Health Inequalities in South Asia at the Launch of Sustainable Development Goals: Exclusions in Health in Kerala, India Need Political Interventions

Abstract

Despite substantial progress in social development during the post-colonial period, health inequalities in the South Asian countries were staggering, with reduced life expectancy, higher maternal and child mortality, and gender discrimination. Notably, even with the rapid economic growth during the neoliberal period, India fares below most of the South Asian countries in several health indicators. The Indian state of Kerala stands out with social sector gains; nevertheless, evidence indicates widening health inequalities, restricted public arenas, and undemocratic practices in health, particularly in the context of increasing market logic in the health and social arenas shaping health. The caste, class, gender, and ethnic ideologies and patriarchal power structure interwoven in the sociopolitical, cultural, moral, and health discourses similar to the South Asian context raise serious inequalities for health. At the launch of the United Nations' Sustainable Development Goals, the populations with lingering privations and forbidden freedoms for gaining better health in Kerala, similar to South Asia, were largely the dalits, ethnic and religious minorities, and women. This necessitates greater political interventions, recognizing the interacting effects of history, culture, social factors, politics, and policies on health. And public health research needs to underscore this approach.

The Health of Indigenous Populations in South Asia: A Critical Review in a Critical Time

“…Historically, community life and health in South Asian countries were entangled with systemic discrimination and confounding inequalities of caste, class, gender, ethnicity, poverty, and beyond. 8,13,[41][42][43] Pakistan has the highest inequality in South Asia in education, food deficit, and life expectancy, followed by India (with the exception of food deficit) ( Table 2).…”

“…72,74 Gender Disparities and Violence Against Women South Asia's deeply entrenched gender discriminatory relations, often legitimized by state and legal discourses, discriminate against women in several social determinants of health, including education, employment, income, landownership, political participation, access to health care, nutrition, and decisionmaking. 8,75 Only one fifth of the women in the CHT can inherit property and, in some communities, almost no women can do so. 48 A similar situation prevails in some parts of India, Nepal, and Pakistan.…”

Field-testing of primary health-care indicators, India

“…According to National Sample Survey estimates from 2017–2018, morbidity levels in the southern state of Kerala are reportedly four times the national average with disparities by sex and place of residence. 12 Although the state has made gains in maternal and child health, 13 it must sustain these gains while addressing the substantial and growing burden of hypertension, diabetes 14 and cancer; 15 vaccine-preventable diseases; 16 , 17 and emerging viral infections such as Nipah virus 18 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 19 – 21 Kerala has been subject to unregulated privatization and cost escalation, 22 resulting in persistent inequalities in service access and health attainment between population subgroups.…”

“…19 – 21 Kerala has been subject to unregulated privatization and cost escalation, 22 resulting in persistent inequalities in service access and health attainment between population subgroups. 13 In 2016, the Government of Kerala announced Aardram, a programme of transformation of existing primary health centres to family health centres; 23 with increased staffing, these family health centres provide access to a greater number of services over longer opening hours compared with the original primary health centres.…”

Psychometric Analysis of the Cultural Competence Scale in Iranian Healthcare Providers

“…ealthcare is one of the most basic human rights that should be equally accessible to all individuals [1]. Many countries not only provide healthcare but also pay special attention to other aspects of health promotion like equality and seek to reduce healthcare inequity [2]. Whitehead has defined healthcare inequities as unnecessary and avoidable differences that are considered unfair and inaccurate [3].…”