Health-related Inequalities Research Articles

Planning for health equity in the Americas: an analysis of national health plans.

ABSTRACTThere is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong

BackgroundWe examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence.Methods752 adult respondents from a previous random...

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review.

This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality

Trends in contraceptive use, unmet need and associated factors of modern contraceptive use among urban adolescents and young women in Guinea

BackgroundIn Guinea, high fertility among adolescents and young women in urban areas remains a public health concern. This study describes trends in contraceptive use, unmet need, and factors associated with the use of modern family planning (FP) methods among urban adolescents and young women in Guinea.MethodsWe used four Guinea Demographic and Health Surveys (DHS) conducted in 1999, 2005, 2012, and 2018. Among urban adolescents and young women (15–24 years), we examined trends over time in three key indicators: 1. Modern Contraceptive use, 2. Unmet need for FP and 3. Modern contraceptive use among those in need of FP (demand satisfied). We used multivariable logistic regression to examine association between socio-demographic factors and modern FP use on the most recent DHS dataset (2018).ResultsWe found statistically significant changes over the time period examined with an increase in modern contraceptive use (8.4% in 1999, 12.8% in 2018, p < 0.01) and demand satisfied (29.0% in 1999, 54.1% in 2018, p < 0.001), and a decrease in unmet need for FP (15.8% in 1999, 8.6% in 2018, p < 0.001). Factors significantly associated with modern FP use were; young women aged 20–24 years (AOR 2.8, 95% CI: 1.9–4.1), living in urban areas of Faranah (AOR: 2.6, 95% CI: 1.1–6.5) and Kankan (AOR: 3.6, 95% CI: 1.7–7.8), living in households in the middle (AOR: 7.7, 95% CI: 1.4–42.2) and richer wealth quintiles (AOR: 6.3, 95% CI: 1.0–38.1). Ever-married women (AOR: 0.5, 95% CI: 0.3–0.9) were less likely to use modern FP methods than never married as were those from the Peulh (0.3, 95% CI: 0.2–0.4) and Malinke (0.5, 95% CI: 0.3–0.8) ethnic groups compared to Soussou ethnic group.ConclusionDespite some progress, efforts are still needed to improve FP method use among urban adolescent and young women. Age, administrative region, wealth index, marital status, and ethnic group are significantly associated with modern FP use. Future policies and interventions should place emphasis on improving adolescents’ reproductive health knowledge, increasing FP availability and strengthening provision. Efforts should target adolescents aged 15–19 years in particular, and address disparities between administrative regions and ethnic groups, and health-related inequalities.

Human rights-based conceptions of deservingness: health and precarity

PurposeIdeas of health-related deservingness in theory and practise have largely been attached to humanitarian notions of compassion and care for vulnerable persons, in contrast to rights-based approaches involving a moral-legal obligation to care based on universal citizenship principles. This paper aims to provide an alternative to these frames, seeking to explore ideas of a human rights-based deservingness framework to understand health care access and entitlement amongst precarious status persons in Canada.Design/methodology/approachDrawing from theoretical conceptualizations of deservingness, this paper aims to bring deservingness frameworks into the language of human rights discourses as these ideas relate to inequalities based on noncitizenship.FindingsDeservingness frameworks have been used in public discourses to both perpetuate and diminish health-related inequalities around access and entitlement. Although, movements based on human rights have the potential to be co-opted and used to re-frame precarious status migrants as “undeserving”, movements driven by frames of human rights-based deservingness can subvert these dominant, negative discourses.Originality/valueTo date, deservingness theory has primarily been used to speak to issues relating to deservingness to welfare services. In relation to deservingness and precarious status migrants, much of the literature focuses on humanitarian notions of the “deserving” migrant. Health-related deservingness based on human rights has been under-theorized in the literature and the authors can learn from activist movements, precarious status migrants and health care providers that have taken on this approach to mobilize for rights based on being “human”.

