OALib Journal期刊
ISSN: 2333-9721
费用：99美元

投递稿件

查看量	下载量

相关文章
更多...

PLOS Medicine 2006

Indigenous Health and Socioeconomic Status in India

DOI: 10.1371/journal.pmed.0030421

S. V Subramanian ,George Davey Smith,Malavika Subramanyam

Full-Text Cite this paper Add to My Lib

Abstract:

Background Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. Methods and Findings Cross-sectional population-based data were obtained from the 1998–1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances. Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13–1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33–1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. Conclusions Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.

References

[1]	Willis R, Stephens C, Nettleton C (2004) The right to health of indigenous peoples. Report of a conference held at the London School of Hygiene and Tropical Medicine. London: Health Unlimited.
[2]	Sen A (1999) Development as freedom. New York: Knopf. 366 p.
[3]	Stephens C, Nettleton C, Porter J, Willis R, Clark S (2005) Indigenous peoples' health—Why are they behind everyone, everywhere? Lancet 366: 10–13.
[4]	Bristow F, Stephens C, Nettleton C, W'achil U (2003) Utz' Wach'il: Health and well being among indigenous peoples. London: Health Unlimited/London School of Hygiene and Tropical Medicine. Available: http://www.lshtm.ac.uk/pehru/indig/utzpa？mphlet.pdf. Accessed on September 25, 2006.
[5]	Hetzel DM (2001) Death, disease and diversity in Australia, 1951 to 2000. Med J Aust 174: 21–24.
[6]	Bramley D, Hebert P, Tuzzio L, Chassin M (2005) Disparities in indigenous health: A cross-country comparison between New Zealand and the United States. Am J Public Health 95: 844–850.
[7]	Wilson K, Rosenberg MW (2002) Exploring the determinants of health for First Nations peoples in Canada: Can existing frameworks accommodate traditional activities? Soc Sci Med 55: 2017–2031.
[8]	Bramley D, Hebert P, Jackson R, Chassin M (2004) Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States. N Z Med J 117: U1215.
[9]	Anand SS, Yusuf S, Jacobs R, Davis AD, Yi Q, et al. (2001) Risk factors, atherosclerosis, and cardiovascular disease among aboriginal people in Canada: The Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP). Lancet 358: 1147–1153.
[10]	Frank JW, Moore RS, Ames GM (2000) Historical and cultural roots of drinking problems among American Indians. Am J Public Health 90: 344–351.
[11]	Gaiser J (1984) Smoking among Maoris and other minorities in New Zealand. World Smoking Health 9: 7–18.
[12]	Finger C (2003) Health care in indigenous populations: The Xingu Indian park. Lancet 362: S38–S39.
[13]	Johnston T, Coory M (2005) Reducing perinatal mortality among indigenous babies in Queensland: Should the first priority be better primary health care or better access to hospital care during confinement? Aust New Zealand Health Policy 2: 11.
[14]	Seale JP, Shellenberger S, Rodriguez C, Seale JD, Alvarado M (2002) Alcohol use and cultural change in an indigenous population: A case study from Venezuela. Alcohol Alcohol 37: 603–608.
[15]	Escobar AL, Coimbra CEJ, Camacho LA, Portela MC (2001) Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil. Cad Saude Publica 17: 285–298.
[16]	Maybury-Lewis D (2002) Indigenous peoples, ethnic groups and the state, 2nd edition. Boston: Allyn and Bacon. p.
[17]	Karlsson BG (2003) Anthropology and the ‘indigenous slot': Claims to and debates about indigenous peoples' status in India. Crit Anthropol 23: 403–423.
[18]	India Ministry of Tribal Affairs (2004) The national tribal policy (draft). New Delhi: India Ministry of Tribal Affairs. Available:http://tribal.nic.in/finalContent.pdf. Accessed 26 September 2006.
[19]	United Nations (2004) The concept of indigenous peoples. New York: United Nations. Available: http://www.un.org/esa/socdev/unpfii/docu？ments/PFII%202004%20WS.1%203%20Definitio？n.doc. Accessed 26 September 2006.
