Application: The “Haves” and “Have Nots”: Why Are There Disparities?
- Bernard F. Richards
Describe two health outcomes for which India and China have had different experiences in the last half century.
It has long been an observation that socio-economic status influences health outcomes. Wilkinson and Pickett (2010) explain that the majority of health-related and social problems that plague nations and even sub-populations within nations are largely influenced by societal inequities (p. 173). Essentially, societies than have greater levels of inequity tend to have inferior health and social standings. This principle has been demonstrated by India and China which are nations with vast populations and shared influence from challenges brought on by globalization and urbanization. However, growing societal inequities in India served as the basis for recent dissimilarity in health status for citizens of said countries.
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The difference in health status of both countries can be seen in several health outcomes. According to Dummera and Cook (2008), both China and India experience similar infectious and chronic illnesses, the burden and prevalence of infectious maladies are significantly higher in India (p. 590). In India, the most common source of mortality is infectious and parasitic illnesses. Conversely, most deaths in China are secondary to chronic illnesses such as cancers. For every 1000 deaths in China, cancer is responsible for 119.7 of them. In India, this number lies at 71 out of every 1000 for cancers however, infectious causes of death lies at 420 out of every 1000 deaths (Dummera & Cook, 2008, pp. 591-592).
Chinese, both males and females, enjoy higher superior life expectancy at birth as compared to their Indian counterparts. In China, life expectancies for males and females in 2004 were 70.4 and 73.7 years respectively. On the other hand, that for Indian males and females was found to be male 63.3 and 64.8 years respectively. In general, China is found to be superior in almost all aspects of health-related demographics. China has better birth, mortality, fertility, and literacy rates. Additionally, there are more physicians and physical spaces within hospitals and other health facilities in China. This offers better service delivery and access to health services that are offered. These statistics suggests significant differences in policies and strategies to counteract sources of ill-health and brings to the fore the importance of social equality in ensuring population health (Dummera & Cook, 2008, p. 592).
Explain the reasons for the disparities noted.
As previously mentioned previously, infectious diseases account for the vast majority of deaths in India as compared to chronic diseases in China. The contrast becomes even more apparent as infectious illnesses are general considered diseases of poverty. Chronic illnesses, on the other hand, are dubbed diseases of affluence. One explanation for this disparity between both nations is the difference in societal development. India has experienced less development which serves as a catalyst for population vulnerability. People live in more unhealthy environments which have been proved to increase the risk of communicable illnesses. China has experienced greater positive development which has diminished levels of social and health-related vulnerability. Chinese people are essentially living longer which predisposes to chronic conditions related to lifestyle behaviors and increased life expectancy. Additionally, the Chinese authorities have enforced strict limitations on reproduction and population growth (Dummera & Cook, 2008, pp. 590-592)
Social division and inequality also accounts for health disparities in both countries. There is present in India a caste system called ‘jati’ which is based on segregation, marginalization and social stratification. At the summit of the social hierarchy is the Brahmins class (Priests) followed by the Kshatriyas (Warriors and rulers), Vaisyas (skilled workers, merchants, minor officials), Sudras (unskilled workers), and Pariah (outcasts, untouchables) in descending order. Hearne (2014) explains that as we progress down the caste hierarchy, social inequity and discrimination increases. An individual’s educational status, income and consequently health status are all dependent on the caste he is in. This system is culturally and historically entrenched in Indian way of life, society and even religion. This ‘legal’ segregation and discrimination has resulted in members of the society put at increased health risks as they lack the socio-economic wherewithal to access health care and protect themselves against the negative social determinants of health. China’s people enjoy greater social equity which has been a major influence in decreasing health disparities in this territory.
Describe the experience for those outcomes in Kerala and suggest reasons for why they are similar or different from the rest of India.
The dynamic nature of health can be illustrated by Kerala which is a state in India. It is quite impressive to observe the wide disparity in this sub-population of India as compared to the country in general. Residents of Kerala experienced superior life expectancies when compared to the rest of the nation. Males and females in Kerala are expected to live for 71.67 years and 75.00 years respectively. In essence, Keralans live approximately 9 years more than the average Indian. Infant mortality rate is 68 per 1000 live births in the general Indian population while that for Kerala is 14 (Ministry of Health and Family Welfare, 2014). Mukherjee et al. (2011) further explains that Kerala demonstrates higher educational and income levels as well as birth, mortality, fertility, and literacy rates when compared to other Indian states (p. 2). According to Dilip (2002), Kerala has higher morbidity but less mortality rates when compared to other states. This phenomenon is due to higher life expectancies and increasing levels of chronic illnesses. Communicable diseases however, are found to be less prevalent than chronic illnesses in this sub-population.
The differences in health outcomes when comparing Kerala to other Indian states is largely due to lower levels of inequality in educational attainment, health and social standing in spite of lower income levels (Mukherjee et al., 2011, p. 2). Although the caste system is present within Kerala, social discrimination is less pervasive. Kerala’s robust communist movement and policies directed to promote welfare has contributed. Greater social equity has resulted in greater access to health care and improved health statuses. This is evidence that removing social inequities has a positive influence on the social determinants of health. This lesson can undoubtedly benefit all nations as the world strives to achieve better health outcomes for this generation and those to come.
Dilip, T. R. (2002). Understanding levels of morbidity and hospitalization in Kerala, India. Retrieved from http://www.scielosp.org/scielo.php?pid=S0042-96862002000900012&script=sci_arttext
Dummera, T. J. B. & Cook, I. G. (2008). Health in China and India: A cross-country comparison
in a context of rapid globalization. Social Science & Medicine, 67, 590–605
Hearne, T. (2014). India’s social justice minister says Christians do not deserve special caste. Retrieved from http://www.christiandaily.com/article/indias.social.justice.minister.says.christians.do.not.deserve.special.caste/49363.htm
Ministry of Health and Family Welfare, India. (2014). Life expectancy and infant mortality rates for selected Indian states. Retrieved from http://infochangeindia.org/women/statistics/life-expectancy-and-infant-mortality-rates-for-selected-indian-states.html
Mukherjee, S., Haddad, S. & Narayana, D. (2011). Social class related inequalities in household
health expenditure and economic burden: Evidence from Kerala, south India. International Journal for Equity in Health, 10(1), 1-13.
Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York, NY: Bloomsbury Press.
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