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INTRODUCTION: Social and economic inequality is detrimental to the health of any society.

Especially when the society is diverse, multicultural, overpopulated and undergoing rapid but unequal economic growth. Poverty, which is a result of social and economic inequality in a society, is detrimental to the health of population. The outcome indicators of health (mortality, morbidity and life expectancy) are all directly influenced by the standards of living of a given population. Healthcare resources in India though not adequate, are ample. There has been a definite growth in the overall healthcare resources and health related manpower in the last decade. The reduction on public health spending and the growing inequalities in health and health care are taking its toll on the marginalized and socially disadvantaged population. The Infant Mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the population. In other words, an infant born in a poor family is two and half times more likely to die in infancy, than an infant in a better off family A child in the Low standard of living economic group is almost four times more likely to die in childhood than a child in the High standard of living group. Child born in the tribal belt is one and half times more likely to die before the fifth birthday than children of other groups. Female child is 1.5 times more likely to die before reaching her fifth birthday as compared to a male child. Children below 3 years of age in scheduled tribes and scheduled castes are twice as likely to be malnourished than children in other groups. A person from the poorest quintile of the population, despite more health problems, is six times less likely to access hospitalization than a person from the richest quintile. A tribal woman is one and a half times more likely to suffer the consequences of chronic malnutrition as compared to women from other social categories. In India though, pre-existing inequality in the healthcare provisions is further enhanced by difficulties in accessing it. These access difficulties can be either due to 1. 2. 3. Geographical distance Socio-economic distance Gender distance

The issue of geographic distance is important in a large country like India with limited means of communication. Direct effect of distance of a given population from primary healthcare centre on the childhood mortality is well documented. It has been shown that the effect of difficult access to health centers is more pronounced for mothers with less education. The same study also states that distance from private hospitals does not affect the health parameters but the distance from public health centre does. Those who live in remote areas with poor transportation facilities are often removed from the reach of health systems. Incentives for doctors and nurses to move to rural locations are generally insufficient and ineffective. Equipping and resupply of remote healthcare facilities is difficult and inadequacies due to poor supply deter people from using the existent facilities. Maternal mortality is clearly much higher in rural areas15 as trained medical or paramedical staff attends fewer births and transport in case of pregnancy complications is difficult. Geographical difficulties in accessing healthcare facilities thus is an important factor, along with gender discrimination, that contributes to higher maternal mortality in women who live in remote areas especially the tribal women in India. A different aspect of healthcare access problem is noticed in cases of urban poor. Urban residents are extremely vulnerable to macroeconomic shocks that undermine their earning capacity and lead to substitution towards less nutritious,

cheaper foods. People in urban slums are particularly affected due to lack of good housing, proper sanitation, and proper education. Economically they do not have back-up savings, large food stocks that they can draw down over time. Urban slums are also home to a wide array of infectious diseases (including HIV/AIDS, tuberculosis, hepatitis, dengue fever, pneumonia, cholera, and malaria) that easily spread in highly concentrated populations where water and sanitation services are non-existent. Poor housing conditions, exposure to excessive heat or cold, diseases, air, soil and water pollution along with industrial and commercial occupational risks, exacerbate the already high environmental health risks for the urban poor. Lack of safety nets and social support systems, such as health insurance, as well as lack of property rights and tenure, further contribute to the health vulnerability of the urban poor. Though the healthcare facilities are overwhelmingly concentrated in urban areas, the socioeconomic distance prevents access for the urban poor. These socio-economic barriers include cost of healthcare, social factors, such as the lack of culturally appropriate services, language/ethnic barriers, and prejudices on the part of providers. There is also significant lack of health education in slums. All these factors lead to an inability to identify symptoms and seek appropriate care on the part of the poor. The third most important access difficulty is due to gender related distance. Gender discrimination makes women more vulnerable to various diseases and associated morbidity and mortality. From socio-cultural and economic perspectives women in India find themselves in subordinate positions to men. They are socially, culturally, and economically dependent on men. In general an Indian woman is less likely to seek appropriate and early care for disease, whatever the socio-economic status of family might be. This gender discrimination in healthcare access becomes more obvious when the women are illiterate, unemployed, widowed or dependent on others. The combination of perceived ill health and lack of support mechanisms contributes to a poor quality of life A major health problem due to hepatitis C virus (HCV) which accounts for onefourth of all cases of chronic liver disease in India. It is estimated that there are 12.5 million HCV carriers in our country2, and at least a quarter of them are likely to develop chronic liver disease in the next 10 to 15 years In India a number of geogenic related diseases are under in depth study. It has been found that arsenic problem is recorded from West Bengal, Chattishgarh, Bihar Uttar Pradesh mostly related to river borne sediments. The enrichment of arsenic in certain geological column are related to the source rock, mode of deposition, and various chemical factors. Excess arsenic concentration (more than 0.05ppm) is found in groundwater. Too little iodine can result in hypothyroidism, causing weight gain, lack of energy, reduced mental focus, and in some cases Goitre, a condition where the thyroid gland grows abnormally large (goitre). Excessive amounts of fluoride can result in mottled teeth (stained, wrinkled), which are very hard but unsightly (dental fluorosis) and skeletal fluorosis (deformities in large bones). A deficiency of selenium has been linked to leukemia, rheumatoid arthritis, Overdose may bring the loss of teeth and hair, painful swelling of fingers, fatigue, nausea, and vomiting. In livestock one finds "staggering", cracking & loss of hooves, and loss of tails. In the medical geology parlence although elements which are detrimental to health are known as toxic elements. The excess as well as deficiency of essential elements induces serious health disorders. The notorious Big four - As, Cd, Pb and Hg are only poisonous and should be strictly avoided. All precautions and intensive studies are called for regarding naturally available Big four and their release anthropologically in the ecosystem. Exposition to metals could give rise to different negative effects to e.g. the kidneys (Pb, Cd), skeleton (Cd, Al), nervous system (Hg, Al, Pb), fertility (Pb, Hg), heart (Pb, As).

