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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

Gender and caste proportions of candidates in state elections in India, 2005-12. The right axis displays the number of states holding elections in each year.
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Fig6: Gender and caste proportions of candidates in state elections in India, 2005-12. The right axis displays the number of states holding elections in each year.

Mentions: FigureĀ 6 displays data on the sex and caste of candidates in state elections held between 2005 and 2012 [20]. Fluctuations in the proportion of SC/ST candidates are attributable to the changing composition of states holding elections in each year; spikes in the less developed states are explained by a few northeast states holding elections in 2008 and 2009. These are the only states in India with majority SC/ST populations and a consistently high proportion of SC/ST candidates. Overall, nearly a third of candidates during 2005-12 belonged to SC/ST, which is proportionate to the fraction of the national population belonging to this group. In contrast, regardless of the states with elections in each year, the low percentage of female candidates showed little change and was similar in both state groups.Figure 6


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

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

Gender and caste proportions of candidates in state elections in India, 2005-12. The right axis displays the number of states holding elections in each year.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig6: Gender and caste proportions of candidates in state elections in India, 2005-12. The right axis displays the number of states holding elections in each year.
Mentions: FigureĀ 6 displays data on the sex and caste of candidates in state elections held between 2005 and 2012 [20]. Fluctuations in the proportion of SC/ST candidates are attributable to the changing composition of states holding elections in each year; spikes in the less developed states are explained by a few northeast states holding elections in 2008 and 2009. These are the only states in India with majority SC/ST populations and a consistently high proportion of SC/ST candidates. Overall, nearly a third of candidates during 2005-12 belonged to SC/ST, which is proportionate to the fraction of the national population belonging to this group. In contrast, regardless of the states with elections in each year, the low percentage of female candidates showed little change and was similar in both state groups.Figure 6

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