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Mental Health in Slums – the Case of Bangladesh Among Other Developing Countries

The share of the world’s population living in urban areas has been predicted to increase from 55% in 2018 to 60% in 2030 (UN, 2018). Every year people move to the urban areas from villages for various reasons. If we try to see this urban-rural migration under the push-pull model, push factors from rural end such as landlessness and poverty, frequent natural calamities (particularly riverbank erosion, tidal surge), lack of social and cultural opportunities for rural rich and The pull factors from the urban end like job opportunities, higher wages, better civic services encourage these migrants. Most of them are low or lower-middle-income people.

Due to high land prices and construction costs, these people cannot afford suitable housing. In rural areas, they may have a house with a courtyard, pond with lots of greenery. It is very hard to get just a shelter under the roof which is far away from the house they used to live in. A lot of slums and unplanned low-income residential areas with poor greeneries, ventilation boom up. People have little scope to take care of their mental health in such settlements. Most of them face severe mental illness due to some social and physical variables including low socioeconomic status, unemployment, impoverished social networks, quality of life, bad living condition, overcrowding, pollution, and limited social supports overall the environment around these people. These variables of the social and physical environment have different types of effects on different age groups, it also varies from gender to gender.

Different geographical contexts – same issues

In a study in India, it has been explored with ethnographic methods that afflictions of the city affecting the emotional well-being and mental health of women and men with respect to gender in the Malvani slum, Mumbai. Mental health issues such as emotional distress, hopelessness, disappointment, demoralization, addictions, instability, hostility, violence, criminality, worthlessness, fatigue and weakness, depression. Poor hygiene and sanitation, subjective quality of life of poor people living in deprived conditions population density, hutment demolition, homelessness, violence, and crime play a vital role in this degrading mental health in slums of Mumbai.

Women face more problems along with the previously mentioned ones such as dual responsibilities of home and work, substandard jobs and pay, sexual exploitation, marital disharmony, abandonment, exploitation of women, domestic violence, the humiliation of women
which creates a great negative impact like depression, fatigue , worthlessness, stress, low self- esteem from menial position etc.

If we look at South Africa, 72% of women in informal settlements have been reported moderate to high levels of depressive symptomology and 57.9% reported very high levels, compared to only 26.4% of women in a nationally representative sample. A lack of access to water, sewage, garbage collection, health care, and other basic services as factors associated with poor mental and physical health in these settlements. The prevalence of IPV in these communities (66.2%) is higher than in the general population (39%). Even in the slum of Bangladesh, 46% of women in the sample tested positive for a UTI (urinary tract infections) which have not only a physical health problem but also severe mental issues.

Adolescents in the urban slums of Bangladesh face more mental problems than other well-off areas. They may have limited chances to learn skills to shape their minds. Thus, non-slum adolescents may be able to feel anxiety when they face stress, whereas slum adolescents may not be able to learn or practice this
highly cognitive procedure but rather vent their frustrations by acting out as they get older. Here also, quality of life plays a role.

Housing conditions in the slums of Bangladesh (photo by Ananya Tahsin)

Healthy housing – a human right

Most studies are consistent about that housing condition plays a major role in mental health issues. Lack of adequate space, utility facilities, open space, the hygienic living environment creates a great negative impact on the people living in the slum. Though the constitution of Bangladesh declared housing is a basic right. But proving proper healthy housing to people is a huge challenge for Bangladesh. 80% of poor HHs in Dhaka live in one-roomed homes of the latter types (1.2 m2 floor area per person). From the National Housing Policy of Bangladesh 1993, we come to know that housing is one of the three basic primary needs of human-like food and clothing. It is considered that housing creates a sense of belonging and safety for the owner. Even the major objective of the Housing Policy 1999 was to ensure housing for all. It has put emphasis on the disadvantaged low and middle-income groups of people. Then again the goal of the Housing Policy 2008 was to provide proper housing available to all citizens and to develop houses, settlements, and workplaces on a sustainable and equal basis. The National Housing Authority undertook a project to provide 5,472 flats in Bhashantek. But govt is failing to provide housing to this increasing number of migrants.

