SOCIAL DETERMINANTS OF HEALTH IN INDIA LOOKING FOR EVIDENCE

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SOCIAL DETERMINANTS OF HEALTH IN INDIA LOOKING
FOR EVIDENCE

• C.A.K. Yesudian
• Dean
• School of Health Systems Studies
• Tata Institute of Social Sciences
• Mumbai, INDIA

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Social Determinants of Health

• India is a multi-cultural, multi-ethnic,
  multi-lingual society with pluralistic health
  system
• Inequality in health status and inequity in
  accessing health resources
• Socio-economic determinants poverty, social
  exclusion and gender discrimination
• Access to basic health services, e.g. access to
  institutional delivery
• Health workforce shortage and skewed distribution
• There is scarcity of evidence on these issues

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• Inequality in Health and Inequity in Health
  Services
• Gender and Health
• Medical Workforce Shortage

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Inequality in Health and Inequity in Health
Services
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India
Gujarat
Maharashtra
Karnataka
Tamil Nadu
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Trend in Infant Mortality Rate
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Infant Mortality Rate by Wealth Quintile (2005
2006)
Q5
Q4
Q3
Q2
Q1
Q5
Q4
Q3
Q2
Q1
Q5
Q4
Q3
Q2
Q1
Q5
Q3
Q2
Q1
Q5
Q5
Q5
Q5
Q5
Q5
Q4
Q4
Q4
Q4
Q3
Q3
Q3
Q3
Q2
Q2
Q2
Q1
Q1
IMR
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Trend of Institutional Delivery (1992-2006)
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Institutional Delivery by Wealth Quintile (2005
2006)
Wealth quintile
Average
Q1- Poorest Q2- Poor Q3- Middle Q4-
Rich Q5-Richest
Q1
Q2
Q3
Q4
Q5
Q3
Q4
Q5
Q4
Q5
Q1
Q2
Q3
Q4
Q5
Q1
Q2
Q3
Q4
Q5
Q5
Q5
Q1
Q2
Q3
Q4
Q5
Q1
Q2
Q3
Q4
Q5
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Gender and Health
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Spousal Violence Against Women and Their Health
Status
Source NFHS-3
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Sexual Violence and Reproductive Health Problems
Source NFHS-3
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Spousal Violence and Utilization of Maternal
Healthcare
Source NFHS-3
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Medical Workforce Shortage
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Medical Workforce Shortage in Government
Healthcare Facilities Case of Maharashtra

• 17 of doctors (4000) come from medical colleges
  in Maharashtra
• 25 doctor shortage in PHCs and 40 shortage in
  rural hospitals
• Reluctance of medical graduates to join the
  government services

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Profile of Medical Graduates

• 66.7 male 71 in age group of 21 to 25 years
  and 92.3 not married
• 62 come from big cities
• 82 belong to upper and middle castes
• 30 are very rich
• 31 have doctors in the family

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Not Opting for Govt. Job Demographic Profile
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Not Opting for Govt. Job Social Profile
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Not Opting for Govt. JobEconomic Profile
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Commission on Social Determinants of Health
government do? What can others do?
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Way Forward I Building Social Science Research
Capacity

• Need to create a critical mass of social
  scientists to work in the field of health
• Emerging public health training institutions
  need to build social science research capacity
• Closer link between ICSSR and ICMR
• Commitment of the government to fund social
  science research on priority areas, especially in
  the light of NRHM

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Way Forward II Interfacing Research and Policy

• Need to communicate research findings that help
  to formulate meaningful and realistic policies.
• Create a platform for social scientists and
  policy makers so that research is relevant for
  policy making
• Indian Health Observatory

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Indian Health Observatory

• Adapting the WHO Euro model and gain from the
  expertise of European Health Observatory
• 29 Indian states and 6 union territories having
  35 different health systems
• Profiling the health system of each state
• Addressing issues of inequality in health status
  and inequity to access health services in
  different states.
• Mapping health sector reforms in different states
  
• Extensively share information with policy makers
  and set-up research agenda in consultation with
  policy makers

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Thank you