Inequitable distribution of health
Discuss about the Social Determinants of Health and Well Being.
India is responsible for the major stake of the global disease burden with 18 % of the global deaths and 20% disability-adjusted life-years (DALYs). Majority of health burden in India is contributed by the rural India and there is significant health inequality among rural India and urban India. It is mainly due to unequal distribution of health within the different geographical and socio-economic sectors of India. Other factors like gender, caste, wealth and education are also responsible for the variation in health in rural and urban India. Most of the health inequalities in India are mainly due to unequal distribution of the primary social goods, power and resources. Perception of health in the past was different from the current time. Hence, specific efforts were not taken to reduce variability in health between rural and urban population. Inequality in the Indian healthcare sector can be effectively addressed by implementing specific strategies based on different determinants like unemployment, illiteracy and poverty. Detailed analysis of the inequality need to be carried out to implement strategies for reducing inequality among rural and urban population in India (Balarajan et al., 2011).
Inequalities in the healthcare is associated with the unequal opportunity for everyone to lead to the healthy life. In India, people residing in the rural area live approximately 5 years less as compared to the people in the urban area. This health inequality can be effectively reduced by giving more attention to these people. In whole, approximately 33 % of the children in age group 6 – 11-year-old are in excess body weight; 43 % children in the same age group are overweight in rural India and 39 % people in urban India are overweight. In past, there was significant inequality in terms of cancer and CVD prevalence among rural and urban population. In rural population, there was more prevalence of cancer and CVD as compared to the urban population. There was health inequality between gender in rural and urban people in India (Goli and Arokiasamy, 2014).
Life expectancy of males is more by 5 years in urban population as compared to the rural population. Life expectancy of females is more by 3 years in urban population as compared to the rural population. Premature mortality due to cancer is more than double in rural population as compared to the urban population. Premature mortality due to CVD is 3.5 times more in rural population as compared to the urban population. Infant mortality rate is almost more than double in rural population as compared to the urban population (Goli and Arokiasamy, 2014).
Inequity in the past
Inequality in access to healthcare services was also evident in India. Utilization of the preventive healthcare services such as antenatal care and immunizations remains suboptimal based on the gender, socioeconomic status and geography (Singh et al., 2012). Immunization coverage was 39 % in rural India and 58 % in urban India (Prusty and Kumar, 2014). Access to the maternal health services is an important indication of the health inequalities among rural and urban population. Approximately 39 % and 16 % women in rural and urban area respectively didn’t receive maternal care. Inequalities in wealth and education are mainly responsible for the inequalities in access to maternal care (Goli et al., 2014).
Approximately, 80 % of the health sector in India is in the hands of private sector. Most of the players among these private sectors are not willing to go the rural areas for providing care to these people. Cost of healthcare services is more in private sector as compared to the public sector. There is huge variation in the healthcare expenditure in different states of India. Approximately 30 % public health expenditure is allocated to the urban population while approximately 12 % of the public expenditure is allocated to the rural population. Physical access to the healthcare services is a major barrier for the people in rural India (Joe et al., 2015). Approximately, 70 % of the population of the India is residing in the rural India; however, number of hospitalised beds are more in urban area as compared to the rural area. Private sector distributed unplanned and unequal distribution of healthcare services to the urban area. Most of the qualified healthcare professionals are not willing to provide healthcare services in the rural area; hence, over a million unqualified people are carrying out healthcare practice in the rural India. In rural India, there is deficiency of approximately more than 40 % of healthcare providers. Moreover, rural healthcare services are associated with limitations like limited opening hours, limited availability of drugs and other supplies, poor physical environments, and poor provider training and knowledge (Pallikadavath et al., 2013). Healthcare expenditure is more among rural population as compared to the urban population. 14 % of the rural population and 12 % of the urban population spend their more than 10 % of total expenditure on the healthcare services (Pallikadavath et al., 2013).
Socio-economic deprivation and personal characteristics like age and sex are mainly responsible for the inequalities in health among people in the rural region. Higher level of deprivation is always associated with the consistent poor health outcomes. Health inequality in rural areas is more because specific groups are living in the same area since long time.
In past, health inequality in Indian population was mainly determined based on the life expectancy. In calculating health inequality in India, life expectancy was compared between the rural population and urban population. Statistical significance was established between inequality of health among rural population and urban population. In the past, it was not feasible to assess the factors responsible for impacting on the life expectancy of people in the rural India. It was evident that illiteracy, unemployment, unhealthy lifestyle and consumption of unhealthy food were responsible for the inequality of health. However, studies were not carried not carried out to establish relationship between these social determinants and inequality of health (Younger, 2016). Hence, it was difficult to provide intervention to target specific social determinant to improve quality of healthy life and reduce health inequality in rural India.
Local authority and local population were not authorised to establish relationship between these social determinants and inequality of health. Local authorities and local population implemented strategies to address these health determinants to reduce health inequality. However, there was lag between the implemented strategy and improvement in the health status of the population. It was mainly due to these strategies were not designed based on the specific health determinant. In the past, strategies for improving health of people in the rural population would have been improved by implementing strategies in combination. However, strategies were not implemented in combination; however, isolated strategies were being implemented. Health inequality was studied in the past mainly based on the difference in the socioeconomic status of the people and not on the baseline health status of the people in the rural India. As a result, it didn’t give accurate data about the health status of the people in the rural area. Study of health inequality based on the baseline health status of the people would have given accurate estimate of the health status of the people. Hence, it gave biased conclusion about the health status of the people in rural India. In the past, there was huge difference observed between the life expectancy between the rural population and urban population because this life expectancy was measured based on the socioeconomic status of the both the population (Subramanyam and Subramanian, 2011; Tomkins et al., 2015). However, population in the high socioeconomic class would have been associated with the low baseline health.
