World Bank Presentation India s urban poor Sonia Hammam, Richard L. Clifford June, 7 1 Key Messages development in India has been anti-poor Consumption poverty is lower in urban areas but it has declined at a slower pace than rural poverty Vulnerability is more widespread than consumption poverty in urban areas Inequality is highest in urban areas General statistics hide the vulnerability and other dimensions of welfare of the urban poor such as access to social services 2 http://www.pennysleuth.com/bin/z/t/2-16longwaytogo.jpg 1
Vulnerability Vs. Poverty Threat of future poverty: Vulnerability is the existence and the extent of poverty and destitution; the danger that a socially unacceptable level of wellbeing will materialize Main finding of the study: Vulnerability is more widespread than poverty Several ways to conceptualize and empirically measure vulnerability: Vulnerability as expected poverty Vulnerability as low expected utility Vulnerability as uninsured exposure to risk Source: Dercon, 5; Hoddinott and Quisumbing 3 for a comparative discussion 3 Vulnerability Vs. Poverty Threat of future poverty: Vulnerability is the existence and the extent of poverty and destitution; the danger that a socially unacceptable level of wellbeing will materialize Main finding of the study: Vulnerability is more widespread than poverty Several ways to conceptualize and empirically measure vulnerability: Vulnerability as expected poverty Vulnerability as low expected utility Vulnerability as uninsured exposure to risk Source: Dercon, 5; Hoddinott and Quisumbing 3 for a comparative discussion 4 2
Worldwide the poor are urbanizing faster than the population as a whole Change in World Poverty 1993-2 5 5 in millions -5 1-15 -1-1 -15 poverty poverty Overall poverty Over 1993/2, while 5 million people were added to the urban poor, the number of rural poor fell by about 15 million 5 Source: Ravaillon (7) South Asia s urban poor constitute almost half of the world s urban poor Distribution of World's urban poor (below $1 day) (2) 46% South Asia Rest of the world many of which are in India Source: Ravaillon (7) 6 3
poverty in India has been declining 5.% 45.%.% 35.% 46.5% 43.6% Poverty Poverty 3.% 25.% 1983 5 28.3% 25.7% but at a slower pace than rural poverty, especially in the Post Reform period 7 And urbanization of poverty is increasing faster than the urbanization of the population Evolution of and Poverty in India 1993-2 1.% 1993 1996 1999 2 % of total 76.46% 75.71% 74.87% 73.95% poor that are rural Log Scale 26.17% 26.81% 27.45% 23.55% 24.29% 25.12% 28.9% 26.5% ization rate % of total poor that are urban 1.% By 3 the urban population will reach % about 1/3 of which will live in slums Source: Ravaillon (7) 8 4
But overall, poverty in India is higher in rural areas than in urban areas / headcount rate by state Poverty headcount ratio 5 3 1 AP Assam Jhar Bihar Guj Har HP Karn Ker Chhat MP Maha Or Punj Raj TN Uttar UP WB poverty, 1983 to 4/5 Poverty headcount ratio 7 6 5 3 1 AP Assam Jhar Bihar Guj Har HP Karn Ker Chhat MP Maha Or Punj 1983 1987-88 1993-94 4-5 Raj TN Uttar UP WB 9 Source:Himanshu (7) While urban poverty is lower in headcount terms, it is deeper and more severe than rural poverty Poverty and inequality, 1983-4/5 Poverty headcount Poverty gap Squared poverty gap Gini coefficient 1983 46.5 43.6 12.4 11.4 4.9 4.4 3.4 33.9 1987-88 39. 38.7 9.3 1.2 3.2 3.8 29.9 35. 1993-94 37.2 32.6 8.5 8. 2.8 2.9 28.6 34.4 4-5 28.7 25.9 5.8 6.2 1.8 2. 3.5 37.6 Distance between the poor and the poverty line Number of absolute poor Inequality reversing the pattern seen in the early 198s and leading to greater vulnerability Source: Himanshu 7 using NSSO surveys. 1 5