Promoting physical activity-related health competences in people with intellectual disability

Abstract Background Physical inactivity is a global health problem. Physically active people show lower rates of chronic diseases or mortality. People with intellectual disabilities (PWID), a vulnerable group for health problems, have significantly lower levels of physical activity (PA) than general population. Due to reduced cognitive abilities, communicative and literacy skills, PWID have less access to health programs. Target-group-oriented interventions are rare. Methods Methodological triangulation to survey PA-related health competences in all 3 subcategories: 3 participating observations and 24 interviews with PWID (inclusion criteria for both: mild or moderate ID); staff online survey (n = 67), all in an integration assistance institution. Participatory approach: 2 expert groups with PWID advise researchers e.g. validating results. Results As expected, movement abilities and body awareness various highly from general population. An effect knowledge is widely spread (PA = health), but execution knowledge of PA is only marginally available e.g. not knowing how to increase PA healthy. Control competences as results from interview and observations: intrinsic motivation is highly present (unlike results from staff survey), but volition - self-efficacy and bring into action - is very poor, self-management and a lack of ideas are identified as a major problem. Low expectation of self-efficacy proved to be the biggest obstacles for PA, but caregiver are an own health resource. Expert groups confirm important of PWID perspectives on living environment. Conclusions To promote a PA lifestyle, health education with a focus on promoting self-efficacy orientated to the living environment (incl. caregiver) regarding own perspectives and health resources is needed. In this way, a vulnerable group for health problems can be empowered. Results indicate a successful approach to promote PA-related health competences in PWID to minimize health inequalities in relation to general population. Key messages Health inequalities among people with intellectual disability through promoting a PA lifestyle can be minimized. Intervention for people with intellectual disabilities must take into account the perspectives and the resources of the users.

People of African Descent of the Americas, Racial Discrimination, and Quality of the Health Services

The WHO urges countries to consider the link between racial discrimination and health and, in particular, the need for further research to study the links between health outcomes and racism, racial discrimination, xenophobia, and related intolerance. This article is carried out within the framework of approximation work towards health-related ethnic inequalities among the population of African descent of the Americas. A qualitative methodology was used to conduct 20 in-depth interviews with a group of key informants composed of leaders of African descent, officials from the ministries of health, international health agencies, and international technicians specialised in African descent health and interculturality from six different countries. The extracted data were categorised and encoded, generating quotations and concept maps with Atlas.ti v.8.2. The concurrency coefficients made it possible to link the codes of each subcategory with the central analytical category. The racial discrimination experienced by people of African descent and the quality of health services received poses a problem. Discrimination is faced in all countries, affecting access to services and the quality of health care, and greater discrimination against women is also detected. This shows the need for an activistpolicy and for the inclusion of specific variables in surveys, censuses, and records in order that they may be researched. Claims are made about the complementary role that traditional medicine may play and the fact that the intercultural approach may be a useful strategy for addressing inequalities. The interviewees agree with the reference theory on the existence of racial discrimination and segregation regarding the African descent population of the Americas and how this translates into ethnic inequities in the field of health. Proposals have been put forward both on how to deepen research and how to contribute to the reduction of ethnic inequalities in health issues.

What should we think about widening relative inequalities in health?

What should we think about widening relative inequalities in health?

Wider Dental Care Coverage Associated with Lower Oral Health Inequalities: A Comparison Study between Japan and England.

Countries with different oral health care systems may have different levels of oral health related inequalities. We compared the socioeconomic inequalities in oral health among older adults in Japan and England. We used the data for adults aged 65 years or over from Japan (N = 79,707) and England (N = 5115) and estimated absolute inequality (the Slope Index of Inequality, SII) and relative inequality (the Relative Index of Inequality, RII) for edentulism (the condition of having no natural teeth) by educational attainment and income. All analyses were adjusted for sex and age. Overall, 14% of the Japanese subjects and 21% of the English were edentulous. In both Japan and England, lower income and educational attainment were significantly associated with a higher risk of being edentulous. Education-based SII in Japan and England were 9.9% and 26.7%, respectively, and RII were 2.5 and 4.8, respectively. Income-based SII in Japan and England were 9.2% and 14.4%, respectively, and RII were 2.1 and 1.9, respectively. Social inequalities in edentulous individuals exist in both these high-income countries, but Japan, with wider coverage for dental care, had lower levels of inequality than England.