[20]	World Bank2005 Jul. Indigenous peoples. OP 4.10. Washington (D. C.): World Bank. Available: http://wbln0018.worldbank.org/Institutio？nal/Manuals/OpManual.nsf/tocall/0F7D6F3F？04DD70398525672C007D08ED?OpenDocument. Accessed 26 September 2006.
[21]	Office of the Registrar General and Census Commissioner ((2001) Total population, population of scheduled castes and scheduled tribes and their proportions to the total population. New Delhi: Office of the Registrar General and Census Commissioner.
[22]	Government of India (1950) Constitution of India. Part XVI. Special provisions relating to certain classes. New Delhi: Government of India.
[23]	International Institute of Population Sciences (2000) National Family Health Survey 1998–99. Mumbai: International Institute of Population Sciences.
[24]	Basu S (2000) Dimensions of tribal health in India. Health Popul Perspect Issues 23: 61–70.
[25]	Thapar RA (1990) A History of India. New Delhi: Penguin. 384 p.
[26]	Minority Rights Group (1999) The Adivasis of India. International Report 98/1. London: Minority Rights Group. Available: http://www.minorityrights.org/Profiles/p？rofile.asp?ID=2. Accessed 26 September 2006.
[27]	Stephens C, Porter J, Nettleton C, Willis R (2006) Disappearing, displaced, and undervalued: A call to action for indigenous health worldwide. Lancet 367: 2019–2028.
[28]	Abu SM, Mahtab H, Akter KP, Abul AK, Banu A, et al. (2004) Diabetes and impaired fasting glycemia in the tribes of Khagrachari hill tracts of Bangladesh. Diabetes Care 27: 1054–1059.
[29]	Granich R, Cantwell MF, Long K, Maldonado Y, Parsonnet J (1999) Patterns of health seeking behavior during episodes of childhood diarrhea: A study of Totzil-speaking Mayans in the highlands of Chiapas, Mexico. Soc Sci Med 48: 489–495.
[30]	Hsu HJ (1990) Incidence of tuberculosis in the hunting tribe E-Lun-Chun in Northeast China. Pneumologie 44: 453–454.
[31]	Kate SL (2001) Health problems of tribal population groups from the state of Maharashtra. Indian J Med Sci 55: 99–108.
[32]	Friedman MS, Somani J (2002) Health conditions in the tribal villages of South Bihar: An epidemiologic survey. J Assoc Physicians India 50: 1376–1380.
[33]	Berkman LF, Kawachi I, editors. (2000) Social epidemiology. New York: Oxford Press. 391 p.
[34]	Marmot M, Wilkinson RG, editors. (1999) Social determinants of health. Oxford: Oxford University Press. 291 p.
[35]	Shimkhada R, Peabody JW (2003) Tobacco control in India. Bull World Health Organ 81: 48–52.
[36]	World Health Organization Tobacco or Health Programme (1997) Tobacco or health: A global status report. Geneva: World Health Organization. Available: http://www.cdc.gov/tobacco/WHO/index.htm Accessed 26 September 2006.
[37]	World Health Organization (2002) Alcohol in developing societies: A public health approach. Geneva: World Health Organization. 263 p.
[38]	Rahman L (2002) Alcohol prohibition and addictive consumption in India. London: London School of Economics. Available: http://www.nottingham.ac.uk/economics/le？verhulme/conferences/postgrad_conf_2003/？Rahman_paper.pdf#search=%22Alcohol%20pro？hibition%20and%20addictive%20consumption？%20in%20India%22. Accessed 21 September 2006.
[39]	Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, et al. (2004) Distribution of major health risks: Findings from the Global Burden of Disease study. PLoS Med 1: e27.. DOI: 10.1371/journal.pmed.0010027.
[40]	Subramanian SV, Nandy S, Irving M, Gordon D, Davey Smith G (2005) Role of socioeconomic markers and state prohibition policy in predicting alcohol consumption amongst men and women in India: A multilevel analysis of the 1998–99 National Family Health Survey. Bull World Health Organ 83: 829–836.
