Urban Health Poverty of Waste Pickers

In Pune City.

Submitted By:

Avijit Bardhan (PRN – 18060242014)

Dhritabrata Paul (PRN – 18060242020)

Madhupriya Ghosh (PRN – 18060242028)

Vikrant Vardhan (PRN – 18060242066)

Introduction
One of the dominant concerns of the present age is the improving the living conditions of the
rapidly increasing population living in cities. For the first time in human history beginning 2007,
more than half of the world’s population will live in cities (Sclar et al., 2005). Estimates by the
United Nations suggest that the world’s urban population has been increasing at a rate of 1.8 per
cent annually and will soon outpace the overall world population growth rate of 1 per cent
(United Nations, 2005). Nearly 48 per cent of the world’s population lives in urban areas and the
prime locus of this spurt in city dwellers are the developing countries such as India (Sclar et al.,
2005; United Nations, 2005). India, as the rest of the developing world, is urbanizing rapidly.
27.8 per cent of the country’s population comprising 285.4 million people lives in urban areas.
India’s urban population grew by 31.2 per cent during the decade 1991-2001 which is
significantly higher than the rural rate of 17.9 per cent. During this preceding decade, the urban
population increased by 68 million persons. Population projections by the United Nations
indicate that by 2030, India’s urban population will grow to 538 million with more than half of
the total population living in urban areas (United Nations, 2005). Accompanying this rapid pace
of urbanization has been a faster growth in the population residing in slums. It is estimated that
the slums represent the fastest growing segments of the urban population at about 5-6 per cent
per annum (Chatterjee, 2002). The near total absences of civic amenities coupled with lack of
primary health care services in most of the urban poor settlements have an adverse impact on the
health status of its residents. The health of the urban poor is significantly worse off than the rest
of the urban population and is often comparable to the health conditions in rural areas (Islam et
al., 2006; Montgomery and Hewett, 2005).

This paper analyzes the association between urban poverty and health of the urban poor in India.
Here, we have considered the waste pickers in the areas in and around Pune City. Questionnaires
had been formed in the Google form and responses have been collected according to the answers
received. The interviewee told us about what are the challenges they are facing in improving
health outcomes of the urban poor and the potential operational solutions to address such
challenges.
Literature Review
Urban poverty is generally defined in two ways. Firstly, it is an absolute standard which is based
on a minimum amount of income needed to sustain a healthy and minimally comfortable life and
secondly as a relative standard that is set based on average the standard of living in a nation.
Urban poverty is most underestimated and inadequately addressed by public policy in India.

Donald A. West (1970) has wanted to show the relationship between the rural and urban
poverty. He has done the classification on the basis of the geographical locations rather than the
personal attributes of families and individuals whose incomes fall below a certain level. He said
that in both the scenarios, there are inadequate education, lack of job training, low aspiration.
There are low rates of growths in employment, inadequate public education, and health and
welfare services. But in the urban areas, there are more job opportunities and superior public
services compared to that of the rural. So, naturally it is more appealing to many poverty-stricken
persons in rural areas which results in more rural-to-urban shift of individuals with low incomes.
It has been viewed with concern as a contributor to the problems of urban areas, particularly in
the large cities.

W.J. Wilson and R. Aponte (1985) stated about the ebb and flow of urban poverty in the city of
America. They have pointed out that due to urban poverty, the structure of the family has drawn
considerable attention from researchers since the mid 1960s and has helped to raise the level of
national interest in the problems of the city and the crystallization of a sizable ghetto underclass.
It is emphasized, however, that with the emergence of longitudinal data sets many assumptions
about the intergenerational transmission of poverty and persistent poverty in the inner city have
been challenged. The problems of the migrants have been noticed which showed that there is a
relationship between poverty and welfare dependency.

Caroline O.N Moser (1998) has defined asset vulnerability as one of the few ways in which the
urban poor can manage their “asset portfolio”, which includes labor, human capital, housing,
household relations, and social capital. This definition basically differs from the definition given
by McDonald and McMillen. They have said that those who are at risk of being in poverty and
those who are systemically stuck in poverty instead of just those who are currently “poor”. This
is possible because by looking at the broader range of assets that are available to the urban poor,
researchers can identify their capabilities and ability to recover from crises. In this framework,
Moser have chosen urban research communities that were from different regions of the world but
had in common a decade of economic difficulties, declining per capita income, and an increasing
rate of urbanization. This has shown that vulnerability increases within a household because it
perpetuates poverty from one generation to the next.

