Cancer in Developing Countries: The Great Challenge for Oncology in the 21st Century

II.7
CanSupport:
Pioneering Domiciliary Palliative Care in Delhi (p. 97-98)

Harmala Gupta and Inder Raj K. Grewal

II.7.1 Introduction

India is a vast and diverse country with a population that officially crossed the one billion mark on May 11, 2000 (1). Though India continues to be predominantly rural (in 1991 only 26% of the population lived in urban areas) the last couple of decades have seen a substantial growth of urban metropolises (cities with a population of several million) (2). Today Delhi is the third largest metropolis in India, after Mumbai and Calcutta and is growing rapidly (3). According to the most recent Census held in 2001, the population of Delhi has exceeded 13 million.

The demographic evolution of the city of Delhi, which is situated in North West India, owes as much to its geographical location as it does to its place in history. Delhi is situated at the heart of a tightly knit group of towns of various sizes, to the west of an immense, fertile and densely populated plain which stretches from the Pakistani frontier to the Gangetic Delta. This part of the Indo-Gangetic plain is constituted mainly by the Punjab, which was ‘partitioned’ between India and Pakistan at the time of Independence. The Indian side of the Punjab was later subdivided to form the states of Punjab and Haryana and it is to the south east of these that the National Capital Territory of Delhi is situated.

After Independence in 1947, Delhi became the capital of the newly formed Indian Union and faced a massive influx of population from the Pakistani part of Punjab soon after. This led to the spatial expansion of the city in all directions, including east of the Yamuna river. The urbanization of the rural hinterland, as well as the emergence of satellite towns that form a ring around the administrative limits of the National Capital Territory, are a result of this. However, Delhi continues to represent a classic model of population density gradients with high densities in the urban core and a sharp decline towards the periphery, In this connection, it is interesting to note, that though 54% of the total area of 1483 square kilometers of Delhi’s National Capital Territory is presently defined as rural, it is the urban areas of Delhi that still harbour 90% of its population (4).

In the last two decades, there has been a concerted attempt by the Delhi Development Authority to move the population to the periphery. Their housing schemes have, however, been confined to the middle and upper middle classes with the result that large sections of the lower middle class have had to resort to illegal construction on agricultural land not officially authorized for this purpose, while the poor live in precarious squatter settlements known as jhuggi-jhonpris, to be found all over the city. In 1994, according to official estimates, about 481,000 fami lies lived in 1,080 jhuggi-jhonpri clusters, which varied in size from a dozen dwelling units to 12,000. They form about 25% of the total population of Delhi (5).

More recent migrants to the city have no option but to live in peripheral areas around Delhi, as most people cannot afford to buy property or pay the high rents within Delhi’s urban agglomeration (this excludes the rich who are moving out to live in luxurious "farm-houses" as a lifestyle choice). This, however, has not eased the in-migration flow into the centre of the city. It has, instead, intensified commuting between these areas and the metropolitan centre where most offices and businesses, and therefore employment opportunities, continue to be located. As a consequence, given the lack of a mass transit system in Delhi (only 9 km of a metro rail line have been constructed so far), there has been a massive increase in the number of vehicles on the road as people have invested in their own means of transportation or are ferried back and forth by private bus operators. In fact, it is estimated that today the number of vehicles on the roads of Delhi is more than the number of vehicles on the roads of Mumbai, Bangalore and Chennai put together. This has affected the quality of life within the city as pollution levels have soared, traffic jams have increased and flyovers are being constructed at all major intersections leading to further delays and traffic disruptions.