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   2007| October  | Volume 126 | Issue 4  
    Online since May 20, 2011

 
 
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REVIEW ARTICLES
Tobacco use & social status in Kerala
KR Thankappan, CU Thresia
October 2007, 126(4):300-308
PMID:18032805
Health indicators of Kerala State such as infant mortality rate (14/ 1000 live births) and life expectancy at birth (71 yr for men and 76 yr for women) are far ahead of the Indian averages (IMR 58, life expectancy men 62 and women 63) and closer to the developed countries. However, tobacco use prevalence is similar to the national average. Smoking is the commonest form of tobacco usage among men in the State whereas chewing tobacco is more common among women and children. Tobacco chewing among men is increasing in Kerala probably due to the smoking ban and industry strategy to focus on smokeless tobacco. Tobacco use is significantly more among the low socio-economic (SE) groups compared to the high SE group. Mortality and morbidity attributed to tobacco is higher among the poorest people in the State. Age adjusted cancer rate of oral cavity and lung cancer has been increasing in the State in recent years. Heart diseases among the young people are increasing in the State. Cancer and heart diseases are chronic illnesses which may pull the individual and the entire family below the poverty line. Tobacco control therefore should be a top priority not only as a health issue but as a poverty reduction issue. Poverty alleviation is one of the major goals of developing economies. No poverty alleviation programme can ignore the potential impoverishment associated with tobacco use. Kerala with a very strong decentralized government has a very good opportunity to address tobacco control as a priority at the grass root level and reduce the impoverishment due to tobacco use.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  210 404 -
Tobacco, education & health
PC Gupta, Cecily S Ray
October 2007, 126(4):289-299
PMID:18032804
The incontrovertible scientific evidence about tobacco use causing serious health consequences is now accepted even by the tobacco industry. Research continues to enlarge the spectrum of diseases caused by tobacco use among users as well as among nonusers exposed to secondhand tobacco smoke. This review attempts to illustrate the greater risk to adverse health outcomes among the less educated due to a greater prevalence of tobacco use among them. Numerous surveys worldwide and in India show a greater prevalence of tobacco use among the less educated and illiterate. In a large population based study in Mumbai, the odds ratios for any kind of tobacco use among the illiterate as compared to the college educated were 7.4 for males and 20.3 for females after adjusting for age and occupation. School-dropouts are more likely to take up tobacco use in childhood and adolescence. Student youth taught about the dangers of tobacco use in school are less likely to initiate tobacco use. High tobacco use among the less educated and under privileged affects them in multiple ways: (i) Tobacco users in such households, because of their nicotine addiction, prefer spending a disproportionate amount of their meager income on tobacco products, often curtailing essential expenditures for food, healthcare and education for the family. (ii) Because of high tobacco use and other factors of disadvantage connected with low educational status, they suffer more from the diseases and other health impacts caused by tobacco. This higher morbidity results in high health care expenditures, which impoverish the family further. (iii) Premature death caused by tobacco use in this under- privileged section often takes away the major wage earner in the family, plunging it into even more hardship. Tobacco use is a terrible scourge particularly of the less educated, globally and in India. Tobacco use, education and health in a human population are inter-related in ways that make sufferings and deaths caused by tobacco use even more tragic than normally realized. Tobacco use works against social and economic development and should be appropriately addressed through health education and tobacco cessation services particularly in the underprivileged, illiterate population.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  206 235 -
Poverty, social stress & mental health
A Kuruvilla, KS Jacob
October 2007, 126(4):273-278
PMID:18032802
While there is increasing evidence of an association between poor mental health and the experience of poverty and deprivation, the relationship is complex. We discuss the epidemiological data on mental illness among the different socio-economic groups, look at the cause -effect debate on poverty and mental illness and the nature of mental distress and disorders related to poverty. Issues related to individual versus area-based poverty, relative poverty and the impact of poverty on woman's and child mental health are presented. This review also addresses factors associated with poverty and the difficulties in the measurement of mental health and illness and levels/impact of poverty.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  213 215 -
Poverty nutrition linkages
P Ramachandran
October 2007, 126(4):249-261
PMID:18032800
