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How Your Caste, Class And Dwelling Determine Your Access To Healthcare

Operationally, public health is a component of both organisation and community effort. In the early twentieth century, community measures towards desirable health outcomes gained attention around the world. Focusing on the significance of collective action and community resolution against various health hazards, public health, at its earlier stage, has gained momentum in the West.

However, with the shift in the social scenario after the industrial era, the concept of public health has become one dimensional and individualistic. The changing scope of public health practice was initially concerned with infectious and environmentally related diseases, but more recently, it has been extended to nutrition, injury prevention, violence, substance abuse and other chronic diseases. With the outbreak of Covid-19, it has become clear that the one-dimensional approach towards health will not yield any fruits for the interaction of a plethora of factors such as society and the environment that determine the health of an individual. Thus, we need to analyse health as a multi-factorial outcome, which is expected to have a fair and just distribution of resources, to acquire and maintain health and well-being.

What Is Health Equity?

A woman & her child receive healthcare services at Myna’s health clinic

Health equity is a terminology that refers to the equality in the distribution of population health outcomes. In other words, it is the absence of inequalities in health outcomes that stem from some form of injustice. From broader socioeconomic disparity to uneven access to education, health, and inadequate knowledge of policies and programmes, inequality permeates most aspects of the social life in India.

Although there are diverse factors that are contributing to the existing inequality, the structural issues in the health sector are widening the gap between those who have and those who do not. Thus, looking at the economic, social, political and geographic determinants of health equity in the context of Covid-19 will equip us with a broader picture of the health equity issues in India.

Economic Determinants

Being the major determinant of access to health services in India, income is an important measure of health equity. Income allows individuals and communities to purchase and consume health services such as medicines, hospital beds, nutritional food, clean water and so on. The satisfaction of basic needs, ownership of a safe and secure shelter, consumption of other goods and services for the maintenance of physical health will be possible for a population only if they are affluent enough to acquire those resources.

Additionally, there is nothing more important than the income of a household, for it determines the social location of the household to acquire goods and services. For citizens, the absence of sufficient income to access health services can lead to their deteriorated mental health and induce stress, which will eventually influence physical health.

India is one of the worst and widest gap between its rich and poor, and this gap has only deepened since the outbreak of the pandemic. Having been influenced by economic status, social position and political identity, access to free and compulsory education stays a dream for many in India. Without proper guidance, the absolute lack of education and the absence of opportunities for employment, the rate of unemployment has been accelerating over the years. Access to education determines the opportunities for employment and employment generates income. This cyclic flow of social capital often decides the number of people with access to fair health services. Hence, half of the population of India, either the poor or the poorest of the poor, cannot access health care, cannot even eat sufficient food.

Social Determinants

Caste, religion, economic class and gender are the major social determinants of an equitable social life in India. These determinants are not different when observing who has or doesn’t have access to healthcare and well-being. Practising caste-based social stratification, the Indian society denies access to health and other services to a multitude of people belonging to various caste identities. Been undermined for a long time, tribal and indigenous communities experience the same but intense discrimination when it comes to accessing health services. Although women and men are somewhat enjoying equitable assistance in health, transgender persons and other gender minorities can’t say the same. Also, financially dependent women face discrimination and difficulties in accessing healthcare, food, clean water or even voicing their needs.

Political Determinants

Even though we are constantly emphasising on the poverty and inequality experienced by gender and social minorities, we often forget about the absence of these minorities on the political apparatus of decision-making and participation in it. Although there are civil and constitutional rights for each individual to participate in the political process to reduce the disparity in the distribution of services, many are not able to make it till the end.

With its devastating effects, Covid-19 unleashed the need for representation of people who belong to various socio-cultural identities to the decision-making class so that opportunities can be equally distributed. However, political participation of people is required not only to b represented in the decision-making process, but also in the discipline and practice of needs-based and rights-based approaches towards healthcare and well-being.

Geographical Determinants

When it comes to healthcare, there is a serious difference in the distribution of the number of hospitals, healthcare workers, and Community Health Centres (CHSc) and Primary Health Centres (PHSc) between urban and rural areas of India. The pandemic severely affected modes of transportation, as people living in rural area suffered while accessing better care. Most hospitals that were providing better care and service are located in the urban centres of India.

Thus, for the rural population, most of who are already unemployed and poor, it is difficult to get past their medical needs. In addition to this, the predominant gap in the systems that provides awareness about diseases and precautionary methods has also affected the outspread of the virus in rural areas. Hence, it is clear that the geographical position along with the centre-periphery developmental differences create maladies when it comes to access to healthcare, social security measures and adequate food items.

Conclusion

In an emergent situation such as the pandemic, health being a multi-factorial concept, gained attention from all facets of society. Stakeholders called for public intervention and community measures rather than scientific and medicinal solutions. The determinants of equity in the distribution of health services have made it clear that either a pandemic, a natural disaster or any hazardous phenomenon in any dimension of social life has a cyclical and continuing effect on every other dimension of a safe and sound life.

Thus, it is high time that we discuss the measures of equity in the outcomes and distribution of health services from an interdisciplinary and multi-dimensional perspective.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

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A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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