URBAN HEALTH-Limits of Medicare

Limits of Medicare HAVING dotted the countryside with health facilities, even if most of them are functional only on paper, the health establishment is now all set to launch an assault on urban ill-health. In Bombay a Rs 70-crore World Bank funded project aimed at bringing health facilities to the doorstep of every slum-dweller is about to be launched. The facts which have motivated the project are of course indisputable: that almost 40 per cent of the population will be living in urban areas by the turn of the century in situations where access to institutional services becomes difficut for various reasons. And the objectives are commendable: each of he health posts-serving a population of 50,000 will provide ante-natal and postnatal care for mothers and children including immunisation against diphtheria, tetanus, polio, measles, whooping cough and tuberculosis which arc the major killers of the zero to one age-group, con- tributing to an infant mortality of five per cent. While every effort must be made to ensure that these services are utilised to the fullest, it is also necessary to recognise the inherent limitations of this approach. Immunisations can prevent early deaths, but there can be no change in the morbidity picture either among adults or children unless the living conditions, viz housing, water supply, sanitation and, most importantly,nutrition at ensured. While the World Bank project is theoretically part of a multisectoral approach, there is little scope for a change in other areas unless there is a clear recognition of the role that slum populations play in the economy.