Bedfordshire university

Student name =

Student ID=

Course name= public health protection

Research topic = Socioeconomic inequalities on access to healthcare system

in India

Course title= PUB008-6

Professor = Bhavneet Singh

Contents
Introduction...........................................................................................................................................3

Social and Economic Inequality.........................................................................................................3

Interventions and Policies by the Government.................................................................................4

Cultural Competence.........................................................................................................................4

Social Determinants of Health in India..................................................................................................5

Impact of Social Class on Health Inequalities in India........................................................................5

Gender's Influence on Healthcare Access and Outcomes..................................................................6

Role of Age, Ethnicity, Education, and Employment/Income............................................................7

Influence of Cultural and Religious Factors on Healthcare Disparities in India..................................8

Perspectives Underpinning Inequalities................................................................................................9

Government Policies...........................................................................................................................10

National Health Mission (NHM):......................................................................................................10

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (A2145*-+B-PMJAY)..................................11

Rashtriya Swasthya Bima Yojana (RSBY)..........................................................................................11

The National Urban Health Mission (NUHM)...................................................................................11

Conclusion...........................................................................................................................................11

Recommendations...............................................................................................................................12

References...........................................................................................................................................13
Table of

ontents

Table 1 54as5a.........................................................................................................................................4
Table 1 54as5a
Introduction

Especially difficult for India, a nation with healthcare disparities and socioeconomic inequality on a
scale never seen before. Socioeconomic health disparities in India: experienced, understood, and
managed are the focus of this research (Majumder, et al, 2023). Disparities in socioeconomic status
are a major factor in healthcare access disparities; this is particularly evident in India, where
individuals hail from a wide range of economic origins. These differences are closely related to
elements that impact the well-being of their ethnic target audience. There is a strong correlation
between a country's healthcare system and demographic variables such as age, gender, ethnicity,
education, employment, and income. These factors show that disparities in healthcare access between
groups are inevitable. One of the social determinants of health in India is the difficulty lower-income
people experience in obtaining adequate medical treatment. Health outcomes and access to healthcare
are profoundly affected by gender discrimination. These differences are exacerbated by other
socioeconomic characteristics like age, ethnicity, education, and occupation, highlighting the complex
role of social factors on these health issues. Because people's interactions with healthcare are complex
and multidimensional, cultural and religious factors are of equal importance. The government of India
has passed legislation to address healthcare disparities after realizing the need to do so. Two initiatives
with the same goal of ensuring that all Indians have access to affordable, high-quality healthcare are
Ayushman Bharat and the National Health Mission (WHO, 2022). Nevertheless, there are scarce
resources, varied cultures, and vast geographical areas to consider along the process. While laws like
the Clinical Establishments (Registration and Regulation Act) aim to standardize health care services,
it is unclear if this actually eliminates disparity. The article delves into the intricate nature of health
disparity in India. We may compare and contrast different theoretical frameworks, evaluate the
efficacy of government programs, and perhaps uncover the sociological causes of these inequalities if
we keep going in this direction. Our next step in understanding India's health-care inequities will be to
look at each of these issues separately.

Defining these three categories will give us the confidence to confront the issue of socioeconomic
inequality in Indian healthcare.
Social and Economic Inequality

Some portions of society are subjected to social inequality as a result of unequal distribution of
material resources. Income, education, and employment gaps all have a negative impact on access to
health care, health resources, and job possibilities Srinivas et al. (2019). Inequality in India is on the
rise as shown in the figure below:

Interventions and Policies by the Government

Governments enact legislation to address healthcare disparities. Expanding access to health insurance,
for example, was a fundamental goal of the National Health Mission and Ayushman Bharat in India.
An examination of the operational outcomes of such initiatives can provide lessons for future
policymakers.

Cultural Competence

When healthcare providers are culturally competent, they think about their patients' varied cultures
and may give them services that are appropriate for their culture (Stubbe, 2020). Healthcare providers
in India must be well-versed in cultural nuances if they are to effectively and fairly serve the country's
multilingual and multifaith population.