urban inequality is also higher. 5 Gini coefficient 3 1 Assam Bihar Guj Or MP UttarK Jhar UP Chhat AP WB Punj Raj Karn Maha 1983 1987-88 1993-94 4-5 Har TN HP Ker 5 Gini coefficient 3 1 Assam Bihar Guj Or MP UttarK Jhar UP Chhat AP WB urban Punj Raj rural Karn Maha Har TN HP Ker 11 Source: Himanshu (7) While lower in absolute terms, smaller urban areas have the highest incidence of poverty % Population below poverty line 1999- (poverty headcounts) Areas, Small urban 28.9% 71.5% areas, 29.3% 53.8% Mega-cities, 17.8% 79.4% Source: 12 6
Smaller urban areas also have higher levels of vulnerability incidence Income level and growth Vulnerability incidence 9 8 7 6 5 3 1 Megaurban Megaurban Income per capita Growth Lo w Medium High Only rural residents in the low percentiles are more vulnerable Source: 13 For a wide range of thresholds vulnerability is far more widespread than poverty 1..9.8.7.6.5.4.3.2.1..1.2.3.4.5.6.7.8.9 1 Vulnerability thres ho ld Overall Poor Non-poor 1..9.8.7.6.5.4.3.2.1..1.2.3.4.5.6.7.8.9 1 Vulnerability thres ho ld Ove rall Poor Non-poor 1..9.8.7.6.5.4.3.2.1. Mega-urban.1.2.3.4.5.6.7.8.9 1. Vulnerability threshold Overall Poor Non-poor specially among the poor 14 7
while their poverty headcount is relatively low, Mega-urban areas display the highest levels of inequality 1993-94 1999-1..8.6.4.2. 53.8%.1.2.3.4.5.6.7.8.9 1 Vulnerability thres ho ld Mega-urban 1..8.6.4 71.5%.2 79.4%..1.2.3.4.5.6.7.8.9 1 Vulnerability thres ho ld Mega-urban Source: Dutta 6. 15 vulnerability and poverty is concentrated in Central, Western and Southern States Geographic location Vulnerability incidence 9 8 7 6 5 3 1 Northern Western Southern Central Eastern Northeastern Mega-urban Central states MP, Bihar, Orissa, UP are among the highest in terms of urban poverty and have the lowest levels of human development and lowest level of and growth of 16 GSDP per capita Source:Himanshu (7) 8
however, smaller urban areas of high growth and urban South and Western States display among the highest rates of vulnerability incidence.. Income level and growth Vulnerability incidence 9 8 7 6 5 3 1 Megaurban Megaurban Income per capita Growth Lo w Medium High 17 Source:Himanshu (7) Job vulnerability is higher in smaller than in mega-urban areas.. 1 8 Distribution of households by principal employment status, 1999- % HHs 6 36.4 51.8 37.238.8 49.9 32.9. 11.8 14.3 9.7 9.4 7.8 53.8% 71.5% Mega-urban Casual labour Regular employment Self-employed Other activities 79.4% Source: Unni and Raveendran 7 18 9
The nature of vulnerability is evolving in India Vulnerability due to lack of resources or exclusion arising from gender, cast and tribal affiliation, living conditions and exposure to shocks Photo: http://www.benettontalk.com/india_aids_worshop.jpg 19 In urban areas, particularly in Mega-urban, vulnerability tends to increase with the age of the HH head, Vulnerability by age of HH head 8 7 6 5 3 1 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-99 Age-group Urba n Me ga -urban in rural areas it is the other way around Source:Dutta (6) 1
Overall, primary education and above significantly reduces the vulnerability of HHs Vulnerability by education of household (HH) head 1 9 8 7 6 5 3 1 Mega-urban Lit erat e Primary Middle Secondary Graduate but the proportional impact of primary education is lower in smaller urban areas Source:Dutta (6) 21 Households headed by a woman or a widow or HH with a widows member have higher rates of vulnerability Vulnerability by gender and marital status of household head, 1999/ Vulnerability by gender of HH head Vulnerability by widowhood 7 8 6 5 6 3 1 53.8% Mega-urban Settlement type 71.5% 79.4% Mega-urban Settlement type Male head Female head No widow One or more widow Widow HH he ad especially in urban areas Source:Dutta (6) using NSS 1999/. 11
