in Health
The important policy interventions to enable the poor to participate in growth as both agents and beneficiaries for sustained improvement in health for socially in- clusive development may be summarized as follows:
Raising Productivity in Urban and Peri-Urban Agriculture
Manning (2007) notes that, a 10 % increase in crop yields may lead to a reduction of between 6 and 10 % of the poor people living on less than US$ 1 a day. Studies (AFD et al. 2005) have cited positive results of increase in agricultural productivity through Green Revolution in Asia that benefited the poor farmers in Bangladesh and Uganda. Since urban dwellers in the South Asian region are on the brink of out- numbering their rural counterparts, urban and periurban agriculture (UPA) presents promising potential for reducing poverty and enhancing food security on which health can be built. As the majority of the urban poor in South Asia who migrate from rural areas (that are agriculture dependent) become the poorest workers with low-skills, the policy priority in such countries should be to raise agricultural pro- ductivity within and around cities and towns to help drive national economies and make healthy food available and affordable.
Investments in Infrastructure
The infrastructure gap facing the urban poor is huge. Increased resource flows from both public and private sectors to urban infrastructure building process should be ensured along with a reasonable tariff structure being put in place to enable the private investors to invest with confidence of reasonable returns. It is also impor- tant that past mistakes and inefficacies related to management and maintenance of infrastructure facilities are avoided so that a reliable and affordable infrastructure system reduces the production and transaction costs of doing business and help poor people to connect with the growth process. Improving their mobility and access to infrastructure such as roads, reliable energy, and modern communication services can help mitigate risks to public health and safety.
Promoting Growth of Non-Farm Income-Generating Activities and Employment Opportunities
Most developing countries are currently unable to create enough jobs in the for- mal sector to absorb the entire annual increase in the workforce in addition to millions already unemployed. Therefore, it is crucially important to create gain-
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ful employment opportunities for the urban informal sector workforces through pursuing labor-intensive manufacturing growth, enhancing skills of the work force, developing export processing zones, and special economic zones. In ad- dition, millions working in the urban informal sector and working in low-paid activities should be supported to engage in more productive and secure jobs to help overcome increasing income disparities that adversely impact the health of the urban poor.
Enhancing Work Opportunities and Social Protection for the Poor
It is crucially important to ensure increased availability and access of the poor to remunerative employment opportunities, whether through higher productivity in agriculture, access to markets or creation of accessible jobs. However, creation of new jobs should be complemented by arrangements and mechanisms to ensure pro- tection of the poor involved in high-risk jobs and also those unable to work. Various social protection schemes and safety-nets measures should be implemented side by side to protect the vulnerable at moments of crisis. Many of the Asian countries have currently invested in the production of social goods and services and adopted innovative measures (e.g., Food-for-Work Program (FFWP), Cash for Education, Vulnerable Group Feeding (VGF) Program in Bangladesh, Thailand’s “30 bath health scheme” to provide the poor with affordable access to health care services) for their delivery (World Bank 2006). Besides human development, these programs play important roles in providing security and protection and enhancing productiv- ity of the poor, and hence contribute to tackling health vulnerability of the urban poor.
Redistributing Growth Across Regions to Combat Poverty and Exclusion
Conventional strategies for spurring growth of the lagging regions include public investments in physical infrastructures, assisted industrialization and reduction of transaction costs for enterprise and trade through special incentives and support measures. But elements of such strategies are cautioned for involvement of high costs, limited developmental impacts, and in some cases negative impacts on en- vironment. Thus, raising the quality and efficiency of investments in the backward regions has to be a priority which may include investment in human capital through enhanced provision of health and education, in public utilities, institutions, and in environmental protection. For example, low-income housing development and slum upgrading can improve the health of and social welfare for the urban poor by providing water, sanitation, solid waste management, storm drainage, electricity, roads and footpaths, and secure tenure. Such urban planning is central to building healthy and inclusive cities.
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Improving Institutions and Governance
Corrupt and inefficient service delivery mechanism, poor bureaucratic procedures, misallocation of resources and lack of decentralization and devolution of power to the local levels of government are the most serious bottlenecks impeding effective implementation of poverty reduction programs in most of the South Asian countries (Ahmed et al. 2007). It is thus crucially important that the institutional bottlenecks are removed and local-level participation and accountability with the public service delivery system or other interventions to combat poverty are enhanced. The recent trends in the engagement of a wider range of actors, stakeholders, and coalitions, particularly from the NGOs and the civil society may also help in overcoming the institutional and governance weaknesses to a considerable extent and hence estab- lish participatory urban governance for building healthy and safe cities.