RAJUK has reserved only 1.2%, 4.3%, and 7.5% of land for low-income groups in the Purbachal, Uttara (3rd Phase), and Jhilmeel projects respectively. Different NGOs are working to provide housing to this low-income community living in an informal settlement. ARBAN, one of the first NGOs  piloted a low-income, urban housing project in Bangladesh. By tapping into micro-credit savings deposits and loan assistance, ARBAN built an apartment complex for 42-member households in Mirpur, Dhaka. The apartments were handed over in 2012. Building on success, ARBAN is taking on another housing project to construct apartments for 85 households on a 1 Bigha plot at the city’s Rampura-Banasree area. “Ghore Fera” or similar kind of rehabilitation opportunities have to be created.

People in our slums are still struggling for a better life…

As we can see there are so many policies but not much really changes for people in slums. They deserve proper housing, a basic healthy life with effective interventions for mental health. Community mental health services should be introduced in these informal settlements. Approaches to mental health policy and planning for community mental health benefit to priorities can be defined with local socio-cultural contexts. So improving and monitoring should also be a concern to the providers to slums. Complimentary approaches to mental health research can also be helpful to address interdisciplinary academic interests and practical needs for mental health planning. Psychiatric epidemiology is required to identify the burden of mental disorders. Quality living may improve their mental health. A housing with better basic facilities such as water sanitation, electricity, open space, basic medical treatment, scopes to talk and getting help about mental health is their right to survive in a good way on this Earth.

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Urban Land Institute/Health Leaders Network

In early 2021 our Board Member and Lead researcher Dr Diana Benjumea was selected to join a prestigious  Health Leaders Network initiated by the Urban Land Institute (ULI). Health Leaders Network is a platform aimed at sharing knowledge and ideas with health leaders across continents. It gathers professionals across the globe with the skills and knowledge to generate impact and help improve health outcomes in their professional practice with the communities.

Among multiple activities on the 09th of June 2021, the group presentation session features Dr Diana's presentation titled Networks of Nature: Designing for harmonious interactions in tangible and intangible ‘spaces’. In it, she introduces NeuroLandscape and some of the work and research projects she has conducted in different countries aimed at investigating the confounding variables that affect the eudemonic health and well-being of urban residents.

Additionally, she explored how the solutions taken in urban spaces in Singapore to promote health (e.g., green infrastructure) can also introduce negative responses from urban residents that are not adapted to coexist with a more biodiverse urban space.

A conceptual model (Nature place-making) abstracted from our scientific explorations unveils the main underlying social/design components needed to promote harmonious coexistence with nature in heavily urbanised cities.

 

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Networks of Nature: Integrating Urban Farming in the city Fabric

Our programme Planting Seeds of Empowerment Mental Health and Well-being of the Communities starts this year with a new project created in collaboration with international organisations to emphasise the importance of nature in the mental health and well-being of people residing in heavily urbanised cities.

The project entitled: Networks of Nature Integrating Urban Farming in the city Fabric will introduce and educative platform that will provide knowledge about the importance of individual and community actions in urban farming activities as accelerators for positive environmental change in Indonesia, Philippines, and Singapore.

Joining efforts with two partnering organisations Binatani Sejahtera Foundation (Indonesia) and Technical Assistance Movement for People and Environment Inc (TAMPEI Philippines), Networks of Nature will provide a platform for empowerment towards nature actions to enable a shared sense of community and support. Three main educational modules will be developed focusing on: Urban farming, improving mental health through urban farming, and adaptable architecture infrastructures for urban farming. Our combined efforts from Indonesia, Philippines, and Singapore will bring different sets of skills and expertise that will also help those engaged in the Networks of Nature to feel supported and connected to a global community.

Networks of Nature Integrating Urban Farming in the city Fabric was selected among the best five projects during the Gobeshona Global Conference in January this year. We will be running this project with the financial support of the International Centre for Climate Change and Development (ICCCD), Climate Justice Resilience Funds, and Gobeshona Global conference.

by Springer

Policy Briefs – Urban Health and Wellbeing Programme by Springer

In our most recent contribution to the Volume Two of the book series Urban Health and Wellbeing Systems Approaches, published by Springer and Zhejian University, we discuss the preliminary findings of our research project currently conducted in low-income communities in Medellin Colombia for our program Planting Seeds of Empowerment: Mental Health and Wellbeing of the Communities.

The book is intended for citizens and political decision-makers interested in systems perspectives of urban health and well-being seeking for inspiration to find solutions for the increasing complexity of cities and the environmental, social, and health impacts of urbanization.

