Nayar K R
Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi, India.
Indian J Med Res. 2007 Oct;126(4):355-63.
Poverty and social exclusion are important socio-economic variables which are often taken for granted while considering ill-health effects. Social exclusion mainly refers to the inability of our society to keep all groups and individuals within reach of what we expect as society to realize their full potential. Marginalization of certain groups or classes occurs in most societies including developed countries and perhaps it is more pronounced in underdeveloped countries. In the Indian context, caste may be considered broadly as a proxy for socio-economic status and poverty. In the identification of the poor, scheduled caste and scheduled tribes and in some cases the other backward castes are considered as socially disadvantaged groups and such groups have a higher probability of living under adverse conditions and poverty. The health status and utilization patterns of such groups give an indication of their social exclusion as well as an idea of the linkages between poverty and health. In this review, we examined broad linkages between caste and some select health/health utilization indicators. We examined data on prevalence of anaemia, treatment of diarrhoea, infant mortality rate, utilization of maternal health care and childhood vaccinations among different caste groups in India. The data based on the National Family Health Survey II (NFHS II) highlight considerable caste differentials in health. The linkages between caste and some health indicators show that poverty is a complex issue which needs to be addressed with a multi-dimensional paradigm. Minimizing the suffering from poverty and ill-health necessitates recognizing the complexity and adopting a perspective such as holistic epidemiology which can challenge pure technocentric approaches to achieve health status.
贫困和社会排斥是重要的社会经济变量，在考虑健康不良影响时常常被视为理所当然。社会排斥主要是指我们的社会无法让所有群体和个人都能达到我们作为社会所期望的、实现其全部潜力的水平。包括发达国家在内的大多数社会都存在某些群体或阶层的边缘化现象，而在不发达国家可能更为明显。在印度的背景下，种姓大致可被视为社会经济地位和贫困的一个代表。在确定贫困人口时，在册种姓和在册部落，以及在某些情况下其他落后种姓被视为社会弱势群体，这些群体生活在不利条件和贫困中的可能性更高。这些群体的健康状况和利用模式既表明了他们的社会排斥情况，也反映了贫困与健康之间的联系。在本综述中，我们研究了种姓与一些选定的健康/健康利用指标之间的广泛联系。我们研究了印度不同种姓群体中贫血患病率、腹泻治疗情况、婴儿死亡率、孕产妇保健利用情况和儿童疫苗接种情况的数据。基于全国家庭健康调查二期（NFHS II）的数据凸显了不同种姓在健康方面的显著差异。种姓与一些健康指标之间的联系表明，贫困是一个复杂的问题，需要采用多维度范式来解决。将贫困和健康不良造成的痛苦降至最低，需要认识到其复杂性，并采用诸如整体流行病学这样的视角，这种视角能够挑战单纯以技术为中心的方法来实现健康状况。