At the time of independence majority of Indians were poor. In spite of spending over 80 per cent of their income on food, they could not get adequate food. Living in areas of poor environmental sanitation they had high morbidity due to infections; nutrition toll due to infections was high because of poor access to health care. As a result, majority of Indians especially children were undernourished. The country initiated programmes to improve economic growth, reduce poverty, improve household food security and nutritional status of its citizens, especially women and children. India defined poverty on the basis of calorie requirement and focused its attention on providing subsidized food and essential services to people below poverty line. After a period of slow but steady economic growth, the last decade witnessed acceleration of economic growth. India is now one of the fastest growing economies in the world with gross domestic product (GDP) growth over 8 per cent. There has been a steady but slow decline in poverty; but last decade's rapid economic growth did not translate in to rapid decline in poverty. In 1970s, country became self sufficient in food production; adequate buffer stocks have been built up. Poor had access to subsidized food through the public distribution system. As a result, famines have been eliminated, though pockets of food scarcity still existed. Over the years there has been a decline in household expenditure on food due to availability of food grains at low cost but energy intake has declined except among for the poor. In spite of unaltered/declining energy intake there has been some reduction in undernutrition and increase in overnutrition in adults. This is most probably due to reduction in physical activity. Under the Integrated Child Development Services (ICDS) programme food supplements are being provided to children, pregnant and lactating women in the entire country. In spite of these, low birth weight rates are still over 30 per cent and about half the children are undernourished. While poverty and mortality rates came down by 50 per cent, fertility rate by 40 per cent, the reduction in undernutrition in children is only 20 per cent. National surveys indicate that a third of the children from high income group who have not experienced any deprivations are undernourished. The high undernutrition rates among children appears to be mainly due to high low birthweight rates, poor infant and young child feeding and caring practices. At the other end of the spectrum, surveys in school children from high income groups indicate that between 10-20 per cent are overnourished; the major factor responsible appears to be reduction in physical activity. Some aspects of the rapidly changing, complex relationship between economic status, poverty, dietary intake, nutritional and health status are explored in this review.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  174 176 -
The negative effects of poverty & food insecurity on child development
M Chilton, M Chyatte, J Breaux
October 2007, 126(4):262-272
PMID:18032801
This paper addresses the importance of the first three years of life to the developing child, examines the importance of early childhood nutrition and the detrimental effects on child health and development due to poverty and food insecurity. As development experts learn more about the importance of the first three years of life, there is growing recognition that investments in early education, maternal-child attachment and nurturance, and more creative nutrition initiatives are critical to help break the cycle of poverty. Even the slightest forms of food insecurity can affect a young child's development and learning potential. The result is the perpetuation of another generation in poverty. Conceptualizing the poorly developed child as an embodiment of injustice helps ground the two essential frameworks needed to address food insecurity and child development: the capability approach and the human rights framework. The capability approach illuminates the dynamics that exist between poverty and child development through depicting poverty as capability deprivation and hunger as failure in the system of entitlements. The human rights framework frames undernutrition and poor development of young children as intolerable for moral and legal reasons, and provides a structure through which governments and other agencies of the State and others can be held accountable for redressing such injustices. Merging the development approach with human rights can improve and shape the planning, approach, monitoring and evaluation of child development while establishing international accountability in order to enhance the potential of the world's youngest children.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  173 149 -
Poverty & health : criticality of public financing
R Duggal
October 2007, 126(4):309-317
PMID:18032806
Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  187 119 -
Racial discrimination & health : pathways & evidence
Ameena T Ahmed, Selina A Mohammed, David R Williams
October 2007, 126(4):318-327
PMID:18032807
