Posts Tagged 'health inequalities'

The relationship between work & health in India

Martin Hyde, co-editor of  Work and health in India, discusses the relationship between work and health in a country with one of the fastest growing economies in the world and with a labour force of nearly half a billion people. 

Martin Hyde

Work stress and its effect on our health is something that we hear a lot about in the UK. Working longer and longer hours, having to do more and more in less and less time, increasing job insecurity are things that many of us experience. Newspapers and internet sites are full of stories about the damage that this can do to our overall sense of well-being as well as remedies to counter these negative effects. Many of these are supported by decades worth of academic research on the relationship between the working environment and health.

However, once we go beyond the high-income countries of Europe, North America and Japan we know very little about the nature of work and its impact on health in lower and middle-income countries. Given that these countries contain some of the world’s largest workforces and fastest growing economies this is a major oversight.

It was the desire to correct this oversight that motivated us to put together this book on the relationship between work and heath in India. Whilst there had been some research on this topic in India this book is one of the first to address the topic of work environment, stress and health in a rapidly developing country.

“The benefits of India’s tremendous economic growth have been unevenly distributed across society.”

India is one of the fastest growing economies in the world. The growth of the Indian economy has been matched by the steady increase in its labour force, which has risen from 330 million in 1990 to nearly half a billion people in 2014. This is roughly double the size of the labour force of the entire European Union.

Not only has the workforce grown but it has also changed from one dominated by agriculture to one with vibrant and growing service and manufacturing sectors. However, the benefits of India’s tremendous economic growth have been unevenly distributed across society.

The same is true of developments in the health of the Indian population. Life expectancy has risen steadily for both sexes and infectious diseases have declined over the past few decades. However, this fall in infectious diseases has been accompanied by a rise in non-communicable diseases (NCD), which now account for the top three causes of death in India.

“Chronic psychosocial stress at work is now becoming an important threat to the health of employees.”

So not only is the Indian economy and workforce beginning to more closely resemble those of the advanced industrial economies, so too are its disease and mortality profiles. As the labour market underwent a substantial transformation and while some traditional occupational hazards disappeared, chronic psychosocial stress at work is now becoming an important threat to the health of employees. For us, these twin developments called for more research to look at these issues.

To start to do so this book brings together a multidisciplinary and multinational authorship with researchers from all across India, from all careers stages, as well as researchers from the UK and Sweden. The range of topics covered, and methods and data used throughout the book reflect the diverse nature of the Indian economy.

Some chapters, such as those by Sanjay K. Mohanty and Anshul Kastor, and Harihar Sahoo, draw on large scale surveys to map the national picture of occupational inequalities in health. Other chapters focus on specific occupational groups such as tea pickers (Subrata K. Roy and Tanaya Kundu Chowdhury), police officers (Vaijayanthee Kumar and T.J. Kamalanabhan) and scavengers (Vimal Kumar).

What comes out in all of these chapters is a complex picture of the relationship between work and health. On the one hand we see many of the same issues in India that we see in other countries. Work stress is bad for your health wherever you live. On the other hand there are some findings that appear contradictory. For example, those in the highest occupations seem to have the highest rate of diagnosed illness. However, this is probably because only those in the top jobs can afford to go to a doctor. Finally, underlying all of this we see the intersections between gender, class and caste that impact on both work and health.


Work and health in India edited by Martin Hyde, Holendro Singh Chungkham and Laishram Ladusingh is available with 20% discount on the Policy Press website. Order here for just £60.00, or as an ebook for £21.59.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Do you want a better NHS or more equal health outcomes for all?

Jonathan Wistow, lead author of Studying health inequalities which published this week, explains why a better NHS is not necessarily the answer to ensuring greater health equality.

Wistow4Few things are as important to the quality of life as the number of years healthy life expectancy and overall life expectancy. 

So why, nearly 70 years after the creation of the NHS, do we have wide variations in health outcomes that are related to peoples’ different and unequal positions in society?  We might expect a universal free at the point of delivery health service to narrow these inequalities.  However, this has not been the case.

Social problem

To address this issue, it is necessary to view health inequalities as a ‘social problem’ – a problem that is created by, and exists within, society.  As such health inequalities provide a useful and significant insight into the dynamics of contemporary societies.

They reflect (amongst other things) the distribution of wealth; the way that we live our lives; the way that services are organised; the quality of, and access to, different services and amenities; the history of places; where people want to live; where people actually live; what people do for work; and the opportunities and options people have throughout their different life stages.

“health is too often conceived of as an individual and medical issue in both the way it is resourced and understood”

However, health is too often conceived of as an individual and medical issue in both the way it is resourced and understood. This is significant not only in terms of how public resources are prioritised (particularly during periods of austerity) between NHS, public health, local government and community and voluntary sectors but also in terms of how we view rights to services and/or outcomes.

Following a general election when resourcing of the NHS was a major issue and priority for all of the main political parties it is reasonable to ask whether we want a better NHS or more equal health outcomes for all?  These are not necessarily mutually reinforcing goals.  The former is about service delivery and the allocation of public funds and the latter is about redistribution as well.