Scheduled caste and tribe HH also tend to be poorer and more vulnerable Vulnerability by caste and tribal status 1999/ Distribution of HHs by caste, 1999/ Vulnerability by HH caste, 1999/ 1 1 8 8 % HHs 6 53.8% Vulnerability 6 71.5% 79.4% Mega-urban ST SC OBC General Mega-urban ST SC OBC General however their relative position in urban areas is somewhat better Source:Dutta (6) 23 In general the urban poor live in appalling conditions of squalor and deprivation Incidence of Slums: 54% of Greater Mumbai and % of Delhi s population lives in slums, but slums are also widespread in smaller urban centers Weak infrastructure in urban informal settlements; overall: 5% of urban poor live in shelter with at most one room; 23% have no access to toilets; 8% have no access to safe drinking water. Insecure tenure Source: Chattopadhyay et al 5, pp. 8 and 1, using NFHS-2 1998/99 24 12
There is a high degree of correlation between slum residence and other indicators of welfare: Literacy rate Caste composition Literacy rate 1 9 8 7 6 5 3 1 Slum 53.8% Male Female Persons Total urban % households 1 8 6 71.5% 79.4% SC ST Ot hers Slum such as literacy and belonging to excluded minorities Source: Chattopadhyay et al 5, pp. 8 and 1, using NFHS-2 1998/99 25 However, not all slum dwellers are poor Povertyincidence 1 3 HP Ker Assam Or Bihar Karn UP Raj TN Jhar Guj 53.8% MP Uttar 71.5% Punj WB Chhat Har AP 79.4% Maha 1 3 % pop. in slums nor all urban poor live in slums Source: Chattopadhyay et al 5, pp. 8 and 1, using NFHS-2 1998/99 26 13
General Statistics do not fully capture trends in access to Health, specially for the urban poor Photo: http://www.benettontalk.com/india_aids_worshop.jpg 27 Overall Health Indicators look better for urban than for rural areas Life expectancy 8 6 1983 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 1 such as Life expectancy of populations Source: Source: Health Information of India 2, Ministry of Health & Family Welfare 28 14
Crude death rates CDR (per 1 population) 16 14 12 1 8 6 4 2 53.8% 71.5% Urba n Source: Source: Health Information of India 2, Ministry of Health & Family Welfare, for CDR; Registrar General of India for life expectancy. 29 pre-natal, delivery and post-natal care to mothers Source: IIPS (6) Provisional Data Performance of Health and Nutrition Services in major States (5/6) proportion (%) of mothers who: Andhra Pradesh Assam Bihar Chhattisgarh Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Madhya Pradesh Maharashtra Orissa Rajasthan Tamil Nadu Uttaranchal Uttar Pradesh West Bengal India Given any antenatal care 98 87 53 97 95 96 93 86 95 93 97 95 92 1 92 79 97 91 95 69 32 88 83 87 9 55 88 77 9 86 71 98 69 64 92 72 Had an institutional delivery 85 59 48 58 78 67 79 54 85 6 85 65 68 95 6 79 69 61 18 19 8 42 3 42 11 57 51 35 23 87 29 18 34 31 Received postnatal care from a health personnel 82 37 33 64 73 63 52 44 7 53 7 54 57 93 52 31 67 61 64 11 13 18 44 33 11 56 49 36 87 23 1 3 28 3 15
or Infant Mortality Rate (IMR) IMR (per 1 live births) 1 1 8 6 while ranking lower than urban, rural health improvements have been more sustained Source: Source: Health Information of India 2, Ministry of Health & Family Welfare 31 As some urban indicators declined during the 199s such as cough and diarrhea prevalence Select Health and Morbidity Indicators for Areas by income quintiles Complete Immunization (% children) Prevalence rate of fever Prevalence rate of cough Prevalence rate of diarrhoea Proportion of mothers delivering at home Average birth interval (months) Medical Attendance at Childbirth (major responses) Doctor Nurse/ midwife Other health Professional Relative or friend TBA Notes: Figures indicate any of the mentioned assisted child-birth; if doctor and nurse both assisted in a delivery, then they are both recorded above. Consequently the figures do not add up to 1%. Source: Indicus (3b) NFHS1 1992/93 Q1 (poorest) pointing out to a link between health and outcomes 32 and environmental issues 59 12 5 n.a. 32 33-49 Q5 (richest) 9 17 9 4 n.a. 36 77 66-5 NFHS2 1998/99 Q1 (poorest) 63 28 36 21 6 32 29 2 41 38 Q5 (richest) 92 21 31 13 9 39 86 74 7 1 7 16
