Indigenous Health and Socioeconomic Status in India
S. V. Subramanian1, George Davey Smith2, Malavika Subramanyam1 1 Harvard School of Public Health, Boston, Massachusetts, United States of America, 2 University of Bristol, Bristol, United Kingdom
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.
Funding: The authors received no specific funding for this study.
Competing Interests: The authors have declared that no competing interests exist.
Academic Editor: Simon Hales, University of Otago, New Zealand
Citation: Subramanian SV, Smith GD, Subramanyam M (2006) Indigenous Health and Socioeconomic Status in India. PLoS Med 3(10): e421 doi:10.1371/journal.pmed.0030421
Received: December 28, 2005;
Accepted: August 4, 2006;
Published: October 24, 2006
Copyright: © 2006 Subramanian et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abbreviations: CI, confidence interval; INFHS, Indian National Family Health Survey; OR, odds ratio; SRS, Sample Registration System
*To whom correspondence should be addressed. E-mail: svsubram@hsph.harvard.edu