Diana Mitlin (2004) this paper is basically based on a debate about how to define and measure
urban poverty and that to at what extent it can be called thus. The paper shows that there is urban
poverty which is increasing gradually and due to which the inequality in the urban areas are
much more than that of rural. It can be called as a review paper as it has reviewed 23 papers of
Poverty Reduction Strategy (PSP). Most of the PRPs are based on income-based poverty lines to
define who is poor. In many nations, a single poverty line is used, with no attempt to take
account of the higher monetary income needed to avoid poverty in some areas, such as the larger
or more prosperous cities. According to the World Bank, measuring poverty is the foundation on
which the analysis in the Strategy Papers rests. At the conclusion, the paper argues that urban
poor needs much better approach, analysis and diagnosis as compared to that of the rural.

Siddharth Agarwal et al (2007) This paper shows the living conditions of the rapidly increasing
population living in cities. They are generally focusing on the issue of increasing population in
the urban. The rapid growth of urbanization depicted the issue of slums as it is the most
important root of development of urban. In slums area there is lack of basic necessities and
amenities. The paper pertains the differences between urban poverty and health poor in India. It
also gave the framework about the challenges and solutions to addresses such issues in
improving the health outcomes of the urban poor. The aim of the paper is to make health services
accessible to the urban poor, so that there is improvement in health programme pertaining to
tackle the challenging and managing problems of hierarchy of urban.

Meera Bapat (2009) in this paper describes the development of the poverty line in India from
19th century to the present. Basically the paper wants to show the falseness of the poverty
estimation like how it is underestimated and how the nature of the poverty is being shown in an
oversimplified way rather than showing the true picture of the down trodden people. It also
examines the wider nature of poverty and how this has changed over time, using data from a
longitudinal study of slum settlements in Pune from 1976 to 2003. Despite Pune’s rapid
economic growth, most of the slum households surveyed saw little or no increase in their real
income or in improved job opportunities – and little possibility of getting accommodation
outside the slums.

A. Ansoms and A. Mckay (2010) applies a quantitative methodology to study poverty and
livelihood profiles of rural Rwanda. The author has taken natural, physical, human, financial and
social resources together with environmental factors to identify the household groups with
varying livelihoods. The paper also explores how these clusters differ with the incidence of
poverty, livelihood strategies and their respective crop preferences.

Diana Mitlin (2004) this paper is basically based on a debate about how to define and measure
urban poverty and that to at what extent it can be called thus. The paper shows that there is urban
poverty which is increasing gradually and due to which the inequality in the urban areas are
much more than that of rural. It can be called as a review paper as it has reviewed 23 papers of
Poverty Reduction Strategy (PSP). Most of the PRPs are based on income-based poverty lines to
define who is poor. In many nations, a single poverty line is used, with no attempt to take
account of the higher monetary income needed to avoid poverty in some areas, such as the larger
or more prosperous cities. According to the World Bank, measuring poverty is the foundation on
which the analysis in the Strategy Papers rests. At the conclusion, the paper argues that urban
poor needs much better approach, analysis and diagnosis as compared to that of the rural.

Data & Methodology

All the literature reviewed deals with Urban Poverty in general. Hence, in this paper a graphical
analysis has been done to find out the current health poverty among the waste pickers in the Pune
city. In order to complete the study, primary data was collected from waste pickers working in
various parts of the city. Data has been collected on parameters like access to basic health
services, monthly income, etc. With the data collected, graphical analysis has been done in order
to reach to a conclusion.

Analysis
Around 21 waste pickers were questioned out of which, 47.6% were female and 52.4% were
male. While most of these workers are from Pune (around 57.1%), 42.9% are migrants.
Average income of the waste pickers lies between 10,000 to 15,000. 47.6% of the people are
mostly uneducated and they are in this profession for sustaining a good life. 38.1% of the people
are basically contractual workers who have been in this field for quite a long time with respect to
the previous case. Once the contract gets over, they have to renegotiate with their agency for
work. The 9.5% people in the above diagram are those workers who work under the umbrella of
Municipality. The interesting feature is that, they are mostly educated and they work in some
other places along with this job. So, they earn a little bit more with respect to others and lastly,
the workers lying in the blue region are uneducated and earn just for their own sake. The
differences in salary among the informal waste pickers is either due to work experience or
differences in educational qualification. It is observed that a waste picker who has passed a
higher secondary education was given formal training to operate vacuum cleaners and these were
the individuals who earn a monthly income ranging to 15,000 to 20,000.