Social Determinants of Health in India

Health disparities in India are deeply rooted in socioeconomic status, notwithstanding the country's
cultural diversity, languages, and customs. By bearing these things in mind, we can better understand
the nuances of the county's health disparities. We look into the ways in which gender, age, ethnicity,
education, income, and employment or income affect health disparities in India, along with cultural
and religious issues.

Impact of Social Class on Health Inequalities in India

Social class is a genuine phenomena in India that affects healthcare access and results, contributing to
health disparities; this is borne out by data as well. A person's socioeconomic status, which is often
associated with their occupation, income, and degree of education, greatly influences their health
results. The well-off and influential elite have access to preventative health programs and screenings,
as well as 24/7 specialized medical treatment in case of emergencies. Health and wealth narratives are
catered to by private hospitals, which have access to state-of-the-art medical technology and teams of
highly qualified professionals. Conversely, it would appear that the bottom rungs of society are living
in a completely different reality. Massive obstacles exist for the impoverished in terms of health.
Because they cannot afford it, people from lower socioeconomic backgrounds may put off getting the
medical treatment they need and may not take the precautions that are recommended. In most cases,
prompt intervention is necessary when dealing with avoidable diseases that pose a burden. People in
need sometimes perceive medication and healthy food as expensive necessities for health care since
they are not part of their everyday lives (Daniel, 2020). Inadequate diet and poor living conditions
laden with environmental risk factors are also connected to these inequities, in addition to medical
care. Health disparities are already severe problems, and poverty makes them even worse. Uneven
access to mental health care is one aspect of healthcare disparities that gets little attention. This is the
way to accomplish it: Rewrite the given sentence such that it is understandable by humans. The chain
reaction that begins with financial stress and ends with a lack of funding for mental health services,
and how this impacts the general population's health. Resolving these disparities will require the
participation of other sectors; the health system cannot do it in isolation. A sea change in economic
and social policies is necessary to get to the bottom of poverty and inequality. Nevertheless,
healthcare reform should be accompanied with initiatives to alleviate poverty and eliminate
socioeconomic status as determinants of health; these initiatives should instead take into account the
varied perspectives of India's indigenous population (Schilinger, 2020). Up until then, the persistent
influence of socioeconomic class on health disparities would shape India's healthcare system, creating
a tale of two systems: one for the well-off and another for those fighting for equal access to
healthcare, a basic human right.

Gender's Influence on Healthcare Access and Outcomes

An important sociocultural factor in India's healthcare system is gender, which affects accessibility,
service quality, and clinical outcomes. Health seeking behaviors, illness diagnosis, and overall health
outcomes are all influenced by this intricate web of inequities based on conventional gender notions
and associated expectations. When it comes to accessing healthcare, women in India face distinct
obstacles. The reality that they need to put their own health first takes a back seat to their expectations
of being caregivers. The maternal health sector is particularly affected by cultural norms that
discourage women from seeking emergency medical care during pregnancy or childbirth. Fetal and
maternal death rates rise as a result of these delays, among other devastating effects. The disparity
between men's and women's health is already problematic, and gender-based violence just makes
things worse (Grugel, 2022). Despite the fact that it has serious consequences for people's emotional
and physical well-being, domestic violence and other forms of gender-based abuse are hardly
discussed. Because they may suffer shame and fear of consequences, victims often have a hard time
getting aid. The horrible cycle that persists as a result of gender-based violence is harmful to women's
physical, emotional, and social health, as well as their sexual and reproductive health. In contrast, men
face a variety of health issues that are exclusive to their gender. Socially constructed masculinities
lead to the denial of medical care to men, even in the face of terminal illnesses. The patient's
symptoms can get worse if life-saving treatment is delayed. The experiences of bisexual and
transgender individuals are under-discussed in relation to health disparities in both access and
outcomes. People who don't fit neatly into one of the binary paradigms face bigotry and ignorance
when they try to get medical help. Considering the high prevalence of transgender people suffering
from gender dysphoria and other prejudice-related mental diseases, this treatment approach is ill-
suited to their needs. In India, gender-based health inequities will disappear if we adopt an inclusive
stance. To eliminate obstacles that prevent equal service delivery to all individuals, governments
should create health services, initiatives, and laws that are more inclusive of women and girls. Every
demographic deserves individualized attention, and transgender people are no exception; they present
in distinct ways and have specific medical requirements.