[41]	Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G (2004) Patterns and distribution of tobacco consumption in India: Cross-sectional multilevel evidence from the 1998–99 National Family Health Survey. BMJ 328: 801–806.
[42]	John RM (2005) Tobacco consumption patterns and its health implications in India. Health Policy 71: 213–222.
[43]	Neufeld KJ, Peters DH, Rani M, Bonu S, Brooner RK (2005) Regular use of alochol and tobacco use in India and its association with age, gender and poverty. Drug Alcohol Depend 77: 283–291.
[44]	Feeney G (1991) Child survivorship estimation: Methods and data analysis. Asian Pac Popul Forum 5: 51–87.
[45]	Hill K (1991) Approaches to the measurement of childhood mortality: A comparative review. Popul Index 57: 368–382.
[46]	Filmer D, Pritchett L (2001) Estimating wealth effects without expenditure data—or tears: An application to educational enrollments in states of India. Demography 37: 155–174.
[47]	Montgomery MR, Gragnolati M, Burke KA, Paredes E (2000) Measuring living standards with proxy variables. Demography 37: 155–174.
[48]	Gwatkin DR, Rustein S, Johnson K, Pande RP, Wagstaff A (2000) Socioeconomic differences in health, nutrition, and population in India. Washington (D. C.): World Bank. Available: http://www1.worldbank.org/prem/poverty/h？ealth/data/india/india.pdf. Accessed 26 September 2006.
[49]	Gordon D, Pantazis C, editors. (1997) Breadline Britain in the 1990s. Aldershot (United kingdom): Ashgate Publishing. 309 p.
[50]	Hallerod B (1998) Poor Swedes, poor Britons: A comparative analysis of relative deprivation. In: Andres A, editor. Empirical poverty research in a comparative perspective. Aldershot (United Kingdom): Ashgate. pp. 283–311.
[51]	Mack J, Lansley S (1985) Poor Britain. London: Allen and Unwin. 324 p.
[52]	Goldstein H (2003) Multilevel statistical models, 3rd edition. London: Arnold. 253 p.
[53]	Subramanian SV, Jones K, Duncan C (2003) Multilevel methods for public health research. In: Kawachi I, Berkman LF, editors. Neighborhoods and health. New York: Oxford University Press. pp. 65–111.
[54]	Rasbash J, Steele F, Browne W, Prosser B (2005) A user's guide to MLwiN version 2.0. Bristol: Centre for Multilevel Modelling, University of Bristol. Available: http://www.mlwin.com/download/userman_20？05.pdf. Accessed 26 September 2006.
[55]	Altman DG, Bland JM (2003) Interaction revisited: The difference between two estimates. BMJ 326: 219.
[56]	Subramanian SV, Nandy S, Irving M, Gordon D, Lambert H, et al. (2006) The mortality divide in India: The differential contribution of gender, caste and standard of living across the life course. Am J Public Health 96: 826–833.
[57]	Gupta PC, Mehta HC (2000) Cohort study of all-cause mortality among tobacco users in Mumbai, India. Bull World Health Organ 78: 877–883.
[58]	Gajalakshmi V, Peto R, Kanaka TS, Jha P (2003) Smoking and mortality from tuberculosis and other diseases in India: Retrospective study of 43000 adult male deaths and 35000 controls. Lancet 362: 507–515.
[59]	Gakidou E, Hogan M, Lopez AD (2004) Adult mortality: Time for a reappraisal. Int J Epidemiol 33: 710–717.
[60]	Timaeus I (1993) Demographic change in sub-Saharan Africa. Washington (D. C.): National Academy of Sciences. 396 p.
[61]	Davey Smith G (2000) Learning to live with complexity: Ethnicity, socioeconomic position, and health in Britain and the United States. Am J Public Health 90: 1694–1698.
[62]	Davey Smith G, editor. (2003) Health inequalities: Lifecourse approaches. Bristol: Policy Press. 548 p.
[63]	Kingsbury B (1998) Indigenous peoples in international law: A constructivist approach to the Asian controversy. Am J Int Law 92: 414–457.
[64]	Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, et al. (2006) Effects of self-reported racial discrimination and deprivation on Maori health and inequalities in New Zealand: Cross-sectional study. Lancet 367: 2005–2009.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133