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Palimpsests of ‘Social Determinants of Health’—From Historical Conceptions to Contemporary Practice in Global and Indian Public Health

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The Social Determinants of Health in India

Abstract

Policy attention to the Social Determinants of Health (SDH) has waxed and waned over the years, both in the international and national arena. From famine to plagues, malnutrition to outbreaks, food and hygiene are ‘determinants’ in that they have motivated the very evolution of public health in India and the globe—albeit stochastically. Moving from colonial to nationalist to neoliberal imperatives, a coherent and abiding vision of social determinants, globally or within India for that matter, has neither endured nor arisen. This vacillation reflects the truly political nature of public health, and also of policymaking on SDH. Following deliberations held in 2013 on an Indian “Health Equity Watch” in which academicians, activists and officials participated, it was acknowledged that for India, there is in fact a substantial literature on SDH that does not explicitly reference the term SDH per se. Thus, this volume seeks to explore two interrelated questions: first, how is action around SDH conceptualized by key stakeholders in our country, and second, what are the themes that bring these conceptualizations together? We have compiled the views of academics and practitioners in both public and private not-for-profit settings to expand upon this issue, supplemented by short commentaries from individuals who reviewed individual chapters and who are involved with the project of health equity in India. From these contributions, we note that there are various vocabularies used to talk about SDH, as well as contestations, various stakeholders, scales and types of activities. Detailing and showcasing this diversity is the contribution of this volume.

Health is a function, not only of medical care, but of the overall integrated development of society – cultural, economic, educational, social and political. … Health also depends on a number of supportive services – nutrition, improvement in the environment and education; and the influence of these services on health status is far greater than that of medical care. The major programmes which will improve health are thus outside the realm of health care proper. These were comparatively neglected in the last 30 years …this error should not be repeated [1].

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Notes

  1. 1.

    The very next Improvement Trust was formed in Mysore (1903), followed by Calcutta (1919), and various other cities under the United Provinces Improvement Act of 1919, which was amended to include Delhi in 1937. Decades later, these trusts were to evolve into Municipal Corporations with dedicated officers overseeing a range of social determinants in urban areas (see Ganesan et al. in this volume, for more). Examining how SDH are viewed in these documents was beyond the scope of our work but remains a key area of further study.

  2. 2.

    As Amrith points out, this devolution circumscribed the social welfare policymaking abilities of municipal and state governments alike because of their inability to raise resources [10].

  3. 3.

    The most crucial areas were adequate food intake/nutrition, and women’s education, identified in Rockefeller’s famous report on ‘Good Health at Low Cost’ [45].

  4. 4.

    Convergence is proposed in the NUHM framework document with (a) the Ministry of Urban Development and Ministry of Housing and Urban Poverty Alleviation for (i) the Basic Services to the Urban Poor sub-mission of the Jawaharlal Nehru National Urban Renewal Mission of, which has a seven point charter including land tenure, affordable shelter, water, sanitation, education, health, and social security—all coordinated through a City Development Plan; (ii) Rajiv Awas Yojana to integrate slums into the formal system; (iii) the Swarn Jayanti Shahri Rozgar Yojana to federate existing Development of Women and Children in Urban Areas (DWCUA) and Neighbourhood Committees groups into Mahila Arogya Samitis; (b) the Ministry of Women and Child Development for local coordination with Anganwadi Centres and Anganwadi Workers for Community Health and Nutrition day and other health promotion activities; and (c) the Ministry of Minority Affairs through convergence with the Multi Sectoral Development Programme underway in 90 minority districts which includes semi-urban areas, by developing district-specific plans for provision of infrastructure for education, sanitation, housing, drinking water, electricity supply, and income generation; (d) within the health ministry, school health programmes as well as adolescent health programmes are also seen as nodal points for convergence, as well as inclusion of specific programming to map, reach, and attend to the special needs of vulnerable groups [37].

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  1. The George Institute for Global Health, New Delhi, Delhi, India

    Devaki Nambiar

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  1. The George Institute for Global Health, New Delhi, Delhi, India

    Devaki Nambiar

  2. WASH in Health and Nutritions, WASH in Schools, WaterAid India, New Delhi, Delhi, India

    Arundati Muralidharan

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Nambiar, D. (2017). Palimpsests of ‘Social Determinants of Health’—From Historical Conceptions to Contemporary Practice in Global and Indian Public Health. In: Nambiar, D., Muralidharan, A. (eds) The Social Determinants of Health in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5999-5_1

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  • DOI: https://doi.org/10.1007/978-981-10-5999-5_1

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