This review provides an overview of the existing empirical research of the multiple ways by which discrimination can affect health. Institutional mechanisms of discrimination such as restricting marginalized groups to live in undesirable residential areas can have deleterious health consequences by limiting socio-economic status (SES) and creating health-damaging conditions in residential environments. Discrimination can also adversely affect health through restricting access to desirable services such as medical care and creating elevated exposure to traditional stressors such as unemployment and financial strain. Central to racism is an ideology of inferiority that can adversely affect non-dominant groups because some members of marginalized populations will accept as true the dominant society's ideology of their group's inferiority. Limited empirical research indicates that internalized racism is inversely related to health. In addition, the existence of these negative stereotypes can lead dominant group members to consciously and unconsciously discriminate against the stigmatized. An overview of the growing body of research examining the ways in which psychosocial stress generated by subjective experiences of discrimination can affect health is also provided. We review the evidence from the United States and other societies that suggest that the subjective experience of discrimination can adversely affect health and health enhancing behaviours. Advancing our understanding of the relationship between discrimination and health requires improved assessment of the phenomenon of discrimination and increased attention to identifying the psychosocial and biological pathways that may link exposure to discrimination to health status.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  184 121 -
Poverty alleviation programmes in India : a social audit
CA K Yesudian
October 2007, 126(4):364-373
PMID:18032811
The review highlights the poverty alleviation programmes of the government in the post-economic reform era to evaluate the contribution of these programmes towards reducing poverty in the country. The poverty alleviation programmes are classified into (i) self-employment programmes; (ii) wage employment programmes; (iii) food security programmes; (iv) social security programmes; and (v) urban poverty alleviation programmes. The parameter used for evaluation included utilization of allocated funds, change in poverty level, employment generation and number or proportion of beneficiaries. The paper attempts to go beyond the economic benefit of the programmes and analyzes the social impact of these programmes on the communities where the poor live, and concludes that too much of government involvement is actually an impediment. On the other hand, involvement of the community, especially the poor has led to better achievement of the goals of the programmes. Such endeavours not only reduced poverty but also empowered the poor to find their own solutions to their economic problems. There is a need for decentralization of the programmes by strengthening the panchayat raj institutions as poverty is not merely economic deprivation but also social marginalization that affects the poor most.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  201 97 -
Social exclusion, caste & health : a review based on the social determinants framework
KR Nayar
October 2007, 126(4):355-363
PMID:18032810
Poverty and social exclusion are important socio-economic variables which are often taken for granted while considering ill-health effects. Social exclusion mainly refers to the inability of our society to keep all groups and individuals within reach of what we expect as society to realize their full potential. Marginalization of certain groups or classes occurs in most societies including developed countries and perhaps it is more pronounced in underdeveloped countries. In the Indian context, caste may be considered broadly as a proxy for socio-economic status and poverty. In the identification of the poor, scheduled caste and scheduled tribes and in some cases the other backward castes are considered as socially disadvantaged groups and such groups have a higher probability of living under adverse conditions and poverty. The health status and utilization patterns of such groups give an indication of their social exclusion as well as an idea of the linkages between poverty and health. In this review, we examined broad linkages between caste and some select health/health utilization indicators. We examined data on prevalence of anaemia, treatment of diarrhoea, infant mortality rate, utilization of maternal health care and childhood vaccinations among different caste groups in India. The data based on the National Family Health Survey II (NFHS II) highlight considerable caste differentials in health. The linkages between caste and some health indicators show that poverty is a complex issue which needs to be addressed with a multi-dimensional paradigm. Minimizing the suffering from poverty and ill-health necessitates recognizing the complexity and adopting a perspective such as holistic epidemiology which can challenge pure technocentric approaches to achieve health status.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  174 108 -
Social evils, poverty & health
R Gupta, P Kumar
October 2007, 126(4):279-288
PMID:18032803