In our paper entitled: Coping with Extreme Circumstances Through Community-Led Local Nature Interventions: A Science-based Policy Analysis, we discuss
the importance of the Local Nature Interventions Projects (LNIP) that are created by low-income communities as coping strategies to extreme events to help them sustain
health and well-being.

We present examples of the LNIP taking place during the Covid-19 pandemic and we argue that the LNIP are part of a secondary green network that could be acknowledged as part of the main city’s urban green infrastructure. Therefore, the internal capacities of the communities to create sustainable projects in the natural and built environment across time should be acknowledged and supported in future urban green projects. With these preliminary findings, we seek to draw attention towards LNIP initiatives as they could become alternatives to sustain community empowerment, environmental awareness, and health and well-being across settlements located in extreme urban environments.

Contents:

  1. COVID-19, Cities and Health: A View from New York  (Jo Ivey Boufford and Anthony Shih)
  2. Current and Future Human Exposure to High Atmospheric Temperatures in the Algarve, Portugal: Impacts and Policy Recommendations  (André Oliveira, Filipe Duarte Santos, and Luís Dias)
  3. Neuroscience-Based Urban Design for Mentally Healthy Cities (Agnieszka Olszewska-Guizzo)
  4. The Role of Money for a Healthy Economy (Felix Fuders)
  5. Developing Health-Promoting Schools: An Initiative in Government Schools of Indore City, India (Alsa Bakhtawar)
  6. Mobility and COVID-19: Time for a Mobility Paradigm Shift  (Carolyn Daher, Sarah Koch, Manel Ferri, Guillem Vich, Maria Foraster, Glòria Carrasco, Sasha Khomenko, Sergio Baraibar, Laura Hidalgo, and Mark Nieuwenhuijsen)
  7. COVID-19 Shows Us the Need to Plan Urban Green Spaces More Systemically for Urban Health and Wellbeing (Jieling Liu)
  8. How Lack or Insufficient Provision of Water and Sanitation Impacts Women’s Health Working in the Informal Sector: Experiences
    from West and Central Africa (H. Blaise Nguendo Yongsi)
  9. Planning Models for Small Towns in Tanzania (Dawah Lulu Magembe-Mushi and Ally Namangaya)
  10. Coping with Extreme Circumstances Through Community-Led Local Nature Interventions: A Science-Based Policy Analysis (Diana Benjumea and Agnieszka Olszewska-Guizzo)

Hardcopy of the book already available at:
https://www.springer.com/gp/book/

Access to the full book in pdf - here.

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The New Urban Normal_Dr Diana’s speech at TecNM (Mexico)_VIDEO

24th September 2020.

Tecnológico Nacional de México, campus Costa Grande, hosted an online event addressing the World New Normal in the interdisciplinary lens.

Dr Diana Benjumea gave a speech regarding architecture and urban planning, where she sets a new paradigm of bottom-up, evidence-based urban design. Moreover,  she introduces NeuroLandscape projects and explains the global implications of the emerging shift in thinking and approaching urban space.

The entire speech and Q&A session are available on youtube! English subtitles coming soon!

Generations of women in slums in a snap

Unraveling links among climate change, poverty and health in slums of Dhaka

It is well known to the environmentalists that Bangladesh is currently considered the 7th most vulnerable country to the adverse effects of ongoing climate change. What we do not know, however, is the adverse effects that are already in place and how much it is tangled with rural-urban migration, rehabilitation, gender, human rights, and health issues with a large share of mental health problems, seldom studied and looked into

To investigate what is the aftermath of women coming into Dhaka and settling inside the slums after facing the atrocities of natural hazards linked with climate change- I, along with my teammate Rupita, Ananya, Mimi, Jahin went through thorough interviews and focus group discussions with the displaced ladies.  We focused on women who came to Dhaka in 10-15 years from the present time, as various studies suggest that more than 80% of displaced people from the time after 2010 would be climate migrants. 

What we found out so far was more astounding than expected. Women, unlike men, came to Dhaka only when their families had reached the bottom level of poverty- when they had lost everything to the disasters. There were attempts to be settled near their origins by many of them, but futile. Dhaka city, to them, was not an option, rather the only hope of survival. None of the interviewees claimed they wish to live in Dhaka– many of them have adopted a tedious life on bare minimums to save money- so that perhaps one day they can go back to their origins and settle. But in reality, this is a dream achievable by only a few. With their average household income of 5 to 10 dollar a day, in the 72nd most expensive city to live in, saving money is nearly impossible. 

