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Social determinants of health in India: progress and inequities across states.

Cowling K, Dandona R, Dandona L - Int J Equity Health (2014)

Bottom Line: Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children.Less than 25% of workers have job security and fewer than 15% have any social security benefit.Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations.

View Article: PubMed Central - PubMed

Affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India. kcowlin1@jhu.edu.

ABSTRACT

Introduction: Despite the recognized importance of social determinants of health (SDH) in India, no compilation of the status of and inequities in SDH across India has been published. To address this gap, we assessed the levels and trends in major SDH in India from 1990 onwards and explored inequities by state, gender, caste, and urbanicity.

Methods: Household- and individual-level SDH indicators were extracted from national household surveys conducted between 1990 and 2011 and means were computed across population subgroups and over time. The multidimensional poverty index (MPI), a composite measure of health, education, and standard of living, was calculated for all three rounds of the National Family Health Survey, adjusting the methodology to generate comparable findings from the three datasets. Data from government agencies were analyzed to assess voting patterns, political participation, and air and water pollution.

Results: Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children. There are large, but narrowing, gender gaps in education indicators, but no measurable change in women's participation in governance or the labor force. Less than 25% of workers have job security and fewer than 15% have any social security benefit. Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations.

Conclusions: This assessment indicates that air pollution (indoor and outdoor), child undernutrition, unimproved sanitation, employment conditions, and gender inequality are priority areas for public policy related to SDH in India.

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Related in: MedlinePlus

Multidimensional Poverty Index Headcount Ratio: state-level trends. NFHS-1, 2, and 3, disaggregated by urban/rural location and caste, for A) less developed states and B) more developed states. Results are not presented for subpopulations (defined by survey year, state, urbanicity, and caste) if the sample size was less than 100 households.
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Fig2: Multidimensional Poverty Index Headcount Ratio: state-level trends. NFHS-1, 2, and 3, disaggregated by urban/rural location and caste, for A) less developed states and B) more developed states. Results are not presented for subpopulations (defined by survey year, state, urbanicity, and caste) if the sample size was less than 100 households.

Mentions: The MPI headcount ratio in each survey-year for states grouped by level of development and disaggregated by urban/rural location and caste are presented in Figure 1. Results by state are presented in Figure 2. Using this index, 42%, 35.7%, and 24.7% of the Indian population were identified as multidimensionally poor in 1992-93, 1998-2000, and 2005-06, respectively. In comparison, the national poverty headcount ratio using the Government of India’s income-based approach showed much less of a decline from 1993-94 to 2004-05: from 45.3% to 37.2% [26]. Significant disparities in the MPI exist across subgroups of the population. Households in less developed states were more deprived in each round of the survey overall, as well as within each subpopulation defined by caste and urbanicity, compared to households in more developed states. Across both state groups, greater disparities are observable between urban and rural households than between castes: in 2005-06, the headcount ratio gap between urban and rural households was 20 to 30% versus 10 to 15% for SC/ST and other households. However, there was a larger reduction in multidimensional poverty in rural subgroups; the headcount ratio among rural households declined by over 15% in both groups of states between 1992-93 and 2005-06 as compared with a less than 10% decline in urban households.Figure 1


Social determinants of health in India: progress and inequities across states.

Cowling K, Dandona R, Dandona L - Int J Equity Health (2014)

Multidimensional Poverty Index Headcount Ratio: state-level trends. NFHS-1, 2, and 3, disaggregated by urban/rural location and caste, for A) less developed states and B) more developed states. Results are not presented for subpopulations (defined by survey year, state, urbanicity, and caste) if the sample size was less than 100 households.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4201685&req=5

Fig2: Multidimensional Poverty Index Headcount Ratio: state-level trends. NFHS-1, 2, and 3, disaggregated by urban/rural location and caste, for A) less developed states and B) more developed states. Results are not presented for subpopulations (defined by survey year, state, urbanicity, and caste) if the sample size was less than 100 households.
Mentions: The MPI headcount ratio in each survey-year for states grouped by level of development and disaggregated by urban/rural location and caste are presented in Figure 1. Results by state are presented in Figure 2. Using this index, 42%, 35.7%, and 24.7% of the Indian population were identified as multidimensionally poor in 1992-93, 1998-2000, and 2005-06, respectively. In comparison, the national poverty headcount ratio using the Government of India’s income-based approach showed much less of a decline from 1993-94 to 2004-05: from 45.3% to 37.2% [26]. Significant disparities in the MPI exist across subgroups of the population. Households in less developed states were more deprived in each round of the survey overall, as well as within each subpopulation defined by caste and urbanicity, compared to households in more developed states. Across both state groups, greater disparities are observable between urban and rural households than between castes: in 2005-06, the headcount ratio gap between urban and rural households was 20 to 30% versus 10 to 15% for SC/ST and other households. However, there was a larger reduction in multidimensional poverty in rural subgroups; the headcount ratio among rural households declined by over 15% in both groups of states between 1992-93 and 2005-06 as compared with a less than 10% decline in urban households.Figure 1

Bottom Line: Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children.Less than 25% of workers have job security and fewer than 15% have any social security benefit.Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations.

View Article: PubMed Central - PubMed

Affiliation: Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India. kcowlin1@jhu.edu.

ABSTRACT

Introduction: Despite the recognized importance of social determinants of health (SDH) in India, no compilation of the status of and inequities in SDH across India has been published. To address this gap, we assessed the levels and trends in major SDH in India from 1990 onwards and explored inequities by state, gender, caste, and urbanicity.

Methods: Household- and individual-level SDH indicators were extracted from national household surveys conducted between 1990 and 2011 and means were computed across population subgroups and over time. The multidimensional poverty index (MPI), a composite measure of health, education, and standard of living, was calculated for all three rounds of the National Family Health Survey, adjusting the methodology to generate comparable findings from the three datasets. Data from government agencies were analyzed to assess voting patterns, political participation, and air and water pollution.

Results: Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children. There are large, but narrowing, gender gaps in education indicators, but no measurable change in women's participation in governance or the labor force. Less than 25% of workers have job security and fewer than 15% have any social security benefit. Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations.

Conclusions: This assessment indicates that air pollution (indoor and outdoor), child undernutrition, unimproved sanitation, employment conditions, and gender inequality are priority areas for public policy related to SDH in India.

Show MeSH
Related in: MedlinePlus