Do cognitively stimulating activities affect the association between retirement timing and cognitive functioning in old age?

AbstractIn response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

The diffusion of innovative diabetes technologies as a fundamental cause of social inequalities in health. The Nord-Trøndelag Health Study, Norway.

This study investigates patterns of adoption and diffusion of innovative health technologies by socioeconomic status (SES) in order to assess the extent to which these technologies may be a fundamental cause of health-related inequalities. Quantitative analyses examined SES-based inequalities in the adoption and diffusion of diabetes technologies. Diabetes data from three panels of the Nord-Trøndelag Health Study (HUNT), Norway, were combined with income and education data. Cross-sectional and longitudinal regression analyses were used to examine relevant inequalities. Cross-sectional analyses suggest often present SES-based gradients in the adoption of diabetes technologies, favouring high-SES groups. Statistically significant differences (p≤0.05) were most often present when technologies were new. In a cohort followed from 1984 to 1997, high SES individuals were more likely to adopt insulin injection technologies but, due to modest sample sizes, these inequalities were not statistically significant after adjusting for age, gender, and duration of illness. Moreover, compared to low SES individuals, high SES individuals are more active users of diabetes technologies. Results suggest that SES-based variations in access and use of innovative health technologies could act as a mechanism through which inequalities are reproduced. This study provides a discussion of mechanisms and a methodological foundation for further investigation.

Testing the regional Convergence Hypothesis for the progress in health status in India during 1980-2015.

The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981-2015), National Family Health Survey (NFHS, 1992-2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981-2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.

Trends in Socioeconomic Health Inequalities in Kazakhstan

According to the relative income hypothesis, the health status of a population is determined by its horizontal social and financial conditions, both mutually interrelated factors. As a former republic of the Soviet Union, Kazakhstan is a particularly interesting case in which to explore the impact of health-related inequalities due to economic, sociodemographic, and institutional changes experienced as the country transitioned to independent status. The goal of this article is to examine the degree to which commonly-used socioeconomic determinants (education, income, living conditions, marital status, occupation) are associated with health inequalities in Kazakhstan. We found significant differences in the health status characteristics among the population. Poor health was found to be significantly associated with living conditions and income level. This article will assist policy makers in developing and improving existing social and health policies to address the apparent lack of health-related equity in Kazakhstan.

Patterns of Health-Related Gender Inequalities—A Cluster Analysis of 45 Countries

PurposeThe paper explores gender inequalities between 45 countries across 10 health indicators among adolescents and whether those differences in health correlate with gender inequality in general. MethodsData from 71,942 students aged 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children survey were analyzed. For this purpose, 10 indicators were selected, representing a broad spectrum of health outcomes. The gender differences in the countries were first presented using odds ratios. Countries with similar risk profiles were grouped together using cluster analyses. For each of the 10 indicators, the correlation with the Gender Inequality Index was examined. ResultsThe cluster analysis reveals systematic gender inequalities, as the countries can be divided into seven distinct groups with similar gender inequality patterns. For eight of the 10 health indicators, there is a negative correlation with the Gender Inequality Index: the greater the gender equality in a country, the higher the odds that girls feel fat, have low support from families, have low life satisfaction, have multiple health complaints, smoke, drink alcohol, feel school pressure, and are overweight compared with boys. Four indicators show a divergence: the higher the gender equality in a country in general, the larger the differences between boys and girls regarding life satisfaction, school pressure, multiple health complaints, and feeling fat. ConclusionsCountries that are geographically and historically linked are similar in terms of the health risks for boys and girls. The results challenge the assumption that greater gender equality is always associated with greater health equality.

