through the wastewater itself. Slum children below two years of age are underweight, and some are severely underweight.
Poor infant feeding practices and high prevalence of infectious diseases threaten child survival among slum children. Only a few per cent infants are breastfed within one hour of birth and colostrums feeding of slum’s infants is only a dream due to lack of knowledge among them. There is lack of recommended vaccinations, including BCG, doses of Penta and polio and measles.
Deliveries in slums take place at home, majority of which are attended by dais, relatives and friends. This has grave implications on maternal and neonatal survival. Use of modern methods of family planning is neglected among married women. This implies greater adolescent fertility among slum women, putting to risk life of both mothers and children. Slum women are also neglected for antenatal care. There is a need of complete antenatal care, which includes three ANC check-ups, two TT injections and consumption of more than 100 IFA tablets to reduce poor quality of antenatal care available to the slum women. Piped water supply is available to only a few per cent of the slum households. Maximum of them depend on public taps for water.
Addressing the challenges in spite of their vital contribution to the city’s economy, the urban poor do not receive the benefits of city life. Their isolation is manifested in slums, which are a reflection of inequality and social exclusion in urban areas. To address the challenges faced by the urban poor in cities like Dhaka, it is essential to identify and map the listed and unlisted slums in the city for realistic evidence-based planning, strengthen services with a focus on vulnerable urban poor settlements; explore innovative approaches to expand breadth of affordable services among vulnerable slums both public and private; influence community demand for services and link community with providers to address the increased demand sufficiently; help slum communities organise themselves to negotiate change through collective action; assist local governments in prioritising slum development with adequate resources, capacities and orientation to work for improved services to slums. Such efforts can be instrumental in improving the lot of the urban slum poor, without which achieving the MDGs would be only a dream for Bangladesh.