Abstract
Introduction: Urban areas in the Global South are marked by widespread informality stemming from the inability of economic, legal, and institutional systems to accommodate diverse populations. Most urban health research is restricted to assessing determinants of health and population vulnerability, while the intersection of informality and urban health remains underexplored.
Methods: The fieldwork was conducted in two low-income settlements in Surat, a city in western India. Qualitative methods included quasi-participant observation (168 hours), focus groups (12), and in-depth interviews (18), with data analysed through reflexive iteration.
Results: The findings revealed that inadequacies in formal systems - spanning governance, law enforcement, civic amenities, the economy, social systems, and urban planning - were entrenched in health inequities. The study mapped cascading pathways where informalities led to a spectrum of health outcomes, including infectious diseases, non-communicable diseases, climate-induced health impacts, mental health disorders, injuries, and violence. Unregulated healthcare further worsened vulnerabilities by increasing recovery challenges and out-of-pocket costs. Life in both settlements demonstrated a natural integration of formal and informal elements. People actively demanded and sometimes negotiated access to resources while responding to exclusionary state policies. Informal economies and unique subcultures emerged as critical coping mechanisms. People accessed healthcare through “informal traditional” and “informal modern” practices. Situational social networks fostered collective action during health crises.
Conclusion: Informality was not merely a symptom of systemic neglect but a dynamic survival strategy that shaped resilience and recovery. This study underscored the need for context-specific theorisation beyond Western paradigms to comprehend urban health inequities in the Global South.