Level of active aging: Influence of environmental, social and health-related factors

ObjectiveTo analyze social, environmental and health-related inequalities in the level of active aging among older adults who participated in the Health Survey conducted in the city of Campinas, Brazil. MethodsThe level of active aging was estimated based on a ranking of engagement in activities using factor analysis. More active older adults (situated in the highest tertile of the ranking) were compared with the others through the prevalence ratios (PR) and respective 95 % confidence intervals (CI) estimated by Poisson regression. ResultsThe study population thus consisted of 986 older adults. The majority of the respondents were female (57.6 %), in the 60–69 years age group (56.7 %), had less than 8 years of schooling (65.3 %) and had a per capita family income of 1–3 minimum salaries (55.3 %). Access to public spaces for the practice of physical activity near the home (PR = 1.44; 95 % CI, 1.07−1.94) and higher level of education (PR = 2.14; 95 % CI, 1.60−2.86), income (PR = 1.73; 95 % CI, 1.25−2.40), physical health (PR = 1.44; 95 % CI, 1.13−1.82) and mental health (PR = 1.62; 95 % CI, 1.05−2.49) were more prevalent among older adults with a high level of active aging. DiscussionThe findings demonstrate that the level of involvement in activities does not solely depend on personal choices. Social, economic, environmental, physical and mental contexts all exert a strong influence.

A decline in patient disclosure of heterosexuality in the English General Practice Patient Survey: a longitudinal analysis of cross-sectional data

Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or 'other' sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or 'other' increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56-0.99%). We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, 'other sexual orientation' or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

Changing relative and absolute socioeconomic health inequalities in Ontario, Canada: A population-based cohort study of adult premature mortality, 1992 to 2017.

BackgroundThis study aimed to characterize trends in absolute and relative socioeconomic inequalities in adult premature mortality between 1992 and 2017, in the context of declining population-wide mortality rates. We conducted a population-based cohort study of all adult premature deaths in Ontario, Canada using provincial vital statistics data linked to census-based, area-level deprivation indices for socioeconomic status.MethodsThe cohort included all individuals eligible for Ontario’s single-payer health insurance system at any time between January 1, 1992 and December 31, 2017 with a recorded Ontario place of residence and valid socioeconomic status information (N = 820,370). Deaths between ages 18 and 74 were used to calculate adult premature mortality rates per 1000, stratified by provincial quintile of material deprivation. Relative inequalities were measured using Relative Index of Inequality (RII) measures. Absolute inequalities were estimated using Slope Index of Inequality (SII) measures. All outcome measures were calculated as sex-specific, annual measures for each year from 1992 to 2017.ResultsPremature mortality rates declined in all socioeconomic groups between 1992 and 2017. Relative inequalities in premature mortality increased over the same period. Absolute inequalities were mostly stable between 1992 and 2007, but increased dramatically between 2008 and 2017, with larger increases to absolute inequalities seen in females than in males.ConclusionsAs in other developed countries, long-term downward trends in all-cause premature mortality in Ontario, Canada have shifted to a plateau pattern in recent years, especially in lower- socioeconomic status subpopulations. Determinants of this may differ by setting. Regular monitoring of mortality by socioeconomic status is the only way that this phenomenon can be detected sensitively and early, for public health attention and possible corrective action.