Role of Age, Ethnicity, Education, and Employment/Income

Many challenges and dangers affect people of all ages. All children need to get vaccinated, eat right,
and get preventative treatment, but the elderly may not always be able to because of age-related
diseases and ailments. The healthcare system should prioritize the detection and treatment of age-
related illnesses. Ethnicity is one of several factors that contribute to health care disparities in India.
There is a vast array of health issues caused by the cultural practices and genetic predispositions of
people from varied ethnic backgrounds. Some genetic disorders and susceptibilities, for instance,
might be more prevalent in some racial or ethnic groups. How people view illness, react to
medication, seek medical attention, and plan for the prevention of disease are all shaped by cultural
norms. Providing culturally appropriate healthcare to the many different cultures in India requires an
understanding of and consideration for these ethically distinct features. Health literacy is an essential
part of personal health empowerment, and education plays a determining role in this. The health of
people increases when they have a high degree of health literacy because they are better educated.
Contrarily, lesser levels of education are linked to poor health literacy, which in turn increases the
likelihood of delayed diagnosis, disobedience with medical advice, and worsening health issues
(Thwin, 2023). One way to reduce health disparities and promote a healthy lifestyle is to close the
educational gap. The social determinant method is already complicated due to income and
employment inequality. Generally speaking, healthcare is more accessible to individuals with greater
incomes. Where people work determines the extent to which they are exposed to health risks and
occupational hazards. Disparities in income impact people's ability to pay for essential health care
services, which in turn prevents them from receiving these services when they need them. Healthcare
solutions on their own will not reduce unemployment and income inequality; these problems are
interrelated and require comprehensive economic strategies to improve social welfare and distribute
wealth more fairly. To reduce health care access and result disparities, it is important to identify the
many barriers created by age, ethnicity, education level, and employment/income. This will help to
support the creation of individualized interventions.

Influence of Cultural and Religious Factors on Healthcare Disparities in India

How people in India perceive the healthcare system, their views on medical intervention, and how
often they seek medical treatment are all significantly impacted by cultural and religious factors.
Hence, health outcomes are significantly affected by the complex environment that is generated by the
nation's different cultural practices and religious beliefs. Behaviours about one's health are impacted
by cultural norms. Traditional healing methods with strong cultural roots and a longer history of
success than modern medicine are what this approach comprises. When dealing with patients from
different cultural origins, healthcare practitioners would do well to learn about and honor these
traditions (Mendoza, et al, 2020). Also adding to health disparities are cultural practices like gender
orientation that promote patients not having agency over their own healthcare decisions. There may be
gaps in healthcare due to people's religious views as well. Whether it's a woman's choice of birth
control or her support of a given medical procedure, religion has a role in these matters. Reflect on the
ways in which attempts to establish family planning programs have been impacted by divergent
viewpoints on reproduction and birth control. People may stay home or refuse medical treatment
altogether if they are religiously stigmatized for a particular illness. In order to help their patients
overcome this obstacle, healthcare providers must possess cultural competence. Healthcare providers
would greatly benefit their patients if they made an effort to understand their patients' cultural
backgrounds and how such factors impact their health. Health intervention outcomes and doctor-
patient interactions are both enhanced by culturally relevant treatment. The reality that different
groups hold different values and beliefs must be seriously considered by health education initiatives.
As an example, Auld et al. (2020) assert that the public can be better educated about health literacy
and the importance of preventive care when community and religious leaders collaborate. An
understanding of the role that cultural and religious factors play in perpetuating health disparities is
crucial for the promotion of inclusive and equitable health management solutions. Every Indian would
have easier access to health care if the existing system prioritized cultural sensitivity and person-
centered care.