Within urban areas there are also wide disparities among indicators Indicators of infant and child mortality by standard of living (SLI) and place of residence Place of residence Std. of living IMR Neonatal mortality Post neonatal mortality Child mortality Underfive mortality Child not anemic Low 77 42 35 64 141 16 Large city Medium 44 34 1 15 59 27 High 27 18 9 5 32 42 Medium city or town Low Medium High 66 56 31 39 36 23 27 19 8 35 19 5 11 75 36 24 32 37 Low 87 53 34 44 13 25 Country side Medium 7 44 26 27 97 29 High 45 33 12 11 56 33 Larger cities rank the worst in some key Child mortality outcomes Source: Chattopadhyay et al 5, pp. 8 and 1, using NFHS-2 1998/99 33 and there are also large disparities between the urban poorest and the urban richest.. Select Health and Morbidity Indicators for Areas by income quintiles Complete Immunization (% children) Prevalence rate of fever Prevalence rate of cough Prevalence rate of diarrhoea Proportion of mothers delivering at home Average birth interval (months) Medical Attendance at Childbirth (major responses) Doctor Nurse/ midwife Other health Professional Relative or friend TBA NFHS1 1992/93 Q1 (poorest) Notes: Figures indicate any of the mentioned assisted child-birth; if doctor and nurse both assisted in a delivery, then they are both recorded above. Consequently the figures do not add up to 1%. Source: Indicus (3b) likely due to the squalid conditions of the urban 34 poor 59 12 5 n.a. 32 33-49 Q5 (richest) 9 17 9 4 n.a. 36 77 66-5 NFHS2 1998/99 Q1 (poorest) 63 28 36 21 6 32 29 2 41 38 Q5 (richest) 92 21 31 13 9 39 86 74 7 1 7 17
Under-provision of public health facilities which together with poor quality has led to greater private use Health Services by Location and Source of Treatment 4-5 % of ailment treated from government sources All India Non-Hospitalisation treatment 19 Hospitalisation treatment 38 42 in urban areas 62% of hospitalization and 81% non-hospitalizations treatments are privately provided Source: NSS 6 th round 4-5 NSSO (4a) pp and 28 35 but the poor and vulnerable continue to be more reliant on public facilities Table*: Utilization of public-private sector by type of treatment and expenditure quintile, urban areas Proportion of ailments treated Location of Child Birth Non-hospitalised treatment Hospitalised treatment UQ1 25 21 61 NSS-52 1995-96 Public/ Government sources UQ5 23 13 27 UQ1 24 33 69 NSS-42 1986-87 UQ5 29 21 47 4/5 42 while there is little variation in use of public facilities among the lowest 4 quintiles, given their low status there is a possibility of the poorest being crowded out of public facilities Source: Source: Indicus (3b) 36 18
For some key services the urban poor are worse off even when compared to rural poor Share of mothers assisted in delivery by professional 56.% 59.% 29.%.% 71.5% 2.% 4.% 79.4% 53.8% Doctor Nurse or Midwife Other Health Professional Poor Poor The poor also report higher incidence of short duration fevers, communicable and waterborne diseases relative to richer households 37 Under-provision of public health facilities in urban areas affects the poor They display poor demand or low health seek behavior related to: Cost of services higher than in rural areas Limited access to facilities Most public spending is on hospitals or curative care which are relatively less accessed by the urban poor (16% less) Vulnerability to health shocks, particularly of the main earner is the single most important source of idiosyncratic risk for poor urban households as they force borrowing and other types of coping 38 19