There is a close association between social circumstances and health. In India, there is a significant burden of both communicable and non communicable diseases. Risk factors responsible for these conditions are underweight, unsafe sex, unsafe water, poor sanitation and hygiene, indoor smoke pollution, zinc, iron and vitamin A deficiency, tobacco use, high blood pressure, and high cholesterol. All these risk factors are influenced by social factors and in India the more important factors are poverty and illiteracy. Changing lifestyles as a result of rising incomes are significant risk factors for non communicable diseases. The social evils that influence poverty and health are macrolevel national and regional issues such as physical geography, governance patterns and failures, geopolitics, economic policy, natural resources decline, population growth, the demographic trap and the fiscal trap. Household and microlevel factors include the poverty trap, cultural barriers, lack of innovation and saving, absence of trade or business, unemployment, technological reversal, adverse productivity shock, social issues related to females, and adolescent social issues. Social determinants important for non communicable diseases, defined by the World Health Organization include the social gradient, stress, early life events, social exclusion, improper work conditions, unemployment, lack of social support, addiction, food scarcity or excess and uneven distribution, lack of proper transport, and illiteracy or low educational status. There are multiple pathways through which social factors influence health, and pathophysiological mechanisms involve homeostatic and allostatic changes in response to stress, neuroendocrine changes and altered autonomic functions, and abnormal inflammatory and immune responses. A concerted action to eradicate these social evils shall have to focus on reducing poverty, improving educational status and providing equitable and accessible healthcare to all.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  175 104 -
Gender equity & human development
Swarna S Vepa
October 2007, 126(4):328-340
PMID:18032808
The welfare of both women and men constitutes the human welfare. At the turn of the century amidst the glory of unprecedented growth in national income, India is experiencing the spread of rural distress. It is mainly due to the collapse of agricultural economy. Structural adjustments and competition from large-scale enterprises result in loss of rural livelihoods. Poor delivery of public services and safety nets, deepen the distress. The adverse impact is more on women than on men. This review examines the adverse impact of the events in terms of endowments, livelihood opportunities and nutritional outcomes on women in detail with the help of chosen indicators at two time-periods roughly representing mid nineties and early 2000. The gender equality index computed and the major indicators of welfare show that the gender gap is increasing in many aspects. All the aspects of livelihoods, such as literacy, unemployment and wages now have larger gender gaps than before. Survival indicators such as juvenile sex ratio, infant mortality, child labour have deteriorated for women, compared to men, though there has been a narrowing of gender gaps in life expectancy and literacy. The overall gender gap has widened due to larger gaps in some indicators, which are not compensated by the smaller narrowing in other indicators both in the rural and urban context.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  179 92 -
Widening economic & social disparities : implications for India.
NJ Kurian
October 2007, 126(4):374-380
PMID:18032812
India is often characterized as an emerging economic super power. The huge demographic dividend, the high quality engineering and management talent, the powerful Indian diaspora and the emerging Indian transnational--kneeling the optimism. In contrast, there is another profile of India which is rather gloomy. This is the country with the largest number of the poor, illiterates and unemployed in the world. High infant mortality, morbidity and widespread anaemia among women and children continue. India suffers from acute economic and social disparities. This article addresses four dimensions of such disparities, viz. regional, rural-urban, social, and gender. There is empirical evidence to indicate that during the last two decades all these disparities have been increasing. As a result of economic reforms, the southern and western States experienced accelerated economic and social development as compared to northern and eastern States. This has led to widening gap in income, poverty and other indicators of development between the two regions. Rural-urban divide also widened in the wake of reforms. While large and medium cities experience unprecedented economic prosperity, the rural areas experience economic stagnation. As a result, there is widespread agrarian distress which results in farmers' suicide and rural unrest. Socially backward sections, especially scheduled castes and tribes (SCs and STs) have gained little from the new prosperity which rewards disproportionately those with assets, skills and higher education. STs have often been victims of development as a result of displacement. The gender gap in social and economic status, traditionally more in India as compared to other societies; has further widened by the economic reforms and globalization. The approach paper to the Eleventh Plan stresses the importance of more inclusive economic growth. It emphasizes the need for bridging the divides discussed in this article. Unless these are achieved in a time-bound manner, there could be serious adverse implications for the Indian economy, society and politics.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  179 91 -
Battered bodies & shattered minds : violence against women in Bangladesh
T Wahed, A Bhuiya
October 2007, 126(4):341-354
PMID:18032809
