Urban Challenges in India: Poverty, Health and Educational Inequalities

India’s cities are growing faster than almost anywhere else in the world, and the pull is easy to understand. Cities promise steady jobs, better schools, hospitals, and a shot at a different life than the one left behind in a village. Yet for a large share of city dwellers, that promise stays just out of reach. Rapid urbanisation has brought overcrowded settlements, stretched infrastructure, and a widening gap between those who can afford city life and those who can barely survive it. Poverty, poor health, and limited education are not three separate problems in India’s cities. They feed into each other, and understanding how is the first step toward fixing any of them.

Why people move to cities, and what actually greets them 🔗

Cities pull people in with the promise of employment, recreation, and education that villages often cannot offer. But this pull is rarely matched by planning. As migrants arrive faster than housing, water lines, schools, and clinics can be built, cities end up with two parallel worlds sitting side by side: gated apartments and glass office towers on one hand, and informal settlements without secure land tenure on the other. India’s urban population has, for the first time since independence, been growing faster than its rural population, and a growing share of the country’s poor now live in towns and cities rather than villages, a shift that has reshaped who needs support and where.

Urban poverty: the thread that ties every problem together 🔗

What does being “poor” in a city actually mean 🔗

Poverty is not just about a low bank balance. It is generally understood as a deprivation in well-being, covering both low income and an inability to access the basic goods and services a person needs to live with dignity, a definition the World Bank uses in its country assessments. In cities, this deprivation shows up as insecure housing, unsafe water, poor sanitation, and patchy access to healthcare and schooling, on top of low or unstable income.

India has made genuine progress on income poverty over the past decade. Using the international benchmark of 2.15 dollars a day, extreme poverty in Indian cities fell sharply between 2011-12 and 2022-23, according to the World Bank’s Poverty and Equity Brief cited in a Press Information Bureau release. But that headline number hides a lot. At the more realistic lower-middle-income benchmark of 3.65 dollars a day, roughly 17 percent of India’s urban population was still below the poverty line in 2022-23, even after a steep decline from over 43 percent in 2011-12. In other words, the poorest of the poor have moved up, but a large working population in cities still struggles to afford daily food, transport, and rent.

What pushes people into poverty once they are in the city 🔗

Urban poverty rarely comes from a single cause. Unemployment and underemployment push many households below subsistence, especially when jobs are informal and offer no security. City life is also simply more expensive than rural life. Every daily activity, commuting to work, buying vegetables, paying rent for even a single room, adds to the cost of living in a way that villages do not. Layered on top of this are structural and administrative gaps: inadequate housing stock, slow and poorly enforced urban planning, and welfare schemes that do not always reach informal workers and unregistered settlements. The result is a large population that works every day yet remains one bad month away from crisis.

The health toll of city living 🔗

Life in crowded, underserved settlements 🔗

India is home to one of the largest slum populations in the world, and roughly one in six urban Indians lives in a slum, most of them without secure tenure or reliable municipal services. Even where water connections exist on paper, the reality on the ground is different. Slum households typically end up buying water from tankers, using shared stand-posts, or making do with a fraction of what the rest of the city receives, and slum residents may receive only a small share of a city’s total water supply despite housing a large share of its population. Combined with poor sanitation and waste disposal, this raises the risk of diarrhoea, typhoid, jaundice, and other waterborne illnesses. Studies of slum households in cities such as Kolkata have found that even when piped water is available, inconsistent supply forces families to store water at home, which often reintroduces contamination at the point of use rather than at the source, a pattern documented in public health research on urban slums in eastern India.

