In India, a large population resides in slums and informal settlements, vulnerable to eviction. Research shows that if the poor have tenure security, it impacts the type of house they live in, which in turn, has positive impacts on health. A new study shows that teenage girls who lived in pucca houses were on an average taller and with higher body mass index (BMI), when compared to those living in semi-pucca and kutcha houses – a finding that has major implications for India’s housing policies.
It is a well-recognised fact that health outcomes of an individual are typically explained by a complex set of factors. Social Determinants of Health (SDH) explain one aspect of this complexity. According to the World Health Organisation, SDH can be used to understand existing health inequities by considering factors such as where individuals are “born, grow, live, work and age”. An important factor within SDH that explains the health status of an individual is their access to adequate housing.
A team of scholars from the Jindal Global University and the Centre for Social and Economic Progress, including the two authors, Krishanu Karmakar and Neelanjana Gupta, tested the possible link between decent housing and health of adolescent Indian girls aged 13-19 years. We capture access to housing through the type of houses (i.e., kutcha,pucca, and semi-pucca houses) in which the adolescent girls reside across the country.
Using data from the Naandi Foundation’s Teen Age Girls (TAG) survey conducted in 2016-17, a new paper by CSEP reveals that property rights may determine the type of housing people live in, which in turn has positive impacts on health. The study was conducted under the Property Rights Research Consortium, with a focus on property rights as a pathway to social mobility. Our results show a clear link between housing and health, which has major implications for housing policy in India.
In a country where a large population resides in slums and informal settlements, the poor are vulnerable to eviction from land they do not own. This negatively influences people’s perception of tenure security. Tenure security is the right of people to government protection against forced eviction. The Housing and Land Rights Network based on limited data reveals that 2,60,000 people in 2018 and 2,02,000 in 2019 were forcibly evicted. 11.3 million Indians live under the threat of eviction and potential displacement. The Property Rights Index (PRINDEX), which measures perceptions of tenure security, in its 2020 report revealed that 22% of Indians feel insecure about the properties they own. Insecurity means that the poor will not invest in their housing for fear of losing their investment. They thus live in makeshift tenements called ‘kutcha houses’, in squalid conditions, often without access to services.
The study examined research from India and around the world which shows that if granted secure tenure and basic services such as water, electricity and sanitation, the poor invest in home improvements. For instance, the Slum Networking Project in Ahmedabad gave certain settlements the promise of no eviction for 10 years alongwith access to infrastructure and basic services such as water, electricity and sanitation. This resulted in 42% of slum residents investing in their homes to make them puccaor permanent structures. In settlements not covered by the program, only 24% converted kutcha homes to pucca homes. In addition to improving their homes, the poor also readily contributed 20% towards the cost of infrastructure. The Naandi foundation survey revealed that teenage girls living in permanent homes (explained by better house type – pucca, semi-pucca, and kutcha, in descending order of house quality) have much better health outcomes as compared to those who live in temporary tenements. Improved homes were found to be indicative of better access to services, such as water, sanitation and electricity. This reiterates the fact that property rights are a bundle of rights that include access to adequate infrastructure and services.
The study found that adolescent girls of comparable age living in pucca houses were on an average taller and with higher body mass index (BMI), when compared to those living in semi-pucca and kutcha houses. The height and BMI among the girls fared systematically poorly with a drop in the quality of house they lived in. This difference is fairly prominent among girls from rural India, thereby affirming the existing rural-urban health inequity in our society.
The government therefore needs to make provisions for improving basic services to rural Indian homes, in particular. This could lead to a higher perception of tenure security amongst the poor, which is bound to have a positive ripple effect, improving the overall health outcomes of the adolescent girls and families in general. In addition, our policymakers should also ensure additional budget allocation and utilisation of funds in other critical domains such as nutrition to minimise the rural-urban gap in health indicators. One must not forget the huge intergenerational costsour society will be forced to bear in future unless we invest in health today. Is someone from the government listening?
This piece is based on a CSEP Impact Paper ‘Do Property Rights Explain Health Outcomes of Adolescent Girls in India: Evidence from the Teen Age Girls Survey’ which can be accessed in full at the Centre for Social and Economic Progress website
(The authors are Visiting Fellows, Centre for Social and Economic Progress, and Associate Professors, Jindal School of Government and Public Policy, OP. Jindal Global University)