From the above diagram it can be clearly understood that the average expenditure mostly lies in
between 10,000 to 15,000. The expenditures are done mostly to lead a sustainable life and to
support their families. There are instances where the expenditure of these individuals exceeds
their monthly income which reflects on the facts that these individuals are also engaged in some
other occupations and are not dependent only on waste picking. Individuals with earning more
than 20,000 tend to invest some amount of money in policies pertaining to health.

While most of these waste pickers are contractually employed, there are some of them who work
under the Pune Municipal Corporation (PMC). There are also some individuals who are
employed by Swachh, but they work under the supervision of the PMC. This clearly shows the
formalization of the prevailing informal sector. It has also been observed that the informal waste
pickers are deprived of their basic identity in the organization in which they work, while the
PMC pays their workers on a timely basis, the other informal workers do not get payment for a
continuous stretch of 3 months. The below diagram shows the Local Urban Body’s (ULBs)
attitude towards employment of these workers where mostly the provision of service is
privatized.
Since we see that most of the workers are employed by a private contractor, who does not pay
these workers at regular intervals. These workers are also not provided with equipment to work
with. They need to collect garbage at times with their bare hands. Whereas the Municipal
workers get all facilities. As a result, the contractual waste pickers on seeing the differences in
their working condition, all aspire to work under the PMC. Another reason for this is – at times
when these workers are not provided with any work, it was known that they need to starve half
the day in the fear of depleting their savings very early.
From the above figure, it can be clearly understood that the waste pickers are generally provided
with gloves, aprons, digging hoe and boots. But, these are not provided adequately and
frequently.

The below diagram shows the willingness of the contractual workers to work under the PMC.

It was found that most of the waste pickers either were sweepers or door to door waste collector.
The contractually paid waste pickers generally lived in kutcha houses with no toilets. Some of
them even lived on footpath. They generally used public toilets which they complain were either
dirty or had no proper supply of water. All the workers were found to get access to drinking
water provided by the PMC through public taps.
Some of the people live in the footpath or stay in a tent like house on the road side. So, they
claim those as their own house and do not want to give rent.

The following diagram depicts the situation explained above:

While most of the waste pickers are from urban Pune, there is only one of them who come from
a village where drains are not underground. The following diagram explains the same.

Given the earnings, these workers cannot self-finance any form of policies neither do these
workers are provided with any health benefits by their employers. Only the workers working
with PMC get these facilities. The following diagram shows:
Since, these workers are not provided with proper working equipment like masks, gloves,
umbrella, etc the waste pickers are exposed to hazardous elements causing serious problems of
skin infection, muscular pain and other internal infection. Some of the workers are of the belief
that they cannot do the work without drinking alcohol. The waste pickers also collect waste
without any umbrella during time of rainy season and thus suffer out of fever, cough and cold.
The following diagram shows the same.

In order to get them diagnosed, a majority (10 out of 21) of the waste pickers go to local area
doctors due to lack of financial support. 3 of the waste pickers go to government hospital and 8
of them visit both private and public hospitals for treatment. The following two diagram shows
the doctor visited by the waste pickers for treatment and also the financial assistance received by
these waste pickers from the organization they are working at.
Conclusion
Rapid urbanization and the explosive growth of the urban poor have posed a several challenges
to policy makers. Achieving the goals set out in our national health and population policies and
those of the Millennium Development Goals (MDGs) is not possible if the health conditions of
this large section of our cities are not improved. In order to make health services accessible to the
urban poor, it is necessary to augment urban primary health infrastructure. The waste pickers
were mostly affected during the floods which happened in the recent times. There are some
people who do not visit any doctor. Instead they prescribe their own medicines which may be
lead to some sorts of unaware diseases. The individuals should be provided with the equipment
for picking the wastes, or else they are very prone to certain skin diseases. Clean drinking water
and proper sanitation must be provided to them. One important aspect is that there exists vast
talent and resources within slum communities. Strengthening community capacity in the form of
self-help groups will help in improving awareness, demand and utilization of health services.