Van de Poel Ellen, Speybroeck Niko
Erasmus University Rotterdam, Rotterdam, Netherlands.
Ethn Health. 2009 Jun;14(3):271-87. doi: 10.1080/13557850802609931.
In India, Scheduled Castes and Scheduled Tribes (ST/SC) have been excluded from Hindu society for thousands of years. Together, they comprise over 24% of India's population and still suffer worse health conditions compared to the rest of the Indian population. This paper decomposes the gap in child malnutrition between the ST/SC and the remaining Indian population, looking at both the ST/SC's disadvantageous distribution of health determinants and possible discriminatory or behavioral differences.
A Blinder-Oaxaca decomposition was applied to decompose the gap in children's average height-for-age z scores, using data from the 1998/1999 Indian Demographic Health Survey.
The gap was found to be primarily caused by the ST/SC's lower wealth, education and use of health care services, but also differences in the effects of health determinants played an important role. It was found that within rural areas ST/SC are not necessarily located further from educational and health care facilities.
The use of Oaxaca type decomposition can be very useful when studying ethnic inequalities in health as it explicitly allows for discriminatory or behavioral effects. The results did not point to discrimination against ST/SC regarding health care or education. However, in the quest to increase health care use and education among ST/SC, policy makers will have to take into account all the barriers to these services, including those related to cultural sensitivity and acceptability.
在印度，在册种姓和在册部落（以下简称“部落/种姓群体”）数千年来一直被排除在印度教社会之外。他们占印度人口总数的24%以上，但其健康状况仍比印度其他人口更差。本文剖析了部落/种姓群体与印度其他人口在儿童营养不良方面的差距，研究了部落/种姓群体在健康决定因素方面的不利分布以及可能存在的歧视性或行为差异。
采用布林德-奥克分解法，利用1998/1999年印度人口与健康调查数据，剖析儿童年龄别身高Z评分的差距。
研究发现，这种差距主要是由部落/种姓群体较低的财富、教育水平以及医疗服务利用率造成的，但健康决定因素的差异也起到了重要作用。研究发现，在农村地区，部落/种姓群体不一定距离教育和医疗设施更远。
在研究健康方面的种族不平等时，使用奥克卡类型分解法可能非常有用，因为它明确考虑了歧视性或行为影响。研究结果并未表明在医疗保健或教育方面存在对部落/种姓群体的歧视。然而，在寻求提高部落/种姓群体的医疗保健利用率和教育水平时，政策制定者必须考虑到获得这些服务的所有障碍，包括与文化敏感性和可接受性相关的障碍。
