Abstract
ABSTRACTBackground: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled.Objective: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term.Methods: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs.Results: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention.Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.
Highlights
The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability
By reviewing the literature on the causes of NCDs in Indian slums from a systems perspective, this study looks to organise the complex networks of Social Determinants of Health (SDH) in slums through Root cause analysis (RCA)
From the inductive analysis of reviewed articles, four themes emerged that were used during the RCA to structure the social determinants of NCDs identified in slums: lack of clean water, education, physicalactivity and transportation
Summary
The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted. The constraints to health placed on slum populations are unique given the combination of their urbanised lifestyle and limited access to healthcare, usually as a result of being relatively poor [7] Whilst these shifts in lifestyle are often associated with economic development – such as, a higher consumption of processed foods and decreases in physical activity – they do not bring the benefits of greater access to healthcare provision [8]. Addressing NCDs in slums must be able to account for the wide-ranging causes of disease wrought by these contextual and social factors, and the Social Determinants of Health (SDH) offers one approach to studying this interplay
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