All of our respondents claimed being stricken with ‘poverty’ after surviving climatic hazards. Neither authorities of their origin nor in Dhaka were prepared to rehabilitate them. The result- migration into shabby slums in Dhaka as these were the only places accessible and ‘relatively’ affordable to them, and the city had better employment opportunities for such ‘ill-fated’ women. 

Women in Tejgaon Railway Slum selling vegetables for a living

Misery, however, never left the ladies.

According to the women, they feel despair from the cutoff of rural lifestyle. The environment and culture is very different from what they are used to live in. They feel out pf space. Poverty in the slums is worse than imagination. Not only the people, especially women, earn less, but the cost of basic facilities are much higher, yet inadequate. Moreover, Gender-Based Violence (GBV) like catcalling and sexual abuse is very common for the women in slums. The structures and design of slums only make things worse for them. The houses in the slum are very small, roughly 100 sq ft. Each family reside within one of such houses, with only one room in it. The houses have no space in between them, and the paths connecting the slums can be as narrow as 3 ft. This makes the residence in the houses and even walking in the paths uncomfortable. They feel a lack of privacy in their new life. Fire hazards are frequent, and fear of eviction is a constant threat in their lives.  Lack of water supply points and toilets leave them prone to health hazards and security threats alike. On one hand, lack of toilets puts women in a vulnerable position to GBV when using the toilet or collecting water, especially during night time. On the other hand, it forces them to reduce drinking water, hold onto urine and follow unsanitary practices during menstruation- causing dehydration, urinary infection, constipation, uterine prolapse, and reproductive problems. Rising temperature increases the demand for drinking water. With groundwater depletion, the supply of water becomes scarce and women are the worst sufferers of the condition. They are the ones expected to reduce consumption first. Also, erratic rainfall causes flooding in the slums, that impede them from collecting water or going to toilets.

Ashes from fire outbreak still remain after a month

A woman inside a ‘toilet’ in Tejgaon Railway Slum

Row of houses in Korail Slum

 

 

 

Abandoned house after ‘development project’

 

 

 

 

 

 

 

 

 

Even though our interviews didn’t focus on the mental health of the woman, prevailing notion of chronic stress and fear they deal with every day was evident within the fear of violence, eviction and lack of belonging and identity. In all of our interviews, participants expressed their frustrations, insecurities and struggles of everyday life. 

In short, the cost of survival is beyond our imagination. Further investigation can help us understand their extent of adaptation within urban spaces, especially in slums. Mental health associated with coping with a new urban environment losing their home,  security threats, condition of facilities and changed identity and their needs for rehabilitation needs to be thoroughly understood to ensure a better life for them. 

Bangladesh has made remarkable improvements in tackling natural hazards by reducing casualties and economic loss. But to be truly a resilient nation, we have to prepare ourselves to restore the lives of climate survivors, not forgetting the ladies.

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Connecting Social and Urban Studies with Health and Well-being of Communities – Speech at the National University of Colombia in Manizales

On January 29th 2020 NeuroLandscape’s Board Member Dr. Diana Benjumea was invited to give a talk in the Universidad Nacional de Colombia to the staff and students of the Department of Architecture and Built Environment in the city of Manizales.

The talk aimed to share the multidisciplinary work that is conducted in NeuroLandscape with special attention to the new program  Nature Connection and Mental Health of the Communities launched last year.

The information included some of the preliminary study results obtained from the two main international research clusters in Medellin (Colombia) and Dhaka (Bangladesh). The presentation discussed the social and scientific research approaches that NeuroLandscape is leading in order to understand the contribution of nature in the mental health of low-income communities with the aim of informing new urban design models.  

Staff from the Universidad de Caldas Manizales and the National Training Service (SENA) joined in the discussion of creating possible cooperation between institutions and NeuroLanscape in order to consolidate future social and scientific projects in the city of Manizales that could contribute to the health and well-being of the communities in this city.

With combined efforts from the educational institutions and the scientific background of Neurolandscape, future projects are envisioned, in which a greater network of opportunities that include new research projects and transfer skills education programs could be established with the aim of benefiting low-income community residents.