Violence against women is a common and insidious phenomenon in Bangladesh. The types of violence commonly committed are domestic violence, acid throwing, rape, trafficking and forced prostitution. Domestic violence is the most common form of violence and its prevalence is higher in rural areas. A higher prevalence of verbal abuse than physical abuse by partners has been observed. The reasons mentioned for abuse were trivial and included questioning of the husband, failure to perform household work and care of children, economic problems, stealing, refusal to bring dowry, etc. The factors associated with violence were the age of women, age of husband, past exposure to familial violence, and lack of spousal communication. The majority of abused women remained silent about their experience because of the high acceptance of violence within society, fear of repercussion, tarnishing family honour and own reputation, jeopardizing children's future, and lack of an alternative place to stay. However, severely abused women, women who had frequent verbal disputes, higher level of education, and support from natal homes were more likely to disclose violence. A very small proportion of women approached institutional sources for help and only when the abuse was severe, became life threatening or children were at risk. Interestingly, violence increased with membership of women in micro-credit organizations initially but tapered off as duration of involvement increased. The high acceptability of violence within society acts as a deterrent for legal redress. Effective strategies for the prevention of violence should involve public awareness campaigns and community-based networks to support victims.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  166 99 -
Poverty, health & intellectual property rights with special reference to India
K Satyanarayana, S Srivastava
October 2007, 126(4):390-406
PMID:18032814
This paper examines the nexus between poverty and global health with specific focus on IPR protection and attempts to highlight the current global endeavours to overcome barriers to access to medicines for diseases of the poor. The number of very poor people in the world has increased by 10.4 per cent between 1987 and 2001 to 2735 million. India is now home to the largest number of millionaires in the developing countries. But over 800 million Indians who still survive on Rs 20.0 (US$0.5) a day, and rural poverty is on the rise. The link between poverty and health is well established with the underprivileged are more vulnerable to major health risks due to poor nutrition, inadequate access to clean drinking water, sanitation, exposure to indoor smoke, etc. all of which contribute to the huge and growing burden of disease in the poor countries. The global disease burden is not just huge but growing: over 10 million children die of preventable conditions including vaccine-preventable diseases, about 14 million are killed by infectious diseases every year, 90-95 per cent in poor countries. An estimated third of global population has limited or no access to essential medicines. While the number of poor and unhealthy is growing, Government expenditure on health is dwindling. Many of the diseases of the poor require new medicines and none are forthcoming as there is little R&D for these infections. There are several barriers to access to existing and the newly discovered drugs. One major reason is the general lack of interest by the pharma industry to discover new medicines for diseases of the poor due to very limited market in developing countries. In addition, global intellectual property rights (IPR) protection regimes like the Trade Related Intellectual Property Rights (TRIPS) are considered a major obstacle for the poor access to medicines. There have been some global initiatives on the need to improve affordability and accessibility of medicines. Some strategies to promote R&D on diseases of the poor such as Prize Fund Model, the Medical R&D Treaty and steps to invoke flexibilities in TRIPS read with Doha Declaration are discussed. Health of the poor is a global problem that requires global solutions with global participation and commitment.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  151 97 -
Rural poverty reduction through centrally sponsored schemes
NC Saxena
October 2007, 126(4):381-389
PMID:18032813
This paper discusses the evolving profile of poverty in India and reviews the national performance of selected anti-poverty programmes between 1997-1998 and 2005. For each programme, it outlines the budgetary allocation principle used for the States and districts and analyzes budgetary performance over the period. The main objective is to explore the extent to which the anti-poverty programmes are reaching their target groups effectively. Finally, it identifies the specific factors responsible for under-performance and provides a set of recommendations for policy makers and programme implementers which could help improve the outcomes of the schemes.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  154 84 -
ORIGINAL ARTICLE
The social determinants of childhood mortality in Sri Lanka : timetrends & comparisons across South Asia
Tanja A Houweling, S Jayasinghe, T Chandola
October 2007, 126(4):239-248
PMID:18032799
Full text not available  [PDF]  [PubMed]
  109 91 -
SOME FORTHCOMING SCIENTIFIC EVENTS
Some forthcoming scientific events

October 2007, 126(4):407-408
Full text not available  [PDF]
  69 63 -
ANNOUNCEMENT
Announcement

October 2007, 126(4):408-408
Full text not available  [PDF]
  54 68 -
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