Two health crises at once: infections and lifestyle disease 🔗

Urban India is unusual in that it carries two very different health burdens simultaneously. Among the urban poor, infectious and nutritional problems dominate: undernutrition, anaemia, and communicable disease outbreaks remain common in overcrowded settlements with weak sanitation. At the same time, India’s wealthier and middle-class urban residents are dealing with a rising wave of non-communicable disease. Faster-paced, more sedentary city jobs, greater reliance on processed and fast food, and shrinking access to safe outdoor space for physical activity have driven up rates of obesity, type 2 diabetes, and hypertension in urban populations, a trend confirmed by a large systematic review of health data from Indian cities since 2000. Both crises, in other words, are products of how cities are built and who gets left out of their benefits, just at opposite ends of the income scale.

Menstrual health: an overlooked layer of urban health inequality 🔗

Women and girls in low-income urban settlements face a distinct set of health challenges tied to menstruation. Cramped housing with no private toilet, unreliable water supply, and the cost of sanitary products all make it harder to manage periods safely and with dignity. Research on menstrual hygiene in slum communities across Indian cities has consistently found that limited privacy, poor access to water and sanitation infrastructure, and safety concerns around using shared or public toilets during menstruation are recurring barriers for women and girls living in urban slums. This is not a minor inconvenience. Poor menstrual hygiene management is linked to reproductive tract infections and can also keep girls away from school during their periods, compounding the educational gap discussed below.

Educational inequalities hiding in plain sight 🔗

When survival competes with school 🔗

Cities generally offer far better educational infrastructure than rural areas, from private playschools to universities and vocational institutes. But that infrastructure is not equally accessible. For households living hand to mouth, sending a child to school means losing a potential earner, and many families cannot absorb that cost. As a result, a significant number of children from poor urban households end up in low-paid informal work, or in visibly harsher occupations like waste picking. India’s 2011 Census had already estimated over 10 million child labourers between the ages of five and fourteen nationwide, and reporting on ragpicking communities in cities such as Ghaziabad and Delhi shows how children from migrant families are drawn into this work early, often because of frequent evictions, unstable schooling, and a lack of family support for continuing education.

Migration, literacy, and the informal economy trap 🔗

Rural-to-urban migrants often arrive in cities with limited literacy or formal skills, which restricts them to low-paying, insecure jobs in the informal sector. This limits their own earning potential and, in turn, their ability to invest in their children’s schooling, creating a cycle that repeats across generations. Global data compiled by the ILO and UNICEF shows that child labour and being out of school are closely linked, with more than a third of children in child labour worldwide also missing out on formal education entirely, according to a UNICEF Innocenti report examining child labour and schooling in India. Breaking this cycle needs more than building more schools. It requires making school genuinely affordable and accessible for families for whom every day a child is not earning is a day of lost income.

Why these three problems cannot be solved separately 🔗

Urban poverty, poor health, and limited education in Indian cities are not parallel issues that happen to coexist. They actively reinforce each other. A family without steady income cannot afford safe housing, which increases disease risk, which in turn reduces working days and school attendance, which limits future earning potential. Any planning that tries to fix housing without addressing income, or expand schooling without addressing sanitation and health, is likely to see only partial results. Effective urban policy needs to treat basic amenities, healthcare access, and education as one connected system, rather than three separate departments working in isolation.

What do you think? 🔗

What do you think? Do you think India’s urban poverty numbers, which look encouraging at the extreme poverty line, tell the full story of how the urban poor are actually living? And between housing, health, and education, which do you think deserves the most urgent policy attention in India’s fastest-growing cities?

References

1. https://documents1.worldbank.org/curated/en/099722104222534584/pdf/IDU-25f34333-d3a3-44ae-8268-86830e3bc5a5.pdf
2. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2124545&reg=48&lang=2
3. https://swasti.org/knowledgebase/blog/water-in-urban-slums-life-saving-or-life-threatening
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892530/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC13455360/
6. https://journals.sagepub.com/doi/abs/10.1177/0971521518811174
7. https://www.thebastion.co.in/politics-and/from-scraps-to-school-education-for-child-ragpickers-in-india/
8. https://www.unicef.org/innocenti/media/9356/file/UNICEF-Innocenti-Child-labour-schooling-India-Report-2024.pdf