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Letter to Editor

Comparative study of slum and non-slum populations to inform urban expansion of Universal Health Coverage

Pitcairn, Charlie Fife Michael

Author Information
Journal of Family Medicine and Primary Care: May 2022 - Volume 11 - Issue 5 - p 2256-2257
doi: 10.4103/jfmpc.jfmpc_1103_21
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To the Editor,

I would like to thank Mendhe and colleagues for the recent publication of their study entitled “Universal Health Insurance coverage and utilization among women in urban slum of Rajnandgaon, Chhattisgarh.”[1] The authors found that expansion of regional basic health insurance systems reduced rates of out-of-pocket (OOP) healthcare expenditures in slum-dwelling females. I would like to suggest a comparative study of slum and non-slum urban populations as an avenue for further research that might paint a more granular picture of the health coverage expansion in the region.

Their analysis of universal healthcare (UHC) expansion in a slum community is an important one. The considerable size of the global slum-dwelling population, coupled with the role that expansion of health coverage has been shown to play in improving urban health outcomes in other low- and middle-income countries,[2] demonstrates slum dwellers as a key potential target demographic for UHC expansion. Slum environments have been theorized to impact health outcomes independently of residents’ sociodemographic characteristics.[3] Poorer, slum-dwelling populations are also more likely to continue work in spite of injury[4] or illness to avoid potentially intolerable OOP health expenditures.

By using a similar cross-sectional study design to Mendhe et al., sampling respondents from both slum and non-slum urban areas, it could be possible to compare differences in the socioeconomic patterning of health coverage between distinct urban environments. Making use of such comparative analysis among slum and non-slum communities in Chhattisgarh, investigators might be able to determine the impact, if any, that slum residence itself has on the success of UHC expansion in the region.

The importance of UHC expansion as a means to reduce urban health inequalities, notably in the field of catastrophic OOP health expenditure,[5] has been recognized. A greater understanding of the role that slum-residence plays in this process in India would allow both local and national policymakers to tailor UHC expansion and other public health interventions with greater accuracy. Cross-sectional studies, similar to that of Mendhe and colleagues, which compared slum and non-slum respondents could provide this important granularity.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


The author would like to thank Dr Tom Hone, Mr Jasper Chan, KJ, LJ, LMR, and MTF for their support and assistance in navigating the field of slum health


1. Mendhe HG, David R, Singh D, Makade KG Universal Health Insurance coverage and utilization among women in urban slum of Rajnandgaon, Chhattisgarh J Family Med Prim Care 2021 10 1313–9
2. Hone T, Saraceni V, Medina Coeli C, Trajman A, Rasella D, Millett C, et al Primary healthcare expansion and mortality in Brazil' s urban poor: A cohort analysis of 1.2 million adults PLoS Med 2020 17 e1003357
3. Lilford R, Kyobutungi C, Ndugwa R, Sartori J, Watson SI, Sliuzas R, et al Because space matters: Conceptual framework to help distinguish slum from non-slum urban areas BMJ Global Health 2019 4 e001267
4. Niessen LW, Mohan D, Akuoku JK, Mirelman AJ, Ahmed S, Koehlmoos TP, et al Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda Lancet (London, England) 2018 391 2036–46
5. Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage Int J Health Plann Manage 2019 34 e1387–404
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