Responsive evaluation of stakeholder dialogue as a worksite health promotion intervention to contribute to the reduction of SEP related health inequalities: a study protocol

BackgroundLarge health inequalities exist in the Netherlands among individuals with a high compared to a low socioeconomic position. Worksite health promotion interventions are considered promising to reduce these inequalities, however, current interventions seem not to have the desired effects. This study proposes ‘moral case deliberation’, a form of stakeholder dialogue on moral dilemmas, as an integrated and inclusive intervention for worksite health promotion. This intervention takes into account three factors that are considered possible underlying causes of low effectiveness of current interventions, namely the lack of deliberate attention to: 1) the diverging values and interests of stakeholders in worksite health promotion, 2) the ethical issues of worksite health promotion, and 3) the connection with the lived experience (lifeworld) of lower SEP employees. Moral case deliberation will help to gain insight in the conflicting values in worksite health promotion, which contributes to the development of a vision for worksite health promotion that is supported by all parties.MethodsThe intervention will be evaluated through Responsive Evaluation, a form of participatory research. Key to Responsive Evaluation is that stakeholders are consulted to determine relevant changes as a result of the intervention. The intervention will be evaluated yearly at both fixed moments (baseline and annual evaluation(s)) and continuously. Mixed methods will be used, including interviews, participatory observations, analyses of HRM-data and short questionnaires. In addition, the intervention will be evaluated economically, on both monetary and non-monetary outcomes.DiscussionThis protocol proposes an innovative intervention and a novel participatory evaluation in the context of worksite health promotion. The study aims to gain understanding in how dialogue on moral dilemmas on health and health promotion can contribute to heightened personal and mutual understanding among stakeholders and practice improvements in the work context. By evaluating the intervention in more than one setting, findings of this study will provide knowledge about how MCD can be adapted to specific work settings and what changes it may lead to in these settings.Trial registrationNetherlands Trial Register (NRT): NL8051. Registration date: 28/09/2019, retrospectively registered. https://www.trialregister.nl/

Development of Serious Games (Equit'Game) to Address Health and Environmental Inequalities: Protocol for an App-Delivered Program to Perform a Territorial Diagnosis.

BackgroundTerritorial diagnosis is a prerequisite for local actions concerning public health and for the reduction of social, environmental, and health-related inequalities. To orient local programs or initiatives targeting health inequalities, policymakers need a simulation of territorial diagnosis tools. Yet, very few platforms have been developed for the purpose of guiding public authorities as they seek to reduce these social inequalities.ObjectiveThis study aimed to describe the design and methods of the development process of a territorial diagnosis tool based on a serious game named Equit’Game that puts learners at the heart of the territorial diagnosis process, asking them to review the current state of health, environmental state, and socioeconomic state of their territory.MethodsThe realistic situations employed in our serious game should encourage players, in a fun and playful manner, to (1) appropriate the data of their own territory, (2) apply their methodological knowledge in a practical way, (3) reflect on the most pertinent statistical or spatial tools for their situation, and (4) ultimately, to acquire new knowledge and skills in the use of territorial diagnosis tools with a spatial dynamic. Equit’Game was deployed over the course of a week’s training and structured into 4 levels: level 1, Dataminer (identifying relevant information to respond to the question); level 2, Analyst (selecting the appropriate method of analysis); level 3, Atlas (mapping the data); and level 4, Cluster (extraction of statistical and spatial information). Equit’Game has also been designed as a sort of virtual campus, creating a fun learning environment in which each door represents a level. Users can access Equit’Game via a platform compatible with tablets, PCs, and mobile phones.ResultsIn the first step, we tested our application interface designed especially for adults among a panel of local health professionals. The following are some of the most relevant points: font size and colors used, voice accompaniment in texts and messages guiding the user, clear and easy interfaces, and the change between successive game levels. In the second step, we used our application, Equit’Game, with postgraduate students from the School of Public Health (École des hautes études en santé publique). At the end of the game session, we conducted a satisfaction survey, including several items covering both the application interface and the execution of the game.ConclusionsEquit’Game was developed to help learners with the techniques of territorial diagnosis, with the aim of creating an innovative tool for public health capable of conveying educational messages and providing a structure for training.International Registered Report Identifier (IRRID)PRR1-10.2196/11786

Testing the Regional Convergence Hypothesis for the Progress in Health Status in India During 1980–2015

The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981–2015), National Family Health Survey (NFHS, 1992–2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981–2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.