Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Abstract

Background: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. Objective: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. Methods: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. Results: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

Re:(In) visible impact of inadequate WaSH Provision on COVID-19 incidences can be not be ignored in large and megacities of India

“…Finally, people living in areas with poor WaSH conditions have prevalence of cardiovascular disease, obesity, diabetes and hypertension which remain unnoticed owing to limited access to healthcare. 29 It is well established that hypertension and diabetes are risk factors for death from COVID-19. 30 In this way, WaSH-deprived clusters and socially excluded slum areas in large and megacities may emerge as a major public health concern in the face of a COVID-19 pandemic.…”

What ails the urban slums - morbidity profile of urban slum dwellers from three major cities of India

“…Obesity is directly linked to both these diseases. 33,34 Also, the fact that a significant proportion of our participants were elderly and both these diseases are known to be more common among the elderly could have contributed to the reason for such high prevalence. 17…”

Towards the Development of an Intervention to Address Social Determinants of Non-Communicable Disease in Kerala, India: A Mixed Methods Study

“…Engaging with the networks of people at risk for CVD may be an effective approach, but such interventions need to be undertaken with an understanding of the complex interplay of these diverse factors, and with full recognition of the social and cultural issues which mediate as barriers to self-management [ 24 ]. For example, Lumagbas et al [ 25 ] described the complex interaction of social determinants such as poverty or low education with structural, behavioural and psychosocial factors as a composite matrix of factors which together increased the risk of CVD. It is likely that a unique approach that accounts for the social and cultural context will be required to address CVD risk in the Indian context.…”

“…Tackling determinants of health such as a lack of education, lack of clean water, poverty, pollution and poor diet is, of course, important, though causal pathways are dynamic and multilayered [ 25 ]. For instance, it may appear that behaviour plays a larger role than poverty or lack of clean water [ 26 ].…”