The George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India.
Public Health Foundation of India, Institutional Area, Plot 47, Sector 44, Gurugram, New Delhi, 122002, India.
Int J Equity Health. 2020 Feb 28;19(1):29. doi: 10.1186/s12939-020-1147-3.
The tea estate sector of India is one of the oldest and largest formal private employers. Workers are dependent on plantation estates for a range of basic services under the 1951 Plantation Labour Act and have been subject to human rights violations. Ad hoc reports related to poor health outcomes exist, yet their determinants have not been systematically studied. This study in Assam, situated in Northeast India, sought to understand the Social Determinants of Health (SDH) of women plantation workers with an aim to offer directions for policy action.
As part of a larger qualitative study, 16 FGDs were carried out with women workers in three plantations of Jorhat district covering permanent and non-permanent workers. Informed consent procedures were carried out with all participants individually. Data were analyzed thematically using Ritchie and Spencer's framework based on an adapted conceptual framework drawing from existing global conceptual models and frameworks related to the SDH.
Determinants at structural, intermediary and individual levels were associated with health. Poverty and poor labour conditions, compounded by the low social position of women in their communities, precluded their ability to improve their economic situation. The poor quality of housing and sanitation, inadequate food and rations, all hampered daily living. Health services were found wanting and social networks were strained even as women were a critical support to each other. These factors impinged on use of health services, diet and nutrition as well as psychosocial stress at the individual level.
Years of subjugation of workers have led to their deep distrust in the system of which they are part. Acting on SDH will take time, deeper understanding of their relative and/or synergistic contribution, and require the building of stakeholdership. Notwithstanding this, to have heard from women workers themselves has been an important step in visibilizing and building accountability for action on the health and SDH of women in plantation estates.
印度的茶园部门是历史最悠久、规模最大的正规私人雇主之一。根据 1951 年《种植园劳工法》，工人们依赖种植园提供一系列基本服务，他们的权利一直受到侵犯。虽然有一些与健康状况不佳有关的专题报告，但这些报告并没有系统地研究其决定因素。这项位于印度东北部阿萨姆邦的研究旨在了解女性种植园工人的社会决定因素（SDH），目的是为政策行动提供方向。
作为一项更大的定性研究的一部分，在乔尔哈特区的三个种植园中，对女性工人进行了 16 次小组讨论，涵盖了永久和非永久性工人。对所有参与者都进行了单独的知情同意程序。数据采用 Ritchie 和 Spencer 框架进行了主题分析，该框架基于从现有全球概念模型和与 SDH 相关的框架中提取的适应性概念框架。
结构、中间和个人层面的决定因素与健康有关。贫困和恶劣的劳动条件，加上妇女在社区中的社会地位低下，使她们无法改善经济状况。住房和卫生条件差、食物和定量配给不足，都影响了日常生活。卫生服务不足，社会网络紧张，尽管妇女是彼此的重要支持。这些因素影响了个人层面的卫生服务利用、饮食和营养以及心理社会压力。
多年来对工人的压迫导致他们对自己所在系统的深深不信任。要采取行动改善社会决定因素，需要时间、更深入地了解它们的相对和/或协同贡献，并需要建立利益相关者关系。尽管如此，听取女性工人自己的意见，是为种植园女性的健康和社会决定因素提高可见度和建立问责制的重要一步。