A key issue to consider here is the nature of the social contract and how the balance between individual and social rights is prioritised. In the UK over the past 30-40 years a more or less free market based capitalism centred on individual rights has been pursued and we have witnessed a substantial increase in socio-economic inequalities in this period.

This shapes how equality is viewed and the extent to which there is a challenge to divisions of power, wealth and security in society. In turn this has implications for both the existence of inequalities in health and policy solutions to these.

“we are more concerned with individual rights to services than with collective rights to more equal outcomes”

Consequently, despite the existence of the NHS we are more concerned (in policy at least) with individual rights to services than with collective rights to more equal outcomes. Such a move to more equal health outcomes would require a much more fundamental redistribution of health across society and a return to the European tradition of pursuing equality of condition.

There is a further methodological issue that is important for framing how we understand and, as a result, respond to health inequalities. At an individual level potential causes of health inequalities relate to a complex combination of lifestyle behaviours which influence the socio-economic distribution of health risks associated with, for example, smoking, diet, exercise, bodyweight, and exposure to sunlight.


It is very difficult to isolate these behaviours and attribute causation to them as individual variables. Indeed we can question whether this is a desirable strategy given that in practice people do not live their lives in neat and separate component parts: diet, frequency of exercise, social and work activities, alcohol and nicotine consumption, are all parts of the complex whole that make up individuals’ lifestyles.

But this is still not the whole picture. Lifestyle, in turn, relates to (but is not wholly determined by) the contexts in which people live their lives. Different people react to these different contexts differently.

When we talk about contexts here we take a broader approach, including family, workplace, neighbourhood settings, towns, cities and regions – all important contextual characteristics within which people lead their lives.  It follows that we should take a research approach that concentrates on the complex interactions between people and settings.

To develop more equitable health outcomes in society our understanding of health needs to be based on the kinds of policy, ideological and methodological issues identified above.  Without such a broad consideration achieving fairer health for all seems particularly challenging.  However, there is scope to consider health as a key focus for redistribution and one that may help to move equality back up the political agenda.

Jonathan Wistow is a researcher and teaching fellow, in School of Applied Social Sciences, Durham University.  His interests include health inequalities, governance and local government.


Studying health inequalities [FC] 4webStudying health inequalities published on 30th June 2015 and you can order your copy from our website here (RRP £24.99).

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The views and opinions expressed on this blog site are solely those of the original blogpost authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

What works in reducing inequalities in child health ?

Helen Roberts, author of What works in reducing inequalities in child health? which was published earlier this year, writes about a forthcoming event of interest to readers of this blog:

What works in reducing inequalities in child health? Free half day meeting at Gresham College, London on 4 October

Gresham College, close to the wealth of the City of London, might seem an odd venue for an afternoon on what works, what counts and what matters in relation to reducing inequalities in health, but it provides a unique, and entirely free, access to education, discussion and learning, for absolutely anyone who cares to come along, with no fees, no fuss, and no examinations.

We tend not to be very perky as a nation, though with a vestige of post Olympics and Paralympics perkiness, a meeting that might be about the positive things that have been done and might be done is needed. After all, the NHS was set up at a time when we were much worse off as a nation than we are now.

But what a difference a decade or two makes, at least at the level of rhetoric. When I was looking after R&D for Barnardo’s, we commissioned and published Richard Wilkinson’s Unfair Shares (Barnardo’s 1995). The then secretary of state for health, Virginia Bottomley wrote to the Head of Barnardo’s to say how disappointed she was that Barnardo’s had taken this step. To his credit, he didn’t flinch, saying that there was a debate to be had. Indeed.

Shortly before becoming Prime Minister, David Cameron took a line rather more Wilkinsonian than Bottomleyian. In his Hugo Young Memorial Lecture in 2009, he said: “ is pointless to draw dividing lines where none exist.. Ask anyone of any political colour the kind of country they want to see and they’ll say a Britain that is richer, that is safer, that is greener but perhaps most important .. a country that is fairer and where opportunity is more equal….the incredible wealth of the City exists side-by-side with some of the poorest neighbourhoods in our country. ..Bringing these two worlds closer is a multi-faceted endeavour: moral, social, and of course economic. Research by Richard Wilkinson and Kate Pickett has shown that among the richest countries, it’s the more unequal ones that do worse according to almost every quality of life indicator. In The Spirit Level, they show that per capita GDP is much less significant for a country’s life expectancy, crime levels, literacy and health than the size of the gap between the richest and poorest in the population. So the best indicator of a country’s rank on these measures of general well-being is not the difference in wealth between them, but the difference in wealth within them”.

The front of The Spirit Level doesn’t (yet) have a banner saying ‘David Cameron agrees with us’. But maybe the PM will drop into Gresham on October 4. And why don’t you? Chaired by Andrea Sutcliffe, the new CEO of SCIE (the Social Care Institute for Excellence), I will introduce an afternoon’s discussions including Danny Dorling from Sheffield, on the positive moves made and still to be made, Judith Green from London School of Hygiene & Tropical Medicine on positive transport policies, and Sharon Witherspoon, the Director of the Nuffield Foundation, on new thinking in the 3rd sector. All will be rounded up by three young people, Zara Todd, Tabitha Manzuangani and Ben Farnes talking about what has ‘worked’ for them, and what they think might work well for others.

There is more information and registration links here.

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