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.
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.
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.
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.
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.
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.
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.