Patterns and distribution of tobacco consumption in India: Authors' reply

Abstract

Editor-The Kerala model in health, cited by Bhutta et al in the theme issue on health in South Asia as replicable for South Asian countries, 1 is facing serious threats. The state has a triple burden of communicable, non-communicable, and traumatic diseases. Stupendous growth of the private sector has resulted in skyrocketing healthcare costs. Lured by the hi tech sophistication of the private sector, people are abandoning basic principles of primary health care. Even poor people prefer private hospitals, and a major reason for sustaining poverty is healthcare cost. 2 The government is reducing its investments in health and education due to fiscal crises and pressure from funding and lending agencies. The opening up of the medical education sector to private entrepreneurs, lack of guidelines for the private practice of government doctors, and shortage of doctors for rural areas are all disturbing developments. Transfer of healthcare institutions under local self-governments is yet to show the desired benefits. The state is developing a long term plan, "Health Vision Kerala 2025," and a health policy. To equip the primary healthcare workforce to face the emerging challenges, 3 job responsibilities were redefined recently. Factors that determined the successful Kerala model, among others, include historically prevalent social justice, commitment of governments to health and education, land reforms, an organised public distribution system, streamlined primary health care, and an organised labour sector. Deterioration in these determinants is likely to have strong negative impact. Kerala should learn from its past to avoid the sad plight of some other Indian states.

Globalization, Distance and Disease: Spatial Health Disparities in Rural India

“…The proportion of 'always institutional' households is lowest among STs, followed by Muslims, in line with what investigations undertaken in other parts of India have earlier revealed (e.g., Subramanian et al 2004;Subramanian, Smith and Subramanyam 2006). As remarked above, the pattern of institutional deliveries for SC households does not differ a great deal from the average for all households.…”

“…Prior examinations of health disparities in India have identified a number of factors, significantly associated with diverse outcomes and behaviours among different population segments. Analysts have examined differences arising on account of caste and wealth, finding significantly poorer outcomes among Scheduled Castes (SCs) and Scheduled Tribes (STs) 4 and between richer and poorer Indians (Balarajan, Selvaraj and Subramanian 2011;Gaudin and Yazbeck 2006;Mohindra, Haddad and Narayana 2006;Subramanian et al 2004). Differences between men and women have also been found to be salient, particularly when seen alongside socioeconomic inequalities (Iyer, Sen and George 2007;Iyer, Sen and Östlin 2008).…”

An Overview on the Prevalence of Drug Abuse Among Children With Special Reference to Tobacco Use in Developed and Developing Countries

“…There may be religious constraints, for example in Muslim countries women have had less spending power than men to buy cigarettes; rural women adhere to traditional methods of smoking, e.g. hubble-bubble pipes, and are therefore exposed to a lower dosage of tobacco; and in some areas, such as parts of India and the Middle East, women use tobacco in other forms, such as chewing tobacco 6 . There may be significant underreporting of smoking among women in countries where it is culturally less acceptable for women to smoke.…”