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Health inequities in India

Released in 2018, this book edited by Gaitonde & Ravindran includes chapters synthesising current evidence on various axes of health inequities (Springer link)

In 2016, I was glad to be invited to join a team of researchers under the leadership of Sundari Ravindran (then Professor at Achutha Menon Centre for Health Science Studies at SCTIST, Trivandrum) who were trying to understand the body of research work on health inequities in India: what was being researched upon, and who was doing this and what was the overall picture emerging from research on health inequities. Among various other outputs (including a lovely annual workshop for early-mid career researchers on research methods for health inequities research), one of the outputs was this lovely book synthesising the research on health inequities in India.

A book release was hosted in Bangalore at the lovely campus of the Indian Institute of Human Settlements where the editors and chapter authors were interviewed in a conversational cafe-style interview by Upendra Bhojani.

Book release at the Indian Institute of Human Settlements, Bengaluru hosted by Upendra Bhojani from Institute of Public Health, Bengaluru

…if not all concepts and theories used to study health inequalities originated outside of India; concepts and theories on inequalities from Indian social sciences do not seem to have trickled down to the teaching and practice of public health locally. Public health is largely an applied discipline, expected to draw from diverse social and medical sciences; research on health inequities in India shows that public health has not capitalized on the rich knowledge base of social science scholarship from Indian theorists. Authors attribute this to predominance of the biomedical perspective in public health practice and a resistance to engaging in social science inquiry in medical research. This continues to be a barrier in transforming public health into a truly interdisciplinary as a science.

From review of book by Nandita Bhan in the July 2018 MedicoFriendsCircle (MFC) Bulletin. Full review can be downloaded here (archive.org).

Interestingly, the authors claim (in the very title of this chapter) that promoting a body of coherent and appropriate health inequity research is not merely a function of promoting better knowledge and skills. It is rather a ‘political project’. Given the potential of health in- equities research to uncover pathways of inequity and to influence decisions with regard to public policies, researchers have a crucial role in the struggle to achieve a just society. Towards this end, they highlight the need to reform the ways we currently fund and govern health research. In this context, the only major concern I have regarding this book is that it is exceedingly costly, pointing to one of the very structural barriers that underlie the authors’ plea for a political project.

Extract from Upendra Bhojani’s review of the book in Current Science; full PDF here.

Although I had the opportunity to co-author many of the chapters, the chapter on health inequities along socio-economic axis is the one I wrote. An extract from Nandita Bhan’s review, calling it “a conceptually clear and trickiest one”, summarises the chapter as follows

..chapter on Health Inequities in India by Socioeconomic Position is conceptually the clearest chapter in the volume and provides a critical overview of the research and meaning of socioeconomic position in the Indian context. His succinct critique highlights the overemphasis on the ‘economic’ in socioeconomic, and he argues that we need to bring forth conceptual clarity on what ‘social’ and ‘status’ mean through deeper examination of constructs like discrimination.

The last chapter attempts to bring together what we can say about the underlying drivers (mechanisms if you will) of these inequities, many of them operating within social institutions and with the force of history, across generations….and some even across millennia….indeed, characterising the knowledge enterprise of dismantling this as a political project rather than an exclusively intellectual one.

.And yes, the book is indeed prohibitively expensive given the nature of the academic publishing industry today. And if anyone interested is not able to already find it on the world-wide web using Google search intelligently, I am happy to share chapters of interest/whole book content with anyone interested (contact me on email/@prashanthns on Twitter)

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