Social determinants of health in India: a critical appraisal of the equity-oriented policies

Abstract

Background: Context-specific policies on social determinants of health (SDH) have been advocated to achieve health equity goals. Therefore, we reviewed the policies and assessed the progress achieved in health equity in India.

Methods: A logical framework with qualitative and quantitative approaches was used to review the contents of policies identified from government websites, and data from the budget and national sample surveys were used to assess inputs and equity outcomes.

Results: India has formulated several rights-based equity-oriented policies and increased financial allocations to the social sector. Civil participation has increased especially among the marginalized population. The Right to Education Act has made education free and compulsory for children. Initiatives on poverty alleviation have led to improvements in living conditions. The National Food Security Act provides subsidized food grains to about 2/3rds of the country's 1.4 billion population. However, undernutrition remains a major issue. Infant Mortality Rate (IMR) has declined from 58 in 2004-05 to 30 per thousand live births in 2019-21, and the gap in IMR has narrowed down between states, various socioeconomic groups, and urban and rural populations.

Conclusions: Although policy initiatives have improved SDH to some extent but inequity in socio-economic, rural-urban, gender, wealth, and caste groups persists in India.