Due to an increase in unplanned urbanization and industrialization, the environment has deteriorated significantly. Pollution from a wide variety of emissions, such as from automobiles and industrial activities, has reached critical levels in many urban and industrial areas, causing respiratory, ocular and other health problems. Monitoring of the urban environment in selected cities in recent years by the pollution control authority has identified 21 critically polluted areas in the country. Agricultural activities including widespread use of fertilizers, pesticides and weed killers also alter the environment and create health hazards. Water stagnation and the consequent multiplication of vectors has increased the risk of vector-borne diseases. The risk associated with disposal of hospital wastes has added to the overall unhealthy situation. The incidence of malaria remained around 2 million cases per year during 1984-1992.The incidence of P. falciparum is increasing and reached to 50% in 1999. For filariasis, present estimates indicate that about 420 million people live in endemic areas. Visceral leishmaniasis, which reappeared in Bihar in the 1970s, is now endemic in 30 districts in Bihar and 9 districts in West Bengal. In 1996 there were 20,466 cases and 260 deaths reported. Japanese encephalitis (JE), though not a major public health problem, has over time been reported from as many as 24 states/UTs during one year, with an estimated 378 million people at risk. Dengue, dengue haemorrhagic fever (DHF) and dengue shock syndrome, all caused by the dengue virus, have been prevalent in India in almost all major urban areas, with periodic outbreaks of dengue fever and DHF. All four serotypes have been detected, and guidelines for prevention and control have been issued to all states Disability prevalence rates per 100,000 population estimated in 2008 are as follows: physical disability 3574, visual disability 827, hearing 806, speech 510, and locomotor disability 2041. The incidence rates per 100,000 population of these disabilities are: physical 173, visual 45, hearing 27, speech 10 and locomotor disability 105. Leprosy 560,000 (2000), malaria 2,276,788 (1999), measles 26,986 (1991), neonatal tetanus 1896 (1995), polio 142 15 (2000/2001), and tuberculosis 1,223,127 (1999). The vaccine-preventable diseases (referred to in Section 6) have declined significantly since implementation of the EPI. HIV affected 3.5 million Indians in 1998, according to UNAIDS estimates, though the overall prevalence of HIV in India is still low. Official surveillance data suggest that the epidemic is progressing rapidly. One in two new HIV infections takes place in people below the age of 25; one in four HIV infections in India are amongst women, most of whom have no risk factor other than being married. However, doubts have been expressed on the quality of epidemiological data. It has also been argued that the HIV epidemic should be seen in the context of other conditions such as diarrhoea, respiratory infections and tuberculosis, which have a higher morbidity and mortality. Cancers killed 653,000 people in 1998, the single largest type being mouth and oropharynx cancer Cardiovascular diseases, which includes those with an infectious origin, such as rheumatic heart disease, killed 2,820,000 people in 1998 Diabetes: In 1994 there were 20 million diabetics in India; there will be more than 33 million in 2005, according to World Health Organisation estimates. One in four diabetics will be Indian. Diabetes was responsible for 102,000 deaths in 1998. Up to 75 per cent don't even know they're diabetic.. Diabetic retinopathy, the most common cause of blindness in urban, middle-class Indians, is on the rise, though most of it is preventable. Diabetes is also the most significant cause of end-stage kidney disease and of amputations in India.

A considerable proportion of women suffer silently from a range of gynaecological problems. 100,000 Indian women die of pregnancy-related causes each year.Abortion, which has been legal in India since 1971, accounts for at least 12 per cent of maternal deaths. CONCLUSION: These are the various heath related problem which are prevailing in India which reduced the Indian economy.