Consideration of baseline health for estimation of life expectancy would have given accurate estimate of the life expectancy in both rural and urban region. Inequality among different neighbourhood populations within the rural region were considered similar by local authorities. Hence, similar interventions were provided throughout the population which proved non-productive for reducing health inequality. In the past patients or affected population from the rural region were not incorporated in determining health inequality (Bhan et al., 2016).
It has been observed that there in little improvement in the male life expectancy, male and female healthy life expectancy, and premature cancer mortality in comparison to the past in the similar rural area. However, there has been no improvement in the female life expectancy from the past in the similar rural area (Dubey and Mohanty, 2014).
Providing children with improved quality of life in the initial phase of life can be helpful in reducing inequality of life. Children ready to go to the school can be one of the aspects for reducing health inequality among the rural Indian children. However, it is evident that children in all the socioeconomic classes are not ready to go the school. Hence, it is difficult to implement single intervention for improving health of people due to diversity socioeconomic classes. Reducing poverty can also be considered as the one of important factor for improving access of the children to the education and reducing health inequality (Nambiar et a., 2015).
After the introduction of the National Rural Health Mission, there was improvement in the accuracy of determination of health inequality. Implementation of this mission helped in estimating life expectancy in accurate manner. It was evident that increased trend in life expectancy from 2007 to 2010, then decreased trend in life expectancy and again it increased from 2012 – 2015. Moreover, after implementation of the National Rural Health Mission overall life expectancy of rural people increased as compared to the period prior to the implementation of the mission. Prior to implementation of the mission, life expectancy in men and women increased by 0.57 and 0.30 months each year respectively. However, after implementation of the mission, life expectancy of both men and women increased by 0.90 and 0.57 months each year respectively. There was statically significant improvement in life expectancy of both men and women after implementation of mission in comparison to prior to implementation of the mission (Nagarajan et al., 2015; Narwal and Gram, 2013).
After implementation of the mission, reduction in the inequalities were observed in rural areas mainly due to the improvement in the most backword rural areas and not due to proportional improvements throughout the rural region. It was also evident that greater decline in inequalities of the neighbourhood regions of the same rural region. It indicates that there was more inequality among neighbourhood regions in the same rural region. However, this factor was not considered in the past. After implementation of the National Rural Health Mission, equality among rural region and urban regions was not completely achieved. There was upturn trend in the improvement in the health status in both rural region and urban region. Though, trend was more prominent in the rural region. Hence, specific strategy need to be implemented to improve health status of people of rural region as compared to the people of urban region. This trend of improvement was not consistent in the recent past. After 2012, decline trend was evident in improvement in the inequality in both rural and urban regions of India (Dhingra and Dutta, 2011).
Health spending inflation proved beneficial in improving number of visits for both inpatient and outpatient visits both in rural and urban India. Even though, there is increase in the health cost overall improvement in the health status improved significantly both in urban and rural area. However, rate of improvement in rural area is not at the expected level. Hence, specific attention need to be given to the health sector in the rural area (Brinda et al., 2012). In India, expenditure on drugs is being increasing constantly. This increase in expenditure is halting healthcare access to the people in the rural India. Hence, there should be effective drug price control and regulation of the pharmaceutical market. In addition to the pharmaceutical cost, additional costs like transportation cost and loss of earning due to ill heath need to be included in the Government schemes for providing healthcare for all. In comparison to the urban people earning of rural people is less and their transportation cost for accessing healthcare services are more. Current public health models recommended equity focused approach in collecting, using and applying the data for providing health for all (Singh and Madhavan, 2015).
Proper data related to health can be generated by integrated efforts of health system network, spanning the public and private sector, and allopathic medicine and non-allopathic medicine like AYUSH. National Health Systems Resource Centre can be helpful in the development of Health Management Information system about the health status of both rural and urban population (Reddy et al., 2011). Resources generation for the rural population in India can be helpful reducing health inequality. There need to be coordination among central, state and local stakeholders for improving allocation efficiency. Multilaterals, national and local government, NGOs, the private sector, pharmaceutical industry, civil society and research and academic institutions need to put efforts collectively to achieve equity in the healthcare sector. Recently, it is evident that public-private partnerships can be helpful in improving public health and primary care (Prinja et al., 2012). NRHM can be helpful in improving quality of the care in the primary centres.
Conclusion:
In Indian healthcare sector, inequality exists between rural and urban healthcare sector. This inequality exists in the form of access to healthcare service, availability of resources and life expectancy. This inequality in healthcare sector was existing time since long time; however, it was not being addressed effectively due to unavailability of the accurate data about factors impacting health inequality. In the past, efforts were made to reduce these inequalities based on knowledge of local authorities. There is convincing argument exists for the implementation of social and economic determinants for reducing healthcare inequality in India. Economic growth and effective policies implemented in the recent times proved helpful in reducing health inequalities. Both physical and personal resource generation proved effective in resolving this issue. After implementation of the new policies and new models, there was significant improvement in health status of the people in the rural India. Since, India is geographically diverse country, specific policies and models specific to the geographic areas need to be implemented for reducing inequality in specific geographical area and among specific population.
References:
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