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Structural Drivers of Inequities in Health

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Health Inequities in India

Abstract

This introductory chapter provides the backdrop against which the evidence on health inequities in India, synthesised in later chapters, may be understood. In this chapter, we argue that the extreme economic inequalities underlying significant inequities in health are fuelled by forces of neo-liberal globalisation. The chapter illustrates with facts and figures that the neo-liberal economic policies that were adopted in India since the mid-1980s have increased income and wealth inequalities. While economic growth has been significant, the benefits have not accrued to those in the lowest income and wealth categories. Growth has not generated adequate employment to absorb the surplus rural labour or the new entrants into the labour force. A large proportion of workers experience insecure livelihoods and poor living and working conditions. These adversities are experienced disproportionately by those already disadvantaged based inter alia on class, caste and gender, and may be expected to impact the pattern of inequities in health in India.

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Notes

  1. 1.

    It is our contention that these are the processes through which social inequality is enforced, and not the causes or drivers.

  2. 2.

    Before the 1980s, national industry and agriculture were protected from competition from imported goods. The growth of monopolies was legally restricted. Small-scale and cottage industries were protected, incentives provided for setting up industries in economically less-developed regions; major public-sector enterprises were vested with responsibility for infrastructural development, mining and production of iron and steel. Subsidies for inputs in agriculture and low-interest credit for agricultural investment were provided. Price controls were in place in priority sectors including for drugs. Public investment in health and education made health services and education free or heavily subsidised at the point of delivery.

  3. 3.

    A note on terminologies is in order here. While we would prefer to use the terms Dalit and Adivasi, and have done so when we are referring to these population groups, where we cite data from published sources, we have maintained the terminologies used by the authors of the study. Thus in almost all places where studies are cited, the terms SC and ST, or as is often the case, SC/ST is used.

  4. 4.

    There is great diversity among those classified as “Scheduled Tribes” under the Constitution of India in terms of cultural traits, social organization and modes of living. They also vary with respect to their exposure to and integration into mainstream society.

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Authors and Affiliations

  1. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India

    T. K. Sundari Ravindran

  2. Centre for Technology and Policy (CTaP) IIT-M, Chennai, India

    Rakhal Gaitonde

  3. Faculty at the Institute of Public Health, Bangalore, India

    Prashanth Nuggehalli Srinivas

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  1. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

    T.K. Sundari Ravindran

  2. Centre for Technology and Policy (CTaP), Indian Institute of Technology Madras, Chennai, Tamil Nadu, India

    Rakhal Gaitonde

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Ravindran, T.K.S., Gaitonde, R., Srinivas, P.N. (2018). Structural Drivers of Inequities in Health. In: Ravindran, T., Gaitonde, R. (eds) Health Inequities in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5089-3_1

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