Perspectives Underpinning Inequalities

There are a number of theoretical frameworks that try to explain the dynamics and causes of health
care disparities; researchers in India would do well to investigate these. Cultural, socioeconomic, and
societal variables' effects on health outcomes have been better understood with the use of a number of
models. To get to the bottom of health inequities, the HBM model has been used to test a lot of
behavioral theories. An influential theory on human behavior, the health belief model proposes that
people think about the gravity of a health problem, how important it is to them, whether they would
benefit from taking precautions, and what obstacles would prevent them from doing so when making
decisions. This model provides a framework for understanding the disproportionate impact of health
disparities on certain Indian tribes. If you add a lack of funds to the base of the pyramid, it might look
impossible to climb.Also, people may delay getting medical treatment when they're sick due to
cultural conventions and ignorance about the signs and symptoms of illness. In a similar vein, SCT
stresses the importance of healthy lifestyle modeling and the influence of peers. Using SCT, we can
gain a better understanding of how individuals in India, a society that places a premium on social
norms, learn about health via their immediate social circles. Imagine the domino effect of health
inequalities that can happen when people living in low-income areas see that their friends and
neighbors also lack health insurance. Multiple social identities, including gender, class, and ethnicity,
can make people vulnerable to various types of oppression, subordination, and discrimination (Kira, et
al, 2021). It is crucial to offer individualized interventions that tackle the intersections of gender and
socioeconomic status since women from lower socioeconomic classes face distinct healthcare
obstacles than men from the same class. Anthropologists trained in medicine study cultural norms,
political processes, and historical contexts to determine their effects on patient care. This approach
delves into the cultural and social factors that influence health in India by following the chain of
causation from societal mores and caste systems to past wrongs that have affected people's well-being.
In order to successfully address current health inequities, critical medical anthropology advocates
resolving broader socioeconomic challenges.
Government Policies

To ensure that people of all income levels have access to quality healthcare, India has implemented a
number of policies and programs. To assess the success of programs to fill health care gaps, a
mountain of data is needed.

National Health Mission (NHM):

Projects like the National Health Mission fall within this category. Affordable, high-quality healthcare
for low-income individuals in rural areas was its primary goal when it was established in 2005 (Prado,
et al, 2022). Important medications, services for the health of mothers and children, and enhancements
to the healthcare system are all part of these components. Unfortunately, the system isn't working
because of a lack of consistency, inadequate funding, and an enduring divide between urban and rural
areas. There has been a lot of improvement, but it's still clear that the most vulnerable people, like
babies and toddlers, need extra care. The impact of NHM in india on infants and Maternal Mortality is
given by the graph below:
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (A2145*-+B-PMJAY)

In 2018, the government launched the AB-PMJAY program with the intention of covering up to one
hundred million low-income individuals with up to five lakh rupees per year. Despite the program's
impressive track record of increasing healthcare access, it continues to face challenges that limit its
ability to reach its maximum potential. For instance, customers are often unaware of the programs'
alternate insurance choices, and there is extensive regional unhappiness and discontent with the
service. Achieving health equity requires addressing not only healthcare insurance but also
socioeconomic characteristics like education and employment possibilities.

Rashtriya Swasthya Bima Yojana (RSBY)

Thirdly, access to health insurance for low-income families was made possible in 2008 through the
government's Hooma Hooda 2020 Rashtriya Swasthya Bimay Yojna (Rsby). The program's claim
processing time is sluggish, and the requirements for treatment quality are not precise, despite
attempts to expand health coverage. If the program wants to keep helping people afford treatment and
adapt to the changing health care landscape, it needs to fix these problems and make improvements.

The National Urban Health Mission (NUHM)

Urbanites have unique healthcare requirements, which NUHM satisfies by providing affordable, top-
notch medical attention (WHO, 2023). Increases in urban populations, healthcare disparities, and the
rate of urbanization are all obstacles that the program must overcome. Making effective use of
targeted interventions in metropolitan settings to address particular health concerns by filling service
gaps caused by healthcare system closures.

Conclusion

Finally, larger societal and cultural issues are the root cause of healthcare inequality. In order to make
successful policies, it is necessary to fully comprehend what causes this event to occur. Several
government programs enable this, despite ongoing challenges. Integrative techniques that encourage
cultural sensitivity, community engagement, and decision-making based on evidence are necessary for
more equitable healthcare provision in India.
Recommendations

Health literacy, cultural sensitivity in healthcare professional training, and the elimination of specific
causes of healthcare disparities are all areas where the Indian government could do more to advance
healthcare equity. There are a variety of tactics to increase citizen engagement in government, such as
reevaluating existing policies. This is the best course of action for the Indian government to pursue if
it wants to create a healthcare system that can serve its people for the long haul and take into account
their diverse interests.
References

Ates, H., Demir Özdenk, G. and Çaliskan, C., 2021. Determinants of Science Teachers' Healthy
Eating Behaviors: Combining Health Belief Model and Theory of Planned Behavior. Journal
of Baltic Science Education, 20(4), pp.573-589.

Auld, M.E., Allen, M.P., Hampton, C., Montes, J.H., Sherry, C., Mickalide, A.D., Logan, R.A.,
Alvarado-Little, W. and Parson, K., 2020. Health literacy and health education in schools:
Collaboration for action. NAM perspectives, 2020.

Daniel, C., 2020. Is healthy eating too expensive?: How low-income parents evaluate the cost of food.
Social Science & Medicine, 248, p.112823.

Gómez, C.A., Kleinman, D.V., Pronk, N., Gordon, G.L.W., Ochiai, E., Blakey, C., Johnson, A. and
Brewer, K.H., 2021. Practice full report: addressing health equity and social determinants of
health through healthy people 2030. Journal of Public Health Management and Practice,
27(6), p.S249.

Grugel, J., Barlow, M., Lines, T., Giraudo, M.E. and Omukuti, J., 2022. Exacerbating inequalities:
gender-based violence and sexual and reproductive health. In The Gendered Face of COVID-
19 in the Global South (pp. 94-122). Bristol University Press.

Hooda, S.K., 2020. Penetration and coverage of government-funded health insurance schemes in
India. Clinical Epidemiology and Global Health, 8(4), pp.1017-1033.

Jennings, L., Barcelos, C., McWilliams, C. and Malecki, K., 2019. Inequalities in lesbian, gay,
bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin.
Preventive Medicine Reports, 14, p.100864.

Kira, I.A., Shuwiekh, H.A., Alhuwailah, A., Ashby, J.S., Sous Fahmy Sous, M., Baali, S.B.A.,
Azdaou, C., Oliemat, E. and Jamil, H.J., 2021. The effects of COVID-19 and collective
identity trauma (intersectional discrimination) on social status and well-being. Traumatology,
27(1), p.29.

Majumder, S., Roy, S., Bose, A. and Chowdhury, I.R., 2023. Understanding regional disparities in
healthcare quality and accessibility in West Bengal, India: A multivariate analysis. Regional
Science Policy & Practice, 15(5), pp.1086-1113.
Mendoza, N.S., Moreno, F.A., Hishaw, G.A., Gaw, A.C., Fortuna, L.R., Skubel, A., Porche, M.V.,
Roessel, M.H., Shore, J. and Gallegos, A., 2020. Affirmative care across cultures: broadening
application. Focus, 18(1), pp.31-39.

Prado, A.M., Robinson, J.A. and Shapira, Z., 2022. Serving rural low‐income markets through a social
entrepreneurship approach: Venture creation and growth. Strategic Entrepreneurship Journal,
16(4), pp.826-852.

Schillinger, D., 2020. The intersections between social determinants of health, health literacy, and
health disparities. Studies in health technology and informatics, 269, p.22.

Srinivas, P.N., Seshadri, T., Velho, N., Babu, G.R., Madegowda, C., Basappa, Y.C., Narasimhamurthi,
N.S., Majigi, S.M., Madhusudan, M.D. and Marchal, B., 2019. Towards Health Equity and
Transformative Action on tribal health (THETA) study to describe, explain and act on tribal
health inequities in India: a health systems research study protocol. Wellcome Open Research,
4.

Stubbe, D.E., 2020. Practicing cultural competence and cultural humility in the care of diverse
patients. Focus, 18(1), pp.49-51.

Thwin, Y.P.P., 2023. A Study on Knowledge, Attitude and Practice towards Covid-19 among
Government Employees in Naypyitaw (Doctoral dissertation, MERAL Portal).

World Health Organization, 2022. Report on evolution of Ayushman Bharat Pradhan Mantri Jan
Arogya Yojana.

World Health Organization, 2023. Regional Meeting with Multisectoral Partners on Urban
Governance for Health and Well-being in South-East Asia Region, Bangkok, 27─ 29
September 2022 (No. SEA-HE-216). World Health Organization. Regional Office for South-
East Asia.