General statistics also do not fully capture trends in access to Education, specially for the urban poor Photo: http://www.aidprojects.org/photos/p183_1.jpg 39 Literacy rates in urban India have steadily increased over time and remain substantially higher /rural ratio Male/female ratio Male Female Male Female Male Female 1961 34.3 1.1 66..5 1.9 4. 3.4 1.6 1971 48.6 15.5 69.8 48.8 1.4 3.1 3.1 1.4 1981 49.6 21.7 76.7 56.3 1.5 2.6 2.3 1.4 1991 57.9 3.6 81.1 64.1 1.4 2.1 1.9 1.3 1 7.7 46.1 86.3 72.9 1.2 1.6 1.5 1.2 although the pace of growth in rural areas has picked up in 1991/1 leading to a narrowing urban-rural differential Source: Census, various years. www.indiastat.com. For Census 1961 to 1981, literacy rates relate to population aged five years and above; for Census 1991 onwards, literacy rates relate to population aged seven and above.
Overall urban areas perform better on selected Human Resource Indicators Table* : Select Human Resource Indicators for Elementary Education in India Staffing Indicators Percentage of schools with: a regular headmaster/ teacher Percentage of schools (negative indicators): Without female teachers** With a pupil teacher ratio above 1 With a single teacher Pupil teacher ratio** Average no of days spent in non-teaching assignments** Source: NIEPA (5), **NIEPA (4) 54 13 5 4 36 2 47 39 7 15 3 Bihar Rajasthan 23 25 but there are wide cross variations, cities in some states ranking lower than overall rural areas 41 Like health, Education is increasingly being privately provided in urban areas Table*: Current Attendance Rates among children aged 5-29 (5-24 for 52 nd round) years across location and type of service provider Distribution of students currently attending school according to type of institution: Government Local Body Private-aided Private unaided NSS (61 st round) 4-5 41 5 24 3 71 6 1 12 Source: NSSO (5) and Indicus (5a) for 52nd round 1995-96 NSS (52 nd round) 1995-96 43 8 31 18 73 8 12 7 54% of all urban children attended private institutions vs. % in rural areas. Findings confirm better performance of students in private schools 42 21
While also declining, the urban poorest still rely predominantly on public schools Poorest Table*: Distribution of students currently attending schools aged 5-24 across economic category, institution type and location Government urban 31 rural Second Quintile 26 23 21 Third Quintile 19 21 21 Fourth Quintile 15 19 18 Richest 9 16 1 18 Source: Indicus (5a) using NSSO 52 nd round (1995-96) 23 Local Bodies urban 27 rural 21 Private-aided urban 13 16 25 24 rural 9 13 19 26 32 Private un-aided urban 12 18 21 27 rural 14 18 19 16 32 58% of them attend public institutions above the rate for the rural poor (44%) 43 Around 3% of children (age 6-17) in urban areas claimed high costs as primary reason for never attending school Public Subsidies to Students (1995/96) in Rupees 4 2,256 97 53.8% Elementary School Poorest Quintile 71.5% 2,749 Secondary Education Top Quintile while public subsidies in elementary education seem to be progressive, the pro-poor expenditure patterns on primary schooling is less strong for secondary education. Source: Jenkins and Barr (6) using NFHS 2 data 44
Closing Remarks 45 Photo by Mark Jacobson Closing Remarks poor are not a homogeneous group: different targeted policy interventions needed Need for disaggregated analysis across regions, city sizes and socio-economic groups Need for new indicators: to capture the living conditions of the most vulnerable groups not reflected by conventional statistic measurement Shift the overwhelming focus on rural poverty to address the needs of the increasing urban poor and vulnerable 46 Photo by Mark Jacobson 23