Abstract
IntroductionDespite 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.MethodsHousehold- 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.ResultsChanges 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-014-0088-0) contains supplementary material, which is available to authorized users.
Highlights
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
As the relative importance of different social determinants of health, the availability of data for tracking progress, and the history of relevant government actions vary by country, it is important to extend this discussion to the country level for national policy relevance
A systematic and continuing understanding of how SDH are evolving in India, as well as analyses of the impacts of changes in SDH on health outcomes, are essential for sustained improvements in the health of the majority of Indians
Summary
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. The broad definition of SDH employed by the CSDH encompasses a web of factors that interact in multiple and complex ways; as a result most analyses are not able to include all underlying factors or do a full analysis of the ways determinants affect one another. With this limitation, this review includes major SDH in India for which there are available data, examined for important inequities when possible. Key SDH not included in this review due to the absence of data are described in the discussion
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