Environmental Sustainability and Pro-Poor Growth
The poor in South Asia and the poor people in general are disproportionately de- pendent on environmental assets and natural resources. They continue to rely on agriculture, livestock, fisheries, and forestry for earning significant shares of their incomes which call for the need to improve productivity and ensure sustainable exploitation of these resources. A major thrust will therefore be to move away from high-input, low-efficiency, high-waste approaches to the low-cost and high-effi- ciency extraction and use of natural resources and toward their more economic, efficient, and sustainable use, namely to generate green growth for healthier cities.
Donor Assistance and Partnerships
In the resource-poor South Asian countries, the development partners can play de- cisive roles in supporting their urban poverty alleviation and health improvement efforts in many ways and directions. For instance, the donors can play significant role in building infrastructures, and supporting research and development, and edu- cation and health sector improvements. The important note of caution is, however, that the donors should forge close cooperation among themselves while participat- ing and supporting the programs of the national governments in order to reduce costs and avoid duplications in their engagements with the recipient countries.
Conclusions
Persistence of acute poverty, inequality, and deprivation in most countries of South Asia despite registering notable growth in the 1990s tends to suggest that the “busi- ness as usual” approach to development (i.e., growth-augmenting and income
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poverty-reducing growth strategy) is inadequate to ensure optimal combination of improved health, growth, and social cohesion. Even high rates of growth in many countries, especially South Asian countries appear to have bypassed the poor in the backward regions, and the poor ethnic groups and other minorities and thereby fail to achieve socially inclusive development. Furthermore, because of systemic failure in the delivery of essential human development services, health, education, water, sanitation, and electricity, especially to the poor in the lagging regions, poverty and deprivation tend to remain chronic and widespread. Thus, the policy consensus is that sustained improvement in health and faster and sustained poverty reduction re- quire urban health communication strategy of pro-poor growth which is a pace and pattern of growth that enhances the capacity of the poor to participate in, contribute to, and benefit from growth. Such a policy consensus echoes with “the shift in thinking about strategic communication as it relates to the contemporary develop- ment paradigm” that is guided by human rights principles such as equality and non discrimination (UNICEF 2005, p. 2).
Effective strategic communication should consider existing policy and legisla- tive environment and be linked to service delivery aspects (UNICEF 2005). In view of that, as a concerted plan, the urban health communication strategy of pro-poor growth in South Asia demands a combination of change in policy and resources.
For instance, extreme poverty is closely linked with limited or lack of access to safe drinking water and sanitation. Since in a country like Bangladesh, poor water qual- ity or the effects of natural disasters are further barriers to dealing with extreme pov- erty and improving access to water and sanitation, policies such as social protection services, namely water supply and sanitation, can play an important role in eradicat- ing extreme poverty (UNHRC 2009). The vision of the urban health communication strategy of pro-poor growth is to enable South Asian governments, policy makers, communities, and households to act, communicate, and lead together so that the countries in the region ultimately have the capacity to achieve sustained improve- ment in health, rapid growth, and sustained poverty reduction.
This chapter set out to show how to pursue the objectives of achieving sustained improvement in health and accelerated economic growth in the face of critical chal- lenges posed by globalization in the countries of South Asia. Focusing on how a faster, participative, and a broad-based inclusive development can be attained, this chapter attempted to connect the local and global issues, build a consensus on the core areas of policy revisions and institutional reforms aimed at facilitating dialogue at the global, regional, and national levels. In doing so, while this chapter advo- cates for a consensus for accelerating pro-poor growth as the broad-based urban health communication strategy for achieving sustained improvement in health, rapid growth, and sustained poverty reduction in the countries of the South Asian region, it also hopes to show other resource-limited regions of the world the use of strategic health communication in urban contexts through increasing productivity in the ur- ban areas, creating gainful employment for the urban poor, encouraging investment in human development, especially ensuring access of the urban poor to health care facilities, and promoting environmental sustainability, hence, the case for a virtu- ous circle (see Fig. 14.1) to augment pro-poor growth for sustained improvement in health. Although, based on the review of recent experiences in the South Asian
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countries, this chapter highlighted some key policy areas and institutional dimen- sions as important areas of interventions to promote pro-poor growth for sustained improvement in health for socially inclusive development, there is a dearth of sys- tematic, comparative studies of the health problems of the urban poor across the regions of Sub-Saharan Africa, Latin America, and Asia (Harpham 2009). However, some patterns do emerge from “ad hoc studies” (p. 111, emphasis in original) that allows recognition of priority actions for urban health. For example, while the rela- tive distribution of diseases—mental ill health and heart disease in Latin America, HIV/AIDS and diarrhea in Africa, and heart disease and diarrhea in Asia—differs across the regions, “physical environment, social and health services all feature as determinants” of those diseases (p. 114). As such, while the ideal combination will naturally vary depending on the particular regional and country circumstances (i.e., levels of development, poverty, human development, efficiency in governance and institutions) the overall urban health communication strategy of pro-poor growth should aim at addressing the constraints that the poor households face in participat- ing in growth and achieving better